Clinical effectiveness of convalescent plasma in hospitalized patients with COVID-19: a systematic review and meta-analysis

  1. Roberto Ariel Abeldaño Zuñiga
  2. Ruth Ana María González Villoria
  3. María Vanesa Elizondo
  4. Anel Yaneli Nicolás Osorio
  5. Silvia Mercedes Coca

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Abstract

Given the variability of previously reported results, this systematic review aims to determine the clinical effectiveness of convalescent plasma employed in the treatment of hospitalized patients with diagnosis of COVID-19.

We conducted a systematic review of controlled clinical trials assessing treatment with convalescent plasma for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, and ventilation requirement.

A total of 50 studies were retrieved from the databases. Four articles were finally included in the data extraction, qualitative and quantitative synthesis of results. The meta-analysis suggests that there is no benefit of convalescent plasma compared to standard care or placebo in the reduction of the overall mortality and in the ventilation requirement; but there could be a benefit for the clinical improvement in patients treated with plasma.

We can conclude that the convalescent plasma transfusion cannot reduce the mortality or ventilation requirement in hospitalized patients diagnosed with SARS-CoV-2 infection. More controlled clinical trials conducted with methodologies that ensure a low risk of bias are still needed.

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  1. ScreenIT

    SciScore for 10.1101/2021.01.16.21249956: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    To conduct the review, the PICOS structure was followed according to these points: The search was carried out in PubMed, Scopus, and Web of Science databases, between November 20th, 2020, and January 9th, 2020.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    All references were managed with Mendeley® software.
    Mendeley®
    suggested: (Mendeley Data, RRID:SCR_002750)
    The data were stored in Microsoft Office Excel spreadsheets and organized in an instrument constructed by the authors considering: Characteristics of the study (author, year, country), sample, study design, and characteristics of the results.
    Microsoft Office Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    Meta-analyses were conducted with Revman v5.4 using pooled fixed effects odds ratios.
    Revman
    suggested: (RevMan, RRID:SCR_003581)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Among the limitations of this study, the rapid generation of new knowledge in times of the pandemic, can potentially affect the timeliness of this review in a few months. The second limitation is the heterogeneity and high risk of bias in the studies. In this review, we chose not to issue recommendations with the GRADE methodology, due to heterogeneity and high risk of bias. Another limitation is that not all studies have used the same dosage of convalescent plasma in infected patients. The fourth limitation that must be considered is regarding the use of antiviral drugs in the control groups or both groups of patients in three out of four clinical trials included in this review. In times of recurring waves of the COVID-19 pandemic, the analysis of potential treatments proposed for hospitalized patients is still necessary since the procurement and logistics of vaccines are still seen within a complex scenario for many low-income countries. In many low-income countries, people are likely to continue to be infected and to continue to die, where vaccination would occur two to four quarters later partly due to logistical issues, as stated The World Bank (38); so the search for a clinically effective treatment is still a major concern globally. In the clinicaltrials.gov platform are currently registered dozens of clinical trials that are assessing the treatment with plasma, so the addition of new evidence in the coming months could change the direction of the analyzes in this revi...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.01.16.21249956v1 on medRxiv
  3. Version published to 10.1177/17534666211028077