Iberoamerican Journal of Medicine
https://iberoamjmed.com/article/doi/10.53986/ibjm.2022.0009
Iberoamerican Journal of Medicine
Original article

Evaluation of the efficacy of immune plasma treatment in COVID-19 infected intensive care unit patients

Evaluación de la eficacia del tratamiento con plasma inmune en pacientes de la unidad de cuidados intensivos infectados por COVID-19

Emel Yıldız, Murat Emre Tokur, Bugra Özlem, Özlem Arık, Canan Balcı

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Abstract

Introduction: Treatment approach in COVID-19 infection consists of antiviral, immunomodulatory, and supportive treatments. Convalescent plasma, immune plasma or hyperimmune plasma refers to the plasma that consisting of high titer polyclonal antibodies against the virus and are amidst the immunomodulatory treatments. Although it has been reported that immune plasma treatment of COVID-19 reduces hospital stay and mortality, the efficacy of immune plasma with COVID-19 infection is not clear yet. The present study aims to investigate the efficacy of immune plasma in patients who are followed up in the intensive care unit with the diagnosis of COVID-19.
Materials and methods: In this retrospective study, the patients who were hospitalized in the intensive care unit with the diagnosis of COVID-19 infection were divided into two groups: those who received IP treatment (Group 1; n=28) and those who did not (Group 2; n=25). The biochemical C -reactive protein, lactate-dehydrogenase, ferritin, D-dimer, total bilirubin, creatine levels, hematological parameters (Leukocyte, neutrophil, lymphocyte, platelet counts), clinical sepsis scores (SOFA, APACHE scores) and mortality rates of the patients were evaluated according to groups.
Results: There was no statistically significant difference between Group 1 and Group 2 in terms of the presence of mechanical ventilation support and tracheostomy, comorbidities, laboratory values, C -reactive protein, SOFA, APACHE scores. The mortality rate was 61% in Group 1 and 52% in Group 2.
Conclusions: Our findings revealed that immune plasma treatment was not effective in recovery and decreasing the mortality rates in the COVID-19 infected intensive care unit patients. Further studies are needed to investigate the efficacy of administering immunomodulatory therapies on the outcome before the hyper inflammatory process starts.

Keywords

COVID-19; Immune plasma; Intensive care unit; Mortality

Resumen

Introducción: El enfoque de tratamiento en la infección por COVID-19 consiste en tratamientos antivirales, inmunomoduladores y de apoyo. El plasma de convalecencia, el plasma inmune o el plasma hiperinmune se refieren al plasma que consiste en anticuerpos policlonales de alto título contra el virus y se encuentra en medio de los tratamientos inmunomoduladores. Aunque se ha informado que el tratamiento con plasma inmune de COVID-19 reduce la estancia hospitalaria y la mortalidad, la eficacia del plasma inmune con la infección por COVID-19 aún no está clara. El presente estudio tiene como objetivo investigar la eficacia del plasma inmune en pacientes que son seguidos en la unidad de cuidados intensivos con el diagnóstico de COVID-19.
Materiales y métodos: En este estudio retrospectivo, los pacientes que fueron hospitalizados en la unidad de cuidados intensivos con el diagnóstico de infección por COVID-19 se dividieron en dos grupos: los que recibieron tratamiento IP (Grupo 1; n = 28) y los que lo hicieron. no (Grupo 2; n = 25). La proteína C reactiva bioquímica, lactato-deshidrogenasa, ferritina, dímero D, bilirrubina total, niveles de creatina, parámetros hematológicos (recuentos de leucocitos, neutrófilos, linfocitos, plaquetas), puntuaciones de sepsis clínica (puntuaciones SOFA, APACHE) y tasas de mortalidad de los pacientes fueron evaluados según grupos.
Resultados: No hubo diferencia estadísticamente significativa entre el Grupo 1 y el Grupo 2 en cuanto a la presencia de soporte ventilatorio mecánico y traqueotomía, comorbilidades, valores de laboratorio, proteína C reactiva, SOFA, puntajes APACHE. La tasa de mortalidad fue del 61% en el grupo 1 y del 52% en el grupo 2.
Conclusiones: Nuestros hallazgos revelaron que el tratamiento con plasma inmune no fue efectivo en la recuperación y la disminución de las tasas de mortalidad en los pacientes de la unidad de cuidados intensivos infectados por COVID-19. Se necesitan más estudios para investigar la eficacia de la administración de terapias inmunomoduladoras sobre el resultado antes de que comience el proceso hiperinflamatorio.

Palabras clave

COVID-19; Plasma inmune; Unidad de Cuidados Intensivos; Mortalidad

References

1. Alkan Çeviker S, Dindar Demiray EK. [Other Respiratory Viruses for Differential Diagnosis of SARS-CoV-2 (COVID 19) Infection]. J Biotechnol and Strategic Health Res. 2020;1(Özel Sayı):45-9. doi: 10.34084/bshr.714383.
2. Kaur KK, Allahbadia G, Singh M. A comprehensive review on epidemiology, aetiopathogenesis, diagnosis and treatment of the novel coronavirus syndrome –- COVID-19. Iberoam J Med. 2020;2(2):110-23. doi: 10.5281/zenodo.3757110.
3. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428-55. doi: 10.1111/all.14657.
4. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192-206. doi: 10.1111/joim.13091.
5. Bloch EM, Shoham S, Casadevall A, Sachais BS, Shaz B, Winters JL, et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest. 2020;130(6):2757-65. doi: 10.1172/JCI138745.
6. Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. Lancet Infect Dis. 2020;20(4):398-400. doi: 10.1016/S1473-3099(20)30141-9.
7. Tanne JH. Covid-19: FDA approves use of convalescent plasma to treat critically ill patients. BMJ. 2020;368:m1256. doi: 10.1136/bmj.m1256.
8. Kurulu Çalışması BD. COVID-19 Pandemisinde Sağlık Kurumlarında Çalışma Rehberi ve Enfeksiyon Kontrol Önlemleri. 2021. Available from: https://covid19.saglik.gov.tr/Eklenti/40282/0/covid19-saglikkurumlarindacalismarehberiveenfeksiyonkontrolonlemleripdf.pdf (accessed May 2021).
9. T.C. SAĞLIK BAKANLIĞI SAĞLIK HİZMETLERİ GENEL MÜDÜRLÜĞÜ Kan ve Kan Ürünleri Dairesi Başkanlığı . COVID-19 İMMÜN (KONVALESAN) PLAZMA TEDARİK VE KLİNİK KULLANIM REHBERİ. Available from: https://shgmkanhizmetleridb.saglik.gov.tr/Eklenti/39167/0/covid-19-immun-plazma-rehberi-v5.pdf. (accessed May 2021).
10. Türkiye’de Kan Tedarik Sisteminin Güçlendirilmesi Teknik Destek Projesi. Ulusal kan ve kan bileşenleri hazırlama, kullanım ve kalite güvencesi rehberi. 2016. Avaiable from: https://shgmkanhizmetleridb.saglik.gov.tr/Eklenti/36313/0/kan-ve-kan-bilesen-rehb-tr-9-mayis-2016-revpdf.pdf (accessed May 2021).
11. Rajendran K, Krishnasamy N, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID-19: Systematic review. J Med Virol. 2020;92(9):1475-83. doi: 10.1002/jmv.25961.
12. Long QX, Tang XJ, Shi QL, Li Q, Deng HJ, Yuan J, et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med. 2020;26(8):1200-4. doi: 10.1038/s41591-020-0965-6.
13. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924. doi: 10.1016/j.ijantimicag.2020.105924.
14. Castro MG, Sadonio MJ, Castillo Landaburo AA, Cuevas G, Cogliano F, Galluccio F. Predicting of por outocmes in COVID-19 patients: Experience from an Argentinean hospital. Iberoam J Med. 2021;3(4):316-25. doi: 10.53986/ibjm.2021.0050.
15. van Griensven J, Edwards T, de Lamballerie X, Semple MG, Gallian P, Baize S, et al. Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea. N Engl J Med. 2016;374(1):33-42. doi: 10.1056/NEJMoa1511812.
16. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, Cleary P, Khaw FM, Lim WS, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis. 2015;211(1):80-90. doi: 10.1093/infdis/jiu396.
17. Arabi Y, Balkhy H, Hajeer AH, Bouchama A, Hayden FG, Al-Omari A, et al. Feasibility, safety, clinical, and laboratory effects of convalescent plasma therapy for patients with Middle East respiratory syndrome coronavirus infection: a study protocol. Springerplus. 2015;4:709. doi: 10.1186/s40064-015-1490-9.
18. Hegerova L, Gooley TA, Sweerus KA, Maree C, Bailey N, Bailey M, et al. Use of convalescent plasma in hospitalized patients with COVID-19: case series. Blood. 2020;136(6):759-62. doi: 10.1182/blood.2020006964.
19. Soo YO, Cheng Y, Wong R, Hui DS, Lee CK, Tsang KK, et al. Retrospective comparison of convalescent plasma with continuing high-dose methylprednisolone treatment in SARS patients. Clin Microbiol Infect. 2004;10(7):676-8. doi: 10.1111/j.1469-0691.2004.00956.x.
20. Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang J, et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. JAMA. 2020;324(5):460-70. doi: 10.1001/jama.2020.10044.
21. Zeng QL, Yu ZJ, Gou JJ, Li GM, Ma SH, Zhang GF, et al. Effect of Convalescent Plasma Therapy on Viral Shedding and Survival in Patients With Coronavirus Disease 2019. J Infect Dis. 2020;222(1):38-43. doi: 10.1093/infdis/jiaa228.
22. Psaltopoulou T, Sergentanis TN, Pappa V, Politou M, Terpos E, Tsiodras S, et al. The Emerging Role of Convalescent Plasma in the Treatment of COVID-19. Hemasphere. 2020;4(3):e409. doi: 10.1097/HS9.0000000000000409.
23. Duan K, Liu B, Li C, Zhang H, Yu T, Qu J, et al. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. Proc Natl Acad Sci U S A. 2020;117(17):9490-6. doi: 10.1073/pnas.2004168117.
24. Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. 2020;323(16):1582-9. doi: 10.1001/jama.2020.4783.
25. Erkurt MA, Sarici A, Berber İ, Kuku İ, Kaya E, Özgül M. Life-saving effect of convalescent plasma treatment in covid-19 disease: Clinical trial from
eastern Anatolia. Transfus Apher Sci. 2020;59(5):102867. doi: 10.1016/j.transci.2020.102867.
26. Alsharidah S, Ayed M, Ameen RM, Alhuraish F, Rouheldeen NA, Alshammari FR, et al. COVID-19 convalescent plasma treatment of moderate and severe cases of SARS-CoV-2 infection: A multicenter interventional study. Int J Infect Dis. 2021;103:439-46. doi: 10.1016/j.ijid.2020.11.198.
27. Omrani AS, Zaqout A, Baiou A, Daghfal J, Elkum N, Alattar RA, et al. Convalescent plasma for the treatment of patients with severe coronavirus disease 2019: A preliminary report. J Med Virol. 2021;93(3):1678-86. doi: 10.1002/jmv.26537.
28. Eckhardt CM, Cummings MJ, Rajagopalan KN, Borden S, Bitan ZC, Wolf A, et al. Evaluating the efficacy and safety of human anti-SARS-CoV-2 convalescent plasma in severely ill adults with COVID-19: A structured summary of a study protocol for a randomized controlled trial. Trials. 2020;21(1):499. doi: 10.1186/s13063-020-04422-y.
29. Joyner MJ, Wright RS, Fairweather D, Senefeld JW, Bruno KA, Klassen SA, et al. Early safety indicators of COVID-19 convalescent plasma in 5000 patients. J Clin Invest. 2020;130(9):4791-7. doi: 10.1172/JCI140200.


Submitted date:
11/20/2021

Reviewed date:
12/15/2021

Accepted date:
01/06/2022

Publication date:
01/06/2022

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