Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19.
<h4>Background</h4>Although frequently used in the early pandemic, data on the effectiveness of COVID-19 convalescent plasma (CCP) remain mixed. We investigated the effectiveness and safety of CCP in hospitalized COVID-19 patients in real-world practices during the first two waves of the...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0273223 |
| _version_ | 1828111912462712832 |
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| author | Cindy Ke Zhou Monica M Bennett Carlos H Villa Kendall P Hammonds Yun Lu Jason Ettlinger Elisa L Priest Robert L Gottlieb Steven Davis Edward Mays Tainya C Clarke Azadeh Shoaibi Hui-Lee Wong Steven A Anderson Ronan J Kelly |
| author_facet | Cindy Ke Zhou Monica M Bennett Carlos H Villa Kendall P Hammonds Yun Lu Jason Ettlinger Elisa L Priest Robert L Gottlieb Steven Davis Edward Mays Tainya C Clarke Azadeh Shoaibi Hui-Lee Wong Steven A Anderson Ronan J Kelly |
| author_sort | Cindy Ke Zhou |
| collection | DOAJ |
| description | <h4>Background</h4>Although frequently used in the early pandemic, data on the effectiveness of COVID-19 convalescent plasma (CCP) remain mixed. We investigated the effectiveness and safety of CCP in hospitalized COVID-19 patients in real-world practices during the first two waves of the pandemic in a multi-hospital healthcare system in Texas.<h4>Methods and findings</h4>Among 11,322 hospitalized patients with confirmed COVID-19 infection from July 1, 2020 to April 15, 2021, we included patients who received CCP and matched them with those who did not receive CCP within ±2 days of the transfusion date across sites within strata of sex, age groups, days and use of dexamethasone from hospital admission to the match date, and oxygen requirements 4-12 hours prior to the match date. Cox proportional hazards model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for effectiveness outcomes in a propensity score 1:1 matched cohort. Pre-defined safety outcomes were described. We included 1,245 patients each in the CCP treated and untreated groups. Oxygen support was required by 93% of patients at the baseline. The pre-defined primary effectiveness outcome of 28-day in-hospital all-cause mortality (HR = 0.85; 95%CI: 0.66,1.10) were similar between treatment groups. Sensitivity and stratified analyses found similar null results. CCP-treated patients were less likely to be discharged alive (HR = 0.82; 95%CI: 0.74, 0.91), and more likely to receive mechanical ventilation (HR = 1.48; 95%CI: 1.12, 1.96). Safety outcomes were rare and similar between treatment groups.<h4>Conclusion</h4>The findings in this large, matched cohort of patients hospitalized with COVID-19 and mostly requiring oxygen support at the time of treatment, do not support a clinical benefit in 28-day in-hospital all-cause mortality for CCP. Future studies should assess the potential benefits with specifically high-titer units in perhaps certain subgroups of patients (e.g. those with early disease or immunocompromised). |
| first_indexed | 2024-04-11T11:42:17Z |
| format | Article |
| id | doaj.art-718fc3f33d8149c7b8b0c341f2a5110c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-11T11:42:17Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-718fc3f33d8149c7b8b0c341f2a5110c2022-12-22T04:25:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01178e027322310.1371/journal.pone.0273223Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19.Cindy Ke ZhouMonica M BennettCarlos H VillaKendall P HammondsYun LuJason EttlingerElisa L PriestRobert L GottliebSteven DavisEdward MaysTainya C ClarkeAzadeh ShoaibiHui-Lee WongSteven A AndersonRonan J Kelly<h4>Background</h4>Although frequently used in the early pandemic, data on the effectiveness of COVID-19 convalescent plasma (CCP) remain mixed. We investigated the effectiveness and safety of CCP in hospitalized COVID-19 patients in real-world practices during the first two waves of the pandemic in a multi-hospital healthcare system in Texas.<h4>Methods and findings</h4>Among 11,322 hospitalized patients with confirmed COVID-19 infection from July 1, 2020 to April 15, 2021, we included patients who received CCP and matched them with those who did not receive CCP within ±2 days of the transfusion date across sites within strata of sex, age groups, days and use of dexamethasone from hospital admission to the match date, and oxygen requirements 4-12 hours prior to the match date. Cox proportional hazards model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for effectiveness outcomes in a propensity score 1:1 matched cohort. Pre-defined safety outcomes were described. We included 1,245 patients each in the CCP treated and untreated groups. Oxygen support was required by 93% of patients at the baseline. The pre-defined primary effectiveness outcome of 28-day in-hospital all-cause mortality (HR = 0.85; 95%CI: 0.66,1.10) were similar between treatment groups. Sensitivity and stratified analyses found similar null results. CCP-treated patients were less likely to be discharged alive (HR = 0.82; 95%CI: 0.74, 0.91), and more likely to receive mechanical ventilation (HR = 1.48; 95%CI: 1.12, 1.96). Safety outcomes were rare and similar between treatment groups.<h4>Conclusion</h4>The findings in this large, matched cohort of patients hospitalized with COVID-19 and mostly requiring oxygen support at the time of treatment, do not support a clinical benefit in 28-day in-hospital all-cause mortality for CCP. Future studies should assess the potential benefits with specifically high-titer units in perhaps certain subgroups of patients (e.g. those with early disease or immunocompromised).https://doi.org/10.1371/journal.pone.0273223 |
| spellingShingle | Cindy Ke Zhou Monica M Bennett Carlos H Villa Kendall P Hammonds Yun Lu Jason Ettlinger Elisa L Priest Robert L Gottlieb Steven Davis Edward Mays Tainya C Clarke Azadeh Shoaibi Hui-Lee Wong Steven A Anderson Ronan J Kelly Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19. PLoS ONE |
| title | Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19. |
| title_full | Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19. |
| title_fullStr | Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19. |
| title_full_unstemmed | Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19. |
| title_short | Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19. |
| title_sort | multi center matched cohort study of convalescent plasma for hospitalized patients with covid 19 |
| url | https://doi.org/10.1371/journal.pone.0273223 |
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