Treatment of Coronavirus Disease 2019 Patients with Convalescent Plasma Reveals a Signal of Significantly Decreased Mortality
Treatment of Coronavirus Disease 2019 Patients with Convalescent Plasma Reveals a Signal of Significantly Decreased Mortality
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DOI：
10.1016/j.ajpath.2020.08.001
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发表时间：
2020-11-01
影响因子：
6
通讯作者：
Musser, James M.
中科院分区：
文献类型：
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作者：
Salazar, Eric;Christensen, Paul A.;Musser, James M.
由严重急性呼吸综合征冠状病毒 2 引起的 2019 冠状病毒病 (COVID-19) 已在全球范围内传播，且经过验证的治疗方法有限。正在研究多种可能有效的治疗方法，其中包括输注从 COVID-19 康复者身上收集的恢复期血浆。我们正在进行一项前瞻性、倾向评分匹配研究，评估 COVID-19 恢复期血浆输注与标准护理治疗重症和/或危重 COVID-19 的疗效。我们在此介绍对 2020 年 3 月 28 日至 7 月 6 日在休斯敦卫理公会医院入组的 316 名患者进行的中期分析结果。在 316 名输血患者中，136 名达到了 28 天的结果，并与 251 名非输血对照 COVID-19 患者进行匹配。匹配标准包括年龄、性别、体重指数、合并症和入院后 48 小时的基线通气需求，以及在第二次匹配分析中，第 0 天的通气状态。相对于入院的输血时间和输注血浆抗体滴度的变异性允许在特定匹配队列中进行分析。分析显示，28 天内死亡率显着降低 (P = 0.047)，特别是在入院 72 小时内输注抗尖峰蛋白受体结合域滴度 >= 1:1350 血浆的患者。这些数据表明，使用高抗受体结合域 IgG 滴度的恢复期血浆治疗 COVID-19 对于早期疾病患者是有效的。
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has spread globally, and proven treatments are limited. Transfusion of convalescent plasma collected from donors who have recovered from COVID-19 is among many approaches being studied as potentially efficacious therapy. We are conducting a prospective, propensity score-matched study assessing the efficacy of COVID-19 convalescent plasma transfusion versus standard of care as treatment for severe and/or critical COVID-19. We present herein the results of an interim analysis of 316 patients enrolled at Houston Methodist hospitals from March 28 to July 6, 2020. Of the 316 transfused patients, 136 met a 28-day outcome and were matched to 251 non-transfused control COVID-19 patients. Matching criteria included age, sex, body mass index, comorbidities, and baseline ventilation requirement 48 hours from admission, and in a second matching analysis, ventilation status at day 0. Variability in the timing of transfusion relative to admission and titer of antibodies of plasma transfused allowed for analysis in specific matched cohorts. The analysis showed a significant reduction (P = 0.047) in mortality within 28 days, specifically in patients transfused within 72 hours of admission with plasma with an anti-spike protein receptor binding domain titer of >= 1:1350. These data suggest that treatment of COVID-19 with high anti-receptor binding domain IgG titer convalescent plasma is efficacious in early-disease patients.