Blood Bank and Transfusion Service, Hospital Clínic de Barcelona, Barcelona, Spain.
Hemathology and Hemotherapy Service, Hospital Clínic de Barcelona, Barcelona, Spain.
Transfusion. 2022 May;62(5):974-981. doi: 10.1111/trf.16863. Epub 2022 Mar 26.
Despite most controlled trials have shown no measurable benefit of COVID-19 convalescent plasma (CCP) in patients with COVID-19, some studies suggest that early administration of CCP with high-titer anti-SARS-CoV-2 can be beneficial in selected patients. We investigated the efficacy of early administration of high-titer CCP to patients with COVID-19 who required hospitalization, STUDY DESIGN AND METHODS: Observational, propensity score (PS) matched case-control study of COVID-19 patients treated with CCP within 72 h of hospital admission and untreated controls from August 2020 to February 2021. All CCP donations had a Euroimmun anti-SARS-CoV-2 sample-to-cutoff ratio ≥3. PS matching was based on prognostic factors and presented features with high-standardized differences between the treated and control groups. The primary endpoint was mortality within 30 days of diagnosis.
A total of 1604 patients were analyzed, 261 of whom received CCP, most (82%) within 24 h after admission. Median age was 67 years (interquartile range: 56-79), and 953 (60%) were men. Presenting factors independently associated with higher 30-day mortality were increased age, cardiac disease, hypoxemic respiratory failure, renal failure, and plasma d-dimer >700 ng/ml. After PS matching, transfusion of CCP was associated with a significant reduction in the 30-day mortality rate (odds ratio [OR]; 0.94, 95% confidence interval [CI]: 0.91-0.98; p = .001) that extended to the 60th day after COVID-19 diagnosis (OR: 0.95; 95% CI: 0.92-0.99; p = .01).
Our results suggest that CCP can still be helpful in selected patients with COVID-19 and call for further studies before withdrawing CCP from the COVID-19 therapeutic armamentarium.
尽管大多数对照试验表明 COVID-19 恢复期血浆（CCP）对 COVID-19 患者没有可衡量的益处，但一些研究表明，早期给予高滴度抗 SARS-CoV-2 的 CCP 对某些患者可能有益。我们调查了早期给予高滴度 CCP 对需要住院治疗的 COVID-19 患者的疗效，研究设计和方法：对 2020 年 8 月至 2021 年 2 月期间在入院后 72 小时内接受 CCP 治疗的 COVID-19 患者和未接受治疗的对照患者进行观察性、倾向评分（PS）匹配的病例对照研究。所有 CCP 捐赠的 Euroimmun 抗 SARS-CoV-2 样本与截止值之比≥3。PS 匹配基于预测因素和具有高标准化差异的特征，这些特征在治疗组和对照组之间。主要终点是诊断后 30 天内的死亡率。
共分析了 1604 例患者，其中 261 例接受了 CCP 治疗，大多数（82%）在入院后 24 小时内接受了治疗。中位年龄为 67 岁（四分位间距：56-79），953 例（60%）为男性。与较高 30 天死亡率相关的独立表现因素是年龄增加、心脏病、低氧性呼吸衰竭、肾衰竭和血浆 D-二聚体>700ng/ml。在 PS 匹配后，输注 CCP 与 30 天死亡率显著降低相关（比值比[OR]；0.94，95%置信区间[CI]：0.91-0.98；p=0.001），这一效果延伸至 COVID-19 诊断后第 60 天（OR：0.95；95%CI：0.92-0.99；p=0.01）。
我们的结果表明，CCP 对 COVID-19 的某些患者仍然有帮助，并呼吁在从 COVID-19 治疗武器库中撤回 CCP 之前进行进一步的研究。
