TY - JOUR
T1 - Convalescent plasma and predictors of mortality among hospitalized patients with COVID-19
T2 - a systematic review and meta-analysis
AU - Franchini, Massimo
AU - Cruciani, Mario
AU - Mengoli, Carlo
AU - Casadevall, Arturo
AU - Glingani, Claudia
AU - Joyner, Michael J.
AU - Pirofski, Liise anne
AU - Senefeld, Jonathon W.
AU - Shoham, Shmuel
AU - Sullivan, David J.
AU - Zani, Matteo
AU - Focosi, Daniele
N1 - Publisher Copyright:
© 2024 European Society of Clinical Microbiology and Infectious Diseases
PY - 2024/12
Y1 - 2024/12
N2 - Background: Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients. Objectives: To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect. Data sources: Electronic databases were searched for studies published from January 2020 to January 2024. Study eligibility criteria: Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19. Participants: Hospitalized patients with COVID-19. Interventions: CCP versus no CCP. Assessment of risk of bias: Cochrane risk of bias tool for RCTs. Methods of data synthesis: The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence. Results: Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61–0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90–1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity. Conclusions: In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.
AB - Background: Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients. Objectives: To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect. Data sources: Electronic databases were searched for studies published from January 2020 to January 2024. Study eligibility criteria: Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19. Participants: Hospitalized patients with COVID-19. Interventions: CCP versus no CCP. Assessment of risk of bias: Cochrane risk of bias tool for RCTs. Methods of data synthesis: The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence. Results: Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61–0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90–1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity. Conclusions: In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.
KW - COVID-19
KW - Convalescent plasma
KW - Efficacy
KW - Mortality
KW - SARS-CoV-2
KW - Systematic review
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U2 - 10.1016/j.cmi.2024.07.020
DO - 10.1016/j.cmi.2024.07.020
M3 - Review article
C2 - 39067517
AN - SCOPUS:85201324397
SN - 1198-743X
VL - 30
SP - 1514
EP - 1522
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 12
ER -