CONVALESCENT PLASMA THERAPY IN CRITICALLY ILL PATIENTS WITH LATE STAGE COVID-19

Abstract

SESSION TITLE: Lessons from the ICU: What have We Learned about the Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: The SARS-CoV-2 (COVID-19) virus has infected millions, while approved treatments for this infection are lacking. Given its efficacy during the SARS outbreak in 2003, convalescent plasma is one potential treatment. Preliminary evidence, currently from only 8 case studies, shows that plasma may be effective against COVID-19. However, these studies used plasma largely in non-critically ill patients or ICU patients in the early stages (within 2 weeks of admission) of COVID-19 infection. The literature also lacks information on the therapeutic dose of plasma. As the first case study in the United States analyzing the effect of plasma in COVID-19 patients, we hope to determine if convalescent plasma can safely and effectively treat critically ill patients in the late stages of SARS-CoV-2 infection. METHODS: This case series examined 8 COVID-19 patients admitted to the ICU of a major teaching hospital in Broward County, Florida, who met criteria for severe or life-threatening complications. Each patient received 1 dose (200ml) of plasma. Clinical information was gathered in intervals of 1 day pre-transfusion and 1 hour, 3 days, and 7 days post-transfusion. The primary outcome was effectiveness of plasma transfusion, measured by clinical improvement, laboratory parameters, all-cause mortality and post-transfusion length of stay in the ICU. Secondary outcome was safety of plasma transfusion, determined by adverse events. RESULTS: 8 ICU patients received plasma late in the course of COVID-19 infection, on average at 16.13 days post-admission and 14.88 days post-intubation. 1 day prior to transfusion, mean SOFA scores, Pao2/Fio2 ratio, GCS and lymphocyte count were 6.5, 228.03, 8.63 and 1.19 respectively. 3 days after plasma treatment, all patients had mean improvement in SOFA score (4.86), Pao2/Fio2 ratio (302.73), GCS (9.29) and lymphocyte count (1.75). However, while mean GCS improved to 10.14 by post-transfusion day 7, the other means marginally worsened: SOFA score of 5.43, Pao2/Fio2 ratio of 280.44 and lymphocyte count of 1.71. Respiratory improvement was noted in 6 patients shown by extubation, tracheostomy and ICU discharge. 5 patients were discharged from the ICU, with an average post-transfusion length of stay in the ICU of 6.6 days. While 1 day pre-transfusion mean SOFA score predicted mortality at 84.4%, mortality of 25% resulted (2 deaths post-transfusion). No significant adverse events were noted post transfusion. CONCLUSIONS: This case series provides preliminary evidence that convalescent plasma is safe and effective in the late stages of COVID-19 infection. Randomized controlled trials are needed to conclusively determine benefits, dosage and timing of treatment. CLINICAL IMPLICATIONS: Convalescent plasma may be used to treat critically ill COVID-19 patients even in the late stages. More than 200ml of plasma transfusion may be necessary to achieve maximum therapeutic effect in these patients. DISCLOSURES: No relevant relationships by Neil Kumar, source=Web Response No relevant relationships by SUNIL KUMAR, source=Web Response No relevant relationships by Shreyans Patel, source=Web Response