Convalescent plasma from COVID 19 patients enhances intensive care unit survival rate. A preliminary report

Abstract

Convalescent plasma from COVID 19 patients enhances intensive care unit survival rate. A preliminary reportCoronavirus pandemic disease (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). At the time of this paper writing, over 2,5 million cases of COVID-19 have been reported, with more than 280,000 deaths all over the world. Italy is one of the first countries involved, with more than 200,000 reported infected people and 30,000 deaths. In the Basilicata south Italy region live 560,000 people, with 372 reported infected cases, 34 recovered in intensive care units (ICU) and 15 deaths [1]. There are no specific treatments for COVID-19 and the vaccine is still far away. Scientific community is trying to better define best shared therapeutic protocols in early and advanced clinical stages. Still, critical cases are about 6%, with serious illness rate of 14%, with involvement of sepsis, acute respiratory distress syndrome (ARDS), multiple organ failure, and vascular and thromboembolic findings [2,3]. Mortality rate is 2-3%, with higher values, more than double, for > 65 years old patients [4]. Among ICU patients, almost 1 patient on 3 dies, with higher rates for older patients [5].A systematic review and exploratory meta-analysis performed in 2014 identified 32 studies of SARS coronavirus infection and severe influenza [6]. These studies involved 699 treated patients and 568 untreated "controls". The review revealed evidence for a consistent reduction in mortality upon plasma therapy. Furthermore, exploratory post hoc meta-analysis showed a significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy [7]. As for SARS-CoV-2, many clinical trials are in course, FDA approved the procedure [8] and there are recent Chinese encouraging reports [9][10][11][12].In order to preliminarly evaluate the importance of convalescent plasma transfusions in intensive care units, authors compared mortality rates between two groups: patients untreated (group 1) and those treated with convalescent plasma (group 2). Group 1 includes all 34 Basilicata region patients recovered in COVID dedicated intensive care units (ICU), with mean age of 63 years old and comorbidity rate > 70%. All patients were treated by means of invasive and not invasive O2 ventilation, tracheostomy when needed, antiretroviral agents, hydrossycloroquine (Plaquenil, Sanofi, Italy), steroids and not steroid antinflammatory agents, heparin, azithromycin and other wide spectrum antibiotics, tocilizumab (Roactemra, Roche, Italy). Group 2 is composed of all actually reported COVID-19 ICU patients in literature, included in three recently published papers [10][11][12], with a total number of 19 cases, mean age of 54 years old, with mean comorbidity rate similar to group 1, underwent to pharmaceutical and supporting treatments with these differences: no heparin, hydrossycloroquine and tocilizumab, but in addiction submitted to arbidol (Umifenovir, Pharmstandard, China) in 10 cases, and in all c...

A Phase II Study on the Use of Convalescent Plasma for the Treatment of Severe COVID-19- A Propensity Score-Matched Control Analysis

“…In our study, we examined the beneficial effect of CP in patients with severe COVID-19 using a matched propensity score analysis. This strategy has already been used in other trials, resulting in contradictory results [ 21 , 23 , 30 , 37 , 38 , 39 , 40 , 41 , 44 , 45 , 46 , 47 , 56 ]. In our study, the univariate analysis comparing the CP to the control group showed a significantly reduced risk of death.…”

Anti-SARS-CoV-2 Serology persistence over time in COVID-19 Convalescent Plasma Donors

“…Studies of individuals who have recovered from natural infection may help to determine how long antibodies persist after an immunizing exposure, and whether or not these antibodies might protect against re-infection. The persistence of antibody response may also help predict the efficacy of vaccines for COVID 19. COVID-19 convalescent plasma (CCP) is an investigational therapy that remains somewhat controversial, with conflicting reports of efficacy [3,4,5]. The underlying principle of this treatment approach is the passive transfer of anti-SARS-CoV-2 antibodies to patients with COVID-19.…”

“…COVID-19 convalescent plasma (CCP) is an investigational therapy that remains somewhat controversial, with conflicting reports of efficacy [3, 4, 5]. The underlying principle of this treatment approach is the passive transfer of anti-SARS-CoV-2 antibodies to patients with COVID-19.…”

Peripheral Blood Immune Profiling of Convalescent Plasma Donors Reveals Alterations in Specific Immune Subpopulations Even at 2 Months Post SARS-CoV-2 Infection

“…Moreover, apart from the direct antibody (Ab)-mediated antiviral effect, CP contains anti-inflammatory cytokines, natural antibodies, and antimicrobial proteins such as defensins and pentraxins, which can control over-activation of the immune system and act in an immunomodulatory mode [ 15 ]. In the case of SARS-CoV-2 and in support of the beneficial use of CP, a recent meta-analysis showed that CP administration was associated with a significant reduction in mortality [ 16 ], whereas the transfusion of CP in 20,000 COVID-19 patients proved that it is safe and carries a very low risk of complications [ 17 ]. Nevertheless, in a most recent clinical trial, CP infusion in 228 COVID-19 patients with severe pneumonia did not offer any significant benefit as for clinical status and overall mortality rate [ 18 ].…”