Convalescent plasma in Severe/ Critically Ill COVID-19 patients; impact of time and mechanical ventilation

Abstract

Background: Convalescent plasma (CP) transfusion is one of the suggested treatments for Coronavirus disease 2019 (COVID-19) especially in critically ill patients. Methods: We investigated the efficacy and safety of CP transfusion in 50 consecutive COVID-19 patients with severe/ critically ill disease. Severe disease was defined as having at least one of the following: shortness of breath, respiratory frequency ≥ 20/min, blood oxygen saturation ≤ 93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300, lung infiltrates > 50% within recent 24-48 hours. Critically ill disease was considered as intensive care unit admission, respiratory failure, septic shock, or multiple organ dysfunction or failure. Primary outcomes included the safety of CP transfusion, 14-day and 30-day survival rate, and change in lung computed tomography (CT) scan score. Several other clinical and laboratory features were evaluated as secondary outcome. Results: Of 50 consecutive patients, 21 were on mechanical ventilation at time of CP transfusion. Totally, 32 patients (64%) survived 30 days after CP transfusion. Survival rate was 74% and 44% in patients who received CP <7 and ≥7 days of admission, respectively. While 92% of patients without mechanical ventilation survived, survival was 29% in patients on mechanical ventilation. CT scan score and some other clinical features were improved. No adverse effects were observed. Conclusion: CP transfusion is a safe and effective treatment in COVID-19 patients with severe/ critically ill disease. The best outcome can be achieved in patients who are not on mechanical ventilation especially early in the disease course.