Epidemiología, Ministerio de Salud de la Provincia de Buenos Aires, La Plata, Buenos Aires, Argentina.
Inmunología, Hospital Interzonal Especializado en Pediatría 'Sor María Ludovica', La Plata, Buenos Aires, Argentina.
J Investig Med. 2022 Jun;70(5):1258-1264. doi: 10.1136/jim-2021-002158. Epub 2022 Feb 8.
This is a multicenter cohort study including consecutive, hospitalized patients ≥18 years, with moderate to severe COVID-19, carried out to evaluate the relationship between the timing of convalescent plasma administration and 28-day mortality. Data were prospectively collected between May 14, 2020 and October 31, 2020. Patients were grouped according to the timing of administration of convalescent plasma as <3 days, between 3 and 7 days, and >7 days. The main outcome variable was 28-day mortality. Independent predictors of mortality were identified by logistic regression. Of 4719 patients receiving convalescent plasma, 3036 (64.3%) were in the general ward, 1171 (24.8%) in the intensive care unit (ICU), and 512 (10.8%) in the ICU on mechanical ventilation. Convalescent plasma was administered to 3113 (66%) patients within the first 3 days of hospital admission, to 1380 (29.2%) between 3 and 7 days, and to 226 after 7 days; 28-day mortality was, respectively, 18.1%, 30.4% and 38.9% (p<0.001). In the regression model, convalescent plasma administration within the first 3 days of admission was associated with reduced 28-day mortality, compared with the administration after 7 days (OR 0.40, 95% CI 0.30 to 0.53). Early convalescent plasma administration was associated to a significant decreased mortality in patients in the general ward (OR 0.45, 95% CI 0.29 to 0.69) and in the ICU (OR 0.35, 95% CI 0.19 to 0.64), but not in those requiring mechanical ventilation (OR 0.52, 95% CI 0.27 to 1.01). In conclusion, this study suggests that early administration of convalescent plasma to patients with COVID-19 pneumonia is critical to obtain therapeutic benefit.
这是一项多中心队列研究，纳入了连续住院的年龄≥18 岁、患有中重度 COVID-19 的患者，旨在评估恢复期血浆治疗时机与 28 天死亡率之间的关系。数据于 2020 年 5 月 14 日至 2020 年 10 月 31 日期间前瞻性收集。根据恢复期血浆治疗的时机将患者分为<3 天、3-7 天和>7 天。主要结局变量为 28 天死亡率。采用逻辑回归识别死亡率的独立预测因素。在接受恢复期血浆治疗的 4719 例患者中，3036 例（64.3%）在普通病房，1171 例（24.8%）在重症监护病房（ICU），512 例（10.8%）在机械通气的 ICU。3113 例（66%）患者在入院后第 1 天内接受了恢复期血浆治疗，1380 例（29.2%）在第 3-7 天内接受了治疗，226 例在第 7 天后接受了治疗；相应的 28 天死亡率分别为 18.1%、30.4%和 38.9%（p<0.001）。在回归模型中，与第 7 天后治疗相比，入院后第 3 天内给予恢复期血浆与降低 28 天死亡率相关（OR 0.40，95%CI 0.30 至 0.53）。早期给予恢复期血浆治疗与普通病房（OR 0.45，95%CI 0.29 至 0.69）和 ICU（OR 0.35，95%CI 0.19 至 0.64）患者死亡率显著降低相关，但与需要机械通气的患者（OR 0.52，95%CI 0.27 至 1.01）无关。总之，本研究表明，COVID-19 肺炎患者早期给予恢复期血浆是获得治疗益处的关键。
