Stefan Hatzl1,2, Florian Posch3, Nazanin Sareban4, Martin Stradner5, Konrad Rosskopf4, Alexander C Reisinger1, Philipp Eller1, Michael Schörghuber6, Wolfgang Toller6, Zdenka Sloup7, Florian Prüller7, Katharina Gütl8, Stefan Pilz9, Alexander R Rosenkranz10, Hildegard T Greinix2, Robert Krause11, Peter Schlenke4, Gernot Schilcher1. 1. Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 2. Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 3. Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 4. Department for Blood Group Serology and Transfusion Medicine, Medical University Graz, Graz, Austria. 5. Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 6. Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria. 7. Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. 8. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 9. Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 10. Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 11. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria. robert.krause@medunigraz.at.
Abstract
BACKGROUND: This study aimed to quantify the potential survival benefit of convalescent plasma therapy (CVP) in critically ill patients with acute respiratory failure related to coronavirus disease-2019 (COVID-19). METHODS: This is a single-center prospective observational cohort study in COVID-19 patients with acute respiratory failure. Immediately after intensive care unit (ICU) admission patients were allocated to CVP treatment following pre-specified criteria to rapidly identify those patients potentially susceptible for this treatment. A propensity score adjustment [inverse probability of treatment weighted (IPTW) analysis] was implemented to account rigorously for imbalances in prognostic variables between the treatment groups. RESULTS: We included 120 patients of whom 48 received CVP. Thirty percent were female with a median age of 66 years [25th-75th percentile 54-75]. Eighty-eight percent of patients presented with severe acute respiratory failure as displayed by a median paO2/FiO2 ratio (Horowitz Index) of 92 [77-150]. All patients required any kind of ventilatory support with more than half of them (52%) receiving invasive ventilation. Thirty-day ICU overall survival (OS) was 69% in the CVP group and 54% in the non-CVP group (log-rank p = 0.049), respectively. After weighing the time-to-event data for the IPTW, the favorable association between CVP and OS became even stronger (log-rank p = 0.035). Moreover, an exploratory analysis showed an overall survival benefit of CVP therapy for patients with non-invasive ventilation (Hazard ratio 0.12 95% CI 0.03-0.57, p = 0.007) CONCLUSION: Administration of CVP in patients with acute respiratory failure related to COVID-19 is associated with improved ICU survival rates.
BACKGROUND: This study aimed to quantify the potential survival benefit of convalescent plasma therapy (CVP) in critically illpatients with acute respiratory failure related to coronavirus disease-2019 (COVID-19). METHODS: This is a single-center prospective observational cohort study in COVID-19patients with acute respiratory failure. Immediately after intensive care unit (ICU) admission patients were allocated to CVP treatment following pre-specified criteria to rapidly identify those patients potentially susceptible for this treatment. A propensity score adjustment [inverse probability of treatment weighted (IPTW) analysis] was implemented to account rigorously for imbalances in prognostic variables between the treatment groups. RESULTS: We included 120 patients of whom 48 received CVP. Thirty percent were female with a median age of 66 years [25th-75th percentile 54-75]. Eighty-eight percent of patients presented with severe acute respiratory failure as displayed by a median paO2/FiO2 ratio (Horowitz Index) of 92 [77-150]. All patients required any kind of ventilatory support with more than half of them (52%) receiving invasive ventilation. Thirty-day ICU overall survival (OS) was 69% in the CVP group and 54% in the non-CVP group (log-rank p = 0.049), respectively. After weighing the time-to-event data for the IPTW, the favorable association between CVP and OS became even stronger (log-rank p = 0.035). Moreover, an exploratory analysis showed an overall survival benefit of CVP therapy for patients with non-invasive ventilation (Hazard ratio 0.12 95% CI 0.03-0.57, p = 0.007) CONCLUSION: Administration of CVP in patients with acute respiratory failure related to COVID-19 is associated with improved ICU survival rates.