@article{53efa9d558654c0eb068651ffe5c51b7,
title = "Convalescent plasma antibody levels and the risk of death from covid-19",
abstract = "BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.",
author = "Joyner, {Michael J.} and Carter, {Rickey E.} and Senefeld, {Jonathon W.} and Klassen, {Stephen A.} and Mills, {John R.} and Johnson, {Patrick W.} and Theel, {Elitza S.} and Wiggins, {Chad C.} and Bruno, {Katelyn A.} and Klompas, {Allan M.} and Lesser, {Elizabeth R.} and Kunze, {Katie L.} and Sexton, {Matthew A.} and {Diaz Soto}, {Juan C.} and Baker, {Sarah E.} and Shepherd, {John R.A.} and {van Helmond}, Noud and Verdun, {Nicole C.} and Peter Marks and {van Buskirk}, {Camille M.} and Winters, {Jeffrey L.} and Stubbs, {James R.} and Rea, {Robert F.} and Hodge, {David O.} and Vitaly Herasevich and Whelan, {Emily R.} and Clayburn, {Andrew J.} and Larson, {Kathryn F.} and Ripoll, {Juan G.} and Andersen, {Kylie J.} and Buras, {Matthew R.} and Vogt, {Matthew N.P.} and Dennis, {Joshua J.} and Regimbal, {Riley J.} and Bauer, {Philippe R.} and Blair, {Janis E.} and Paneth, {Nigel S.} and Fairweather, {De Lisa} and Wright, {R. Scott} and Arturo Casadevall",
note = "Funding Information: Supported by a contract (75A50120C00096) from the Department of Health and Human Services, the Office of the Assistant Secretary for Preparedness and Response, and BARDA; grants (UL1TR002377) from the National Center for Advancing Translational Sciences, (5R35HL139854, to Dr. Joyner; 1F32HL154320, to Dr. Senefeld; 5R35HL139854S1, to Mr. Clayburn; and RO1 HL059842, to Dr. Casadevall) from the National Heart, Lung, and Blood Institute, (PDF-532926-2019, to Dr. Klassen) from the Natural Sciences and Engineering Research Council of Canada, (5T32DK07352, to Dr. Wiggins) from the National Institute of Diabetes and Digestive and Kidney Diseases, (R21 AI145356, R21 AI152318, and R21 AI154927, to Dr. Fairweather; and R01 AI152078 9, to Dr. Casadevall) from the National Institute of Allergy and Infectious Diseases, and (U54AG044170, to Dr. Baker) from the National Institute on Aging; and donations from the UnitedHealth Group, National Basketball Association, Millennium Pharmaceuticals, Octapharma USA, Mayo Clinic, and (from Eric E. Schmidt and Wendy Schmidt) the Schwab Charitable Fund. Publisher Copyright: Copyright {\textcopyright} 2021 Massachusetts Medical Society.",
year = "2021",
month = mar,
day = "18",
doi = "10.1056/NEJMoa2031893",
language = "English (US)",
volume = "384",
pages = "1015--1027",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "11",
}