Convalescent Plasma Antibody Levels and the Risk of Death from Covid-19.
Convalescent Plasma Antibody Levels and the Risk of Death from Covid-19.
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DOI：
10.1056/nejmoa2031893
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发表时间：
2021-03-18
期刊：
影响因子：
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通讯作者：
Casadevall A
中科院分区：
文献类型：
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作者：
Joyner MJ;Carter RE;Senefeld JW;Klassen SA;Mills JR;Johnson PW;Theel ES;Wiggins CC;Bruno KA;Klompas AM;Lesser ER;Kunze KL;Sexton MA;Diaz Soto JC;Baker SE;Shepherd JRA;van Helmond N;Verdun NC;Marks P;van Buskirk CM;Winters JL;Stubbs JR;Rea RF;Hodge DO;Herasevich V;Whelan ER;Clayburn AJ;Larson KF;Ripoll JG;Andersen KJ;Buras MR;Vogt MNP;Dennis JJ;Regimbal RJ;Bauer PR;Blair JE;Paneth NS;Fairweather D;Wright RS;Casadevall A
恢复期血浆已被广泛用于治疗2019冠状病毒病（Covid-19），前提是此类血浆含有针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的潜在治疗性抗体，这些抗体可以被动转移到血浆受体。尚不清楚具有高抗体水平而不是低抗体水平的恢复期血浆是否与较低的死亡风险相关。在一项基于美国国家登记处的回顾性研究中，我们确定了用于治疗住院Covid-19成人的恢复期血浆中的抗SARS-CoV-2 IgG抗体水平。主要结局为血浆输注后30天内死亡。分析中纳入了截至2020年7月4日入组的患者，以及可获得血浆输血中抗SARS-CoV-2抗体水平和30天死亡率数据的患者。在纳入本分析的3082例患者中，高滴度组515例患者中有115例（22.3%）在血浆输注后30天内死亡，中滴度组2006例患者中有549例（27.4%），低滴度组561例患者中有166例（29.6%）。抗SARS-CoV-2抗体水平与Covid-19死亡风险的相关性受到机械通气状态的调节。在输血前未接受机械通气的患者中，观察到高滴度组30天内死亡风险低于低滴度组（相对危险度，0.66; 95%置信区间[CI]，0.48 - 0.91），在接受机械通气的患者中未观察到对死亡风险的影响（相对危险度，1.02; 95% CI，0.78 - 1.32）。在未接受机械通气的新冠肺炎住院患者中，输注抗SARS-CoV-2 IgG抗体水平较高的血浆与输注抗体水平较低的血浆相比，死亡风险较低。（由卫生与公众服务部和其他部门资助; ClinicalTrials.gov编号，NCT 04338360。
Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. In a retrospective study based on a U.S. national registry, we determined the anti–SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti–SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti–SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti–SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT04338360.)