Senefeld Jonathon W, Gorman Ellen K, Johnson Patrick W, Moir M Erin, Klassen Stephen A, Carter Rickey E, Paneth Nigel S, Sullivan David J, Morkeberg Olaf H, Wright R Scott, Fairweather DeLisa, Bruno Katelyn A, Shoham Shmuel, Bloch Evan M, Focosi Daniele, Henderson Jeffrey P, Juskewitch Justin E, Pirofski Liise-Anne, Grossman Brenda J, Tobian Aaron A R, Franchini Massimo, Ganesh Ravindra, Hurt Ryan T, Kay Neil E, Parikh Sameer A, Baker Sarah E, Buchholtz Zachary A, Buras Matthew R, Clayburn Andrew J, Dennis Joshua J, Diaz Soto Juan C, Herasevich Vitaly, Klompas Allan M, Kunze Katie L, Larson Kathryn F, Mills John R, Regimbal Riley J, Ripoll Juan G, Sexton Matthew A, Shepherd John R A, Stubbs James R, Theel Elitza S, van Buskirk Camille M, van Helmond Noud, Vogt Matthew N P, Whelan Emily R, Wiggins Chad C, Winters Jeffrey L, Casadevall Arturo, Joyner Michael J
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL.
Mayo Clin Proc Innov Qual Outcomes. 2023 Oct 10;7(5):499-513. doi: 10.1016/j.mayocpiqo.2023.09.001. eCollection 2023 Oct.
To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19.
On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization.
Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio [OR], 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82).
During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.
探讨新型冠状病毒肺炎（COVID-19）康复期血浆输注与死亡率的关联以及COVID-19住院患者亚组之间的差异。
2022年10月26日，对2020年1月1日至2022年10月26日文献中关于COVID-19康复期血浆的临床研究进行系统检索。纳入在确诊的COVID-19住院患者中比较COVID-19康复期血浆输注与标准治疗或安慰剂的随机临床试验和匹配队列研究。电子检索得到3841条独特记录，其中744条被纳入全文筛选。筛选过程由5名评审员独立进行。该研究遵循系统评价和Meta分析的首选报告项目指南。数据由5名独立评审员重复提取，并使用逆方差随机效应模型进行汇总。预先设定的终点是住院期间的全因死亡率。
系统评价纳入了39项随机临床试验（21529名参与者）和70项匹配队列研究（50160名参与者）。单独的Meta分析报告称，对于随机临床试验（优势比[OR]，0.87；95%可信区间[CI]，0.76 - 1.00）和匹配队列研究（OR，0.76；95%CI，0.66 - 0.88），与对照组相比，COVID-19康复期血浆输注与死亡率降低相关。亚组Meta分析有两项重要发现。第一，与低抗体水平的康复期血浆相比，高抗体水平的康复期血浆治疗与死亡率降低相关（OR，0.85；95%CI，0.73至0.99）。第二，与延迟治疗组相比，早期使用COVID-19康复期血浆治疗与死亡率降低相关（OR，0.63；95%CI，0.48至0.82）。
在COVID-19期间，康复期血浆的使用与死亡率降低13%相关，这意味着对COVID-19住院患者有死亡率获益，特别是那些在病程早期接受高抗体水平康复期血浆治疗的患者。
