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

Soledad E González, Lorena Regairaz, Martin R Salazar, Noelia S Ferrando, Verónica V González Martínez, Patricia M Carrera Ramos, Santiago A Pesci, Juan M Vidal, Nicolás Kreplak, Elisa Estenssoro
DOI: 10.1136/jim-2021-002158 Published 22 June 2022
Soledad E González
1 Epidemiología, Ministerio de Salud de la Provincia de Buenos Aires, La Plata, Buenos Aires, Argentina
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Lorena Regairaz
2 Inmunología, Hospital Interzonal Especializado en Pediatría ‘Sor María Ludovica’, La Plata, Buenos Aires, Argentina
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Martin R Salazar
3 Clínica Médica, Hospital Interzonal General de Agudos General San Martin, La Plata, Argentina
4 Medicina Interna, Universidad Nacional de la Plata Facultad de Ciencias Medicas, La Plata, Buenos Aires, Argentina
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  • ORCID record for Martin R Salazar
Noelia S Ferrando
5 Estadística, Instituto de Hemoterapia, La Plata, Buenos Aires, Argentina
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Verónica V González Martínez
6 Dirección de Investigación, Ministerio de Salud de la Provincia de Buenos Aires, La Plata, Argentina
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Patricia M Carrera Ramos
7 Instituto de Investigaciones Pediátricas ‘Prof. Fernando E. Vitieri’, La Plata, Buenos Aires, Argentina
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Santiago A Pesci
1 Epidemiología, Ministerio de Salud de la Provincia de Buenos Aires, La Plata, Buenos Aires, Argentina
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Juan M Vidal
1 Epidemiología, Ministerio de Salud de la Provincia de Buenos Aires, La Plata, Buenos Aires, Argentina
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Nicolás Kreplak
8 Ministro de Salud Pública, Ministerio de Salud de la Provincia de Buenos Aires, La Plata, Buenos Aires, Argentina
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Elisa Estenssoro
9 Terapia Intensiva, Hospital Interzonal General de Agudos General San Martin, La Plata, Argentina
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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.

Footnotes

  • Twitter @Salazar

  • Collaborators Luis Cantaluppi, Yanina Spinelli, Cecilia Girard Bosch, Patricia Méndez, Andrea Gamarnik, Gian Pietro Fernández Rojas, Alejandra Debonis, Laura Vives, Verónica Copolillo, Vanesa Fernandez, Natalia Nuñez, Ariel Sola, Alejandra Toledo, Miriam Cardalda, Agustina Lagrava, Rosario Céspedes, Jorgelina Aberer, Silvana Gabriela Turano, Carlos Antonio Cuchetti, Agustina Martins, Luciana Spizzirri, Gustavo Mariño, Andrea Lopardi, Cecilia Avatte, Viviana Falasco, Martin Fabian Ruiz, Ana Laura Gonzalez, Gabriela Rodriguez, Horacio Rubén López Alegre, Pablo Schon, Mariana Casalins, Gustavo Cañete, Soledad Vallejo, Karina Sarmiento, Christian Martinez Kovach, Fabiana Ferrero, Liliana Disalvo, Ana Varea, Ignacio Méndez, Lucrecia Fotia, Marcela Padua, Isabel Ballesteros, Adriana Hilda Romani, Daniela Federico, Diego Ortale, Viviana Jalife, Josefina Viaño, Mariana Jaime, Federico Gorini, Sandra González, Analia Vairo, Marina Alvarez, Pablo Marocco, Diego Saez, Federico Paicher y Marcelo Cordero.

  • Contributors Design of the work: MRS, EE, SEG, NK. Acquisition of data: LR, NSF, SAP, JMV, PMCR. Analysis of data: JMV, PMCR, MRS, NSF. Interpretation of data: SEG, LR, EE, MRS. Drafting the work or revising it critically for important intellectual content: SEG, EE, MRS, NK. Final approval of the version to be published: all authors. Guarantor: MRS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement

Data are available upon reasonable request.

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Journal of Investigative Medicine: 70 (5)
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Timing of convalescent plasma administration and 28-day mortality in COVID-19 pneumonia
Soledad E González, Lorena Regairaz, Martin R Salazar, Noelia S Ferrando, Verónica V González Martínez, Patricia M Carrera Ramos, Santiago A Pesci, Juan M Vidal, Nicolás Kreplak, Elisa Estenssoro
Journal of Investigative Medicine Jun 2022, 70 (5) 1258-1264; DOI: 10.1136/jim-2021-002158

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Timing of convalescent plasma administration and 28-day mortality in COVID-19 pneumonia
Soledad E González, Lorena Regairaz, Martin R Salazar, Noelia S Ferrando, Verónica V González Martínez, Patricia M Carrera Ramos, Santiago A Pesci, Juan M Vidal, Nicolás Kreplak, Elisa Estenssoro
Journal of Investigative Medicine Jun 2022, 70 (5) 1258-1264; DOI: 10.1136/jim-2021-002158
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Timing of convalescent plasma administration and 28-day mortality in COVID-19 pneumonia
Soledad E González, Lorena Regairaz, Martin R Salazar, Noelia S Ferrando, Verónica V González Martínez, Patricia M Carrera Ramos, Santiago A Pesci, Juan M Vidal, Nicolás Kreplak, Elisa Estenssoro
Journal of Investigative Medicine Jun 2022, 70 (5) 1258-1264; DOI: 10.1136/jim-2021-002158
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