Mortality rates among hospitalized patients with COVID-19 treated with convalescent plasma A Systematic review and meta-analysis
Mortality rates among hospitalized patients with COVID-19 treated with convalescent plasma A Systematic review and meta-analysis
Abstract IMPORTANCEMany hospitalized patients with COVID-19 have been treated with convalescent plasma. However, it is uncertain whether this therapy lowers mortality and if so, if the mortality benefit is larger among specific subgroups, such as recipients of plasma with high antibody content and patients treated early in the disease course. OBJECTIVETo examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19. DATA SOURCESOn October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature. STUDY SELECTIONRandomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3,841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of five reviewers. DATA EXTRACTION AND SYNTHESISThe study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using inverse-variance random-effects model. MAIN OUTCOMES AND MEASURESPrespecified end point was all-cause mortality during hospitalization. RESULTSThirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses demonstrated that transfusion of COVID-19 convalescent plasma was associated with a significant decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio (OR), 0.87 [95% CI, 0.76-1.00]) and matched cohort studies (OR, 0.77 [95% CI, 0.64-0.94]). Meta-analysis of subgroups revealed two important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared to convalescent plasma containing low antibody levels (OR, 0.85 [95% CI, 0.73 to 0.99]). Second, earlier treatment with COVID-19 convalescent plasma was associated with a significant decrease in mortality compared with the later treatment cohort (OR, 0.63 [95% CI, 0.48 to 0.82]). CONCLUSIONS AND RELEVANCECOVID-19 convalescent plasma use was associated with a 13% reduced risk in mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course. Key Points QuestionWhat is the evidence regarding the potential mortality benefit associated with transfusion of convalescent plasma in hospitalized patients with COVID-19? FindingsIn this meta-analysis of 39 randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants, transfusion of convalescent plasma was associated with a 13% mortality benefit. Subgroup analyses revealed that patients treated with plasma containing higher levels of antibodies and patients treated earlier in the course of the disease had a greater mortality benefit associated with COVID-19 convalescent plasma transfusion. MeaningThese findings suggest that transfusion of COVID-19 convalescent plasma is associated with a mortality benefit for hospitalized patients, particularly those treated earlier in the disease course.
Clayburn Andrew J.、Hurt Ryan T.、Kay Neil E.、Baker Sarah E.、Dennis Joshua J.、Kunze Katie L.、Larson Kathryn F.、Regimbal Riley J.、Ripoll Juan G.、Sexton Matthew A.、Theel Elitza S.、Wiggins Chad C.、Joyner Michael J.、Vogt Matthew N.P.、Senefeld Jonathon W.、Paneth Nigel S.、Morkeberg Olaf H.、Wright R. Scott、Bruno Katelyn A.、Focosi Daniele、Henderson Jeffrey P.、Pirofski Liise-anne、Ganesh Ravindra、Sullivan David J.、Shoham Shmuel、Stubbs James R.、Klassen Stephen A.、Diaz Soto Juan C.、Buras Matthew R.、Buchholtz Zachary A.、Fairweather DeLisa、Carter Rickey E.、Tobian Aaron A.R.、Klompas Allan M.、Juskewitch Justin E.、Gorman Ellen K.、Grossman Brenda J.、van Helmond Noud、van Buskirk Camille M.、Shepherd John R.A.、Bloch Evan M.、Parikh Sameer A.、Franchini Massimo、Herasevich Vitaly、Moir M. Erin、Winters Jeffrey L.、Whelan Emily R.、Johnson Patrick W.、Mills John R.、Casadevall Arturo
Department of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of General Internal Medicine, Mayo ClinicDivision of Hematology, Mayo Clinic||Department of Immunology, Mayo Clinic, RochesterDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Quantitative Health Sciences, Mayo ClinicDepartment of Cardiovascular Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Laboratory Medicine and Pathology, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Epidemiology and Biostatistics and Department of Pediatrics and Human Development, Michigan State UniversityDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Cardiovascular Medicine, Mayo Clinic||Human Research Protection Program, Mayo ClinicDepartment of Cardiovascular Medicine, Mayo Clinic||Center for Regenerative Medicine and Division of Cardiology, University of FloridaNorth-Western Tuscany Blood Bank, Pisa University HospitalDivision of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis||Department of Molecular Microbiology, Washington University School of Medicine in St. LouisDivision of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical CenterDepartment of General Internal Medicine, Mayo ClinicDepartment of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public HealthDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins University School of MedicineDepartment of Laboratory Medicine and Pathology, Mayo ClinicDepartment of Kinesiology, Brock UniversityDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Quantitative Health Sciences, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Cardiovascular Medicine, Mayo ClinicDepartment of Quantitative Health Sciences, Mayo ClinicDepartment of Pathology Johns Hopkins University School of MedicineDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Laboratory Medicine and Pathology, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Pathology & Immunology, Washington University School of MedicineDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Laboratory Medicine and Pathology, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Pathology Johns Hopkins University School of MedicineDivision of Hematology, Mayo ClinicDivision of Transfusion Medicine, Carlo Poma HospitalDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Kinesiology, University of Wisconsin-MadisonDepartment of Laboratory Medicine and Pathology, Mayo ClinicDepartment of Cardiovascular Medicine, Mayo ClinicDepartment of Quantitative Health Sciences, Mayo ClinicDepartment of Laboratory Medicine and Pathology, Mayo ClinicDepartment of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health
医学研究方法临床医学内科学
Clayburn Andrew J.,Hurt Ryan T.,Kay Neil E.,Baker Sarah E.,Dennis Joshua J.,Kunze Katie L.,Larson Kathryn F.,Regimbal Riley J.,Ripoll Juan G.,Sexton Matthew A.,Theel Elitza S.,Wiggins Chad C.,Joyner Michael J.,Vogt Matthew N.P.,Senefeld Jonathon W.,Paneth Nigel S.,Morkeberg Olaf H.,Wright R. Scott,Bruno Katelyn A.,Focosi Daniele,Henderson Jeffrey P.,Pirofski Liise-anne,Ganesh Ravindra,Sullivan David J.,Shoham Shmuel,Stubbs James R.,Klassen Stephen A.,Diaz Soto Juan C.,Buras Matthew R.,Buchholtz Zachary A.,Fairweather DeLisa,Carter Rickey E.,Tobian Aaron A.R.,Klompas Allan M.,Juskewitch Justin E.,Gorman Ellen K.,Grossman Brenda J.,van Helmond Noud,van Buskirk Camille M.,Shepherd John R.A.,Bloch Evan M.,Parikh Sameer A.,Franchini Massimo,Herasevich Vitaly,Moir M. Erin,Winters Jeffrey L.,Whelan Emily R.,Johnson Patrick W.,Mills John R.,Casadevall Arturo.Mortality rates among hospitalized patients with COVID-19 treated with convalescent plasma A Systematic review and meta-analysis[EB/OL].(2025-03-28)[2025-07-03].https://www.medrxiv.org/content/10.1101/2023.01.11.23284347.点此复制
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