Effect of Convalescent plasma on clinical outcome in severe to critically ill hospitalized COVID-19 patients
Аннотация
Objectives: COVID 19 continues to challenge healthcare systems around the globe. India has been one of the worst-hit countries battling the second wave. Convalescent plasma is a cheap, readily available therapeutic intervention underutilized due to a lack of data and conflicting reports of benefit. We performed this study to understand the role of plasma further.
Methods: This single-center prospective observational study was conducted from July 2020 to October 2020. Patients with positive nasopharyngeal real-time reverse transcriptase-polymerase chain reaction for SARS COV 2 and severe or critical disease were included in the study. Patients who received convalescent plasma therapy were compared with patients who didn’t receive it. Comparison of length of hospital stay, 30-day mortality, overall mortality, clearance of virus, time to improvement was made. The safety of CPT was also recorded.
Results: Out of the total 385 patients, 177 had received plasma, and 208 acted as controls. 30-day mortality in patients who received CPT was significantly lower than the control group (median survival 13 days in Control vs 17 days CP group, p=0.02). This benefit was highest in patients who received CPT within seven days of symptom onset (39.4% vs 63.9%, p = 0.010). The mean duration of hospital stay was significantly higher in patients who received CPT than controls. (14.34 days in the CPT group and 11.59 days in the control group, p=0.001). No significant differences were noted in death from CPT and viral clearance between patient groups who received CPT within or after seven days of illness. [With-in 7 days: median 6 (IQR 2.5-6.5 days) vs After 7 days: median 4(IQR 2-6.5), p= 0.29]. Among patients who improved after receiving CPT, a significant reduction in WHO grade (defined as a 2-point reduction on WHO ordinal scale) was achieved in 19.4% (n=14) patients on day 3, in 50% (n=36) patients on day seven and in 30.6% (n=22) patients on day 14 of CPT. None of the patients developed any serious adverse effects due to plasma. Minor adverse effects were noted in 8 (4.5 %) patients.
Conclusions: The present study suggests that CPT, when given early in the course of illness, significantly reduces mortality in severe and critical patients without any significant adverse effects.
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Литература
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