International Journal of Critical Illness and Injury Science

EDITORIAL
Year
: 2021  |  Volume : 11  |  Issue : 1  |  Page : 1--3

What's new in critical illness and injury science? Convalescent plasma for coronavirus disease-2019 patients with severe or critical illness


Andrew Carl Miller1, Shadi Ghadermarzi2, Shobi Venkatachalam3,  
1 Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
2 Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
3 Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA, USA

Correspondence Address:
Dr. Andrew Carl Miller
Department of Emergency Medicine, Nazareth Hospital, 2601 Holme Avenue, 3rd Floor, Marian Building, Philadelphia 19152, PA
USA




How to cite this article:
Miller AC, Ghadermarzi S, Venkatachalam S. What's new in critical illness and injury science? Convalescent plasma for coronavirus disease-2019 patients with severe or critical illness.Int J Crit Illn Inj Sci 2021;11:1-3


How to cite this URL:
Miller AC, Ghadermarzi S, Venkatachalam S. What's new in critical illness and injury science? Convalescent plasma for coronavirus disease-2019 patients with severe or critical illness. Int J Crit Illn Inj Sci [serial online] 2021 [cited 2021 Apr 18 ];11:1-3
Available from: https://www.ijciis.org/text.asp?2021/11/1/1/312262


Full Text



Since emerging in December 2019, the coronavirus disease-2019 (COVID-19) pandemic caused by the beta-coronavirus severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) virus has resulted in over 118 million cases worldwide and over 2.62 million deaths (as of 11 March 2021). Roughly 20% of patients require hospitalization, with one-quarter of those necessitating intensive care unit (ICU) admission for reasons including refractory hypoxemia, shock, or multiple organ failure.[1],[2] The paucity of therapeutics with demonstrable efficacy has led many to employ less substantiated treatments supported by case series, small nonrandomized studies, or even intellectual intuition. Recently, we discussed the use of intravenous immunoglobulin.[3] This editorial focuses on convalescent plasma (CP) to treat COVID-19 patients with a severe or critical illness.

CP refers to plasma that is collected from individuals, following resolution of infection and development of antibodies.[4] It has been hypothesized that infusion of the SARS-CoV-2 neutralizing antibodies contained within this serum may improve patient outcomes. CP has been utilized to treat other infectious diseases with variable results, including outbreaks of other beta-coronaviruses (SARS-CoV-1, Middle East respiratory syndrome),[5] Ebola,[6] and influenza;[7] however, the efficacy of CP in critically ill patients with SARS-CoV-2 infection remains unclear.

Several nonrandomized studies indicated that CP treatment for patients with COVID-19 may be safe,[4],[8],[9] with variable results regarding mortality and clinical markers of critical illness.[10],[11],[12] Moreover, when combined with remdesivir, CP did not improve outcomes over remdesivir alone.[13] Despite this modest evidence, the United States Food and Drug Administration has approved the use of experimental CP therapy in clinical trials and critical COVID-19 patients without other treatment options.[14]

A listing of randomized controlled trials in adult patients with severe or critical illness due to COVID-19 is presented in [Table 1].[15],[16],[17],[18],[19] Four studies were excluded for including patients other than those with a severe or critical illness.[20],[21],[22],[23] Risk of bias was assessed for each study using the Cochrane risk-of-bias tool [Table 2], and evidence was graded according to the GRADE rating system.{Table 1}{Table 2}

The results of included studies are summarized in [Table 3]. When compared to usual care, CP treatment for COVID-19 with severe or critical illness does not show statistically significant benefit on hospital mortality (4 studies,[16],[17],[18],[19] 514 patients, CP 37 [11.7%] vs. usual care 33 [16.6%]; odds ratio [OR]: 0.74 [95% confidence interval [CI]: 0.44, 1.24); evidence certainty by GRADE criteria low). Furthermore, the incidence of serious adverse events was not statistically different between the groups (3 studies,[17],[18],[19] 485 patients, CP 55 [18.3%] vs. usual care 19 [10.3%]; OR: 1.44 [95% CI: 0.81, 2.56]; evidence certainty by GRADE criteria low). In addition, treatment with CP does not appear to improve hospital or ICU length of stay (data not presented due to space limitations). Finally, it should be noted that two of the studies are preprints,[15],[16] and a number of clinical trials have been undertaken (some abandoned), thus necessitating careful review once additional data are available.{Table 3}

In conclusion, available evidence suggests that CP treatment for COVID-19 patients with a severe or critical illness does not decrease hospital mortality or increase rates of serious adverse events. Routine use of CP treatment for severe or critically ill COVID-19 patients without other indications for its use is not advised.

References

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