Efficacy of convalescent plasma for the treatment of severe influenza

  1. Zhiheng Xu
  2. Jianmeng Zhou
  3. Yongbo Huang
  4. Xuesong Liu
  5. Yonghao Xu
  6. Sibei Chen
  7. Dongdong Liu
  8. Zhimin Lin
  9. Xiaoqing Liu
  10. Yimin Li

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Abstract

Background

Convalescent plasma administration may be of clinical benefit in patients with severe influenza, but reports on the efficacy of this therapy vary.

Methods

We conducted a systematic review and meta-analysis assessing randomized controlled trials (RCTs) involving the administration of convalescent plasma to treat severe influenza. Healthcare databases were searched in February 2020. All records were screened against eligibility criteria, and the risks of bias were assessed. The primary outcome was the fatality rate.

Results

A total of 2861 studies were retrieved and screened. Five eligible RCTs were identified. Pooled analyses yielded no evidence that using convalescent plasma to treat severe influenza resulted in significant reductions in mortality (odds ratio, 1.06; 95% CI, 0.51–2·23; P  = 0.87; I 2  = 35%), number of days in the intensive care unit, or number of days on mechanical ventilation. This treatment may have the possible benefits of increasing hemagglutination inhibition titers and reducing influenza B viral loads and cytokine levels. No serious adverse events were reported. The included studies were generally of high quality with a low risk of bias.

Conclusions

The administration of convalescent plasma appears safe but may not reduce the mortality, number of days in the intensive care unit, or number of days on mechanical ventilation in patients with severe influenza.

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  1. Version published to 10.1186/s13054-020-03189-7
  2. ScreenIT

    SciScore for 10.1101/2020.02.20.20025593: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationInclusion and exclusion criteria: We included prospective randomized controlled trials (RCTs) involving patients with influenza treated by convalescent plasma and hyperimmune immunoglobulin.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    To increase the sensitivity of our search strategy, we combined the terms “influenza” with “convalescent plasma” or “convalescent serum” or “hyperimmune immunoglobulin” or “immune plasma” or “H-IVIG” as key words or Medical Subject Headings (MeSH) terms.
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    We searched 4 databases (Pubmed, EMBASE, Scopus, and Web of Science) from electronic databases inception to February 10th, 2020.
    Pubmed
    suggested: (PubMed, RRID:SCR_004846)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    We appraised trial quality using the Cochrane collaboration tool for assessing risk of bias (RoB) (16) including assessment of random sequence generation, allocation concealment, blinding (of interventions and outcome measurement or assessment), incomplete outcome data, selective reporting bias and other potential sources of bias (e.g., industry funding).
    Cochrane collaboration tool
    suggested: None
    Statistical analyses were conducted with Review Manager (RevMan) Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014), and two-sided p values < 0.05 were considered statistically significant.
    RevMan
    suggested: (RevMan, RRID:SCR_003581)
    Cochrane Collaboration
    suggested: None

    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04264858Not yet recruitingTreatment of Acute Severe 2019-nCoV Pneumonia With Immunoglo…

    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.

  3. Version published to 10.1101/2020.02.20.20025593 on medRxiv