Timing of convalescent plasma administration and 28-day mortality in COVID-19 pneumonia

  1. Soledad E González
  2. Lorena Regairaz
  3. Martin R Salazar
  4. Noelia S Ferrando
  5. Verónica V González Martínez
  6. Patricia M Carrera Ramos
  7. Santiago A Pesci
  8. Juan M Vidal
  9. Nicolás Kreplak
  10. Elisa Estenssoro

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Abstract

This is a multicenter cohort study including consecutive, hospitalized patients ≥18 years, with moderate to severe COVID-19, carried out to evaluate the relationship between the timing of convalescent plasma administration and 28-day mortality. Data were prospectively collected between May 14, 2020 and October 31, 2020. Patients were grouped according to the timing of administration of convalescent plasma as <3 days, between 3 and 7 days, and >7 days. The main outcome variable was 28-day mortality. Independent predictors of mortality were identified by logistic regression. Of 4719 patients receiving convalescent plasma, 3036 (64.3%) were in the general ward, 1171 (24.8%) in the intensive care unit (ICU), and 512 (10.8%) in the ICU on mechanical ventilation. Convalescent plasma was administered to 3113 (66%) patients within the first 3 days of hospital admission, to 1380 (29.2%) between 3 and 7 days, and to 226 after 7 days; 28-day mortality was, respectively, 18.1%, 30.4% and 38.9% (p<0.001). In the regression model, convalescent plasma administration within the first 3 days of admission was associated with reduced 28-day mortality, compared with the administration after 7 days (OR 0.40, 95% CI 0.30 to 0.53). Early convalescent plasma administration was associated to a significant decreased mortality in patients in the general ward (OR 0.45, 95% CI 0.29 to 0.69) and in the ICU (OR 0.35, 95% CI 0.19 to 0.64), but not in those requiring mechanical ventilation (OR 0.52, 95% CI 0.27 to 1.01). In conclusion, this study suggests that early administration of convalescent plasma to patients with COVID-19 pneumonia is critical to obtain therapeutic benefit.

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  1. Version published to 10.1136/jim-2021-002158
  2. ScreenIT

    SciScore for 10.1101/2021.02.02.21250758: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the Central Ethics Committee of the Ministry of Health of Buenos Aires Province (2020-14965594).
    Consent: The administration of convalescent plasma required signed consent from each patient or legal representative, according to CROCPD-BA regulations (2919/2123/2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    This study has limitations, mostly due to its observational nature. Unmeasured confounders such as other risk factors or treatments might have influenced the results. Given that severity of illness on admission could not be evaluated with an established score, misclassification of patients might have occurred. Notwithstanding this, the use of admission site as a surrogate of acuity has been already been utilized 2; and recently, the rate of clinical improvement after plasma administration could be determined according to the hospital site where the patients received the infusion, among other variables 15. A more detailed analysis of the clinical variables collected could not be done, because of the type of registry. Finally, the date of symptom beginning might be a more adequate variable than the time to receiving plasma since hospital admission.

    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

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  3. Version published to 10.1101/2021.02.02.21250758v1 on medRxiv