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康复期血浆——隧道尽头的曙光:随机对照试验的系统评价与荟萃分析

Convalescent Plasma-A Light at the End of the Tunnel: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

作者信息

Sarkar Soumya, Khanna Puneet, Singh Akhil K

机构信息

Department of Anesthesia, Pain Medicine and Critical Care, AIIMS, Delhi, India.

出版信息

Indian J Crit Care Med. 2021 Nov;25(11):1292-1300. doi: 10.5005/jp-journals-10071-24023.

Abstract

UNLABELLED

In the absence of a definitive therapy during this ongoing unprecedented crisis, coronavirus disease-2019 (COVID-19) pandemic, convalescent plasma transfusion (CPT) has shown some promising results. This review summarizes the existing evidence of the efficacy of CPT in COVID-19 patients based upon scientific publications to date. We have included only the randomized controlled trials (RCTs) through an extensive screening of electronic databases up to July 31, 2021. In 19 RCTs, with a total of 16,476 COVID-19 patients we found low-quality evidence of significant reduction in mortality (odds ratio (OR) = 0.80; 95% confidence interval (CI): 0.66-0.96, I = 40%), better clinical outcome when applied <7 days (OR = 2.13, 95% CI 1.28-3.53, I = 0%), and improved viral clearance (OR = 2.6, 95% CI: 1.3-5.45, I = 74%). Meta-regression analysis found that as a covariate, intubation on admission ( = 0.007) had a significant impact. However, there was any significant reduction neither in duration for clinical improvement (MD = -0.79, 95% CI: -2.76-1.18, I = 98%), nor in total period of hospital stay (MD = 0.02, 95% CI: -0.75-0.78, I = 81%). Early application of CPT is still relevant in reducing morbidity and mortality in critically ill patients and is too early to write it off as a potential therapeutic modality for COVID-19 patients.

HOW TO CITE THIS ARTICLE

Sarkar S, Khanna P, Singh AK. Convalescent -Plasma-A Light at the End of the Tunnel: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2021;25(11):1292-1300.

摘要

未标注

在这场前所未有的危机,即2019冠状病毒病(COVID-19)大流行期间,由于缺乏确切的治疗方法,恢复期血浆输注(CPT)已显示出一些有前景的结果。本综述基于迄今为止的科学出版物,总结了CPT对COVID-19患者疗效的现有证据。我们通过广泛筛选截至2021年7月31日的电子数据库,仅纳入了随机对照试验(RCT)。在19项RCT中,共有16476例COVID-19患者,我们发现低质量证据表明死亡率显著降低(优势比(OR)=0.80;95%置信区间(CI):0.66 - 0.96,I² = 40%),在<7天应用时临床结局更好(OR = 2.13,95% CI 1.28 - 3.53,I² = 0%),以及病毒清除改善(OR = 2.6,95% CI:1.3 - 5.45,I² = 74%)。Meta回归分析发现,作为一个协变量,入院时插管(P = 0.007)有显著影响。然而,临床改善持续时间(MD = -0.79,95% CI:-2.76 - 1.18,I² = 98%)和住院总时长(MD = 0.02,95% CI:-0.75 - 0.78,I² = 81%)均未出现显著降低。早期应用CPT对于降低重症患者的发病率和死亡率仍然具有重要意义,现在就将其排除作为COVID-19患者的一种潜在治疗方式还为时过早。

如何引用本文

Sarkar S, Khanna P, Singh AK. 恢复期血浆——隧道尽头的曙光:随机对照试验的系统评价和荟萃分析。《印度重症监护医学杂志》2021;25(11):129–1300。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9dc2/8608648/7cb06650d758/ijccm-25-1292-f001.jpg

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