ABDULLAH OMER ATSAL, Belgin AKAN, Handan ANKARALI, Canan ÇAM GÖNEN, Işıl ÖZKOÇAK TURAN, Duygu Kayar Calili

Yoğun Bakımda Yatan COVID-19’lu Hastaların Tedavisinde Erken ve Geç Dönem Konvalesan Plazma Uygulamalarının Retrospektif Olarak Karşılaştırılması

Amaç: Yoğun bakımda konvalesan plazma tedavisi alan Corona- virüs hastalığı 2019 (COVID-19)’lu hastaları tedavi uygulanma za- manlarından yola çıkarak, kan grupları, laboratuvar değerleri ve sonlanım açısından karşılaştırmayı amaçladık. Yöntem: Çalışmada yoğun bakımda 200 mL konvalesan plazma te- davisi almış hastalar retrospektif olarak değerlendirildi. Semptom başlangıcı göz önüne alınarak, erken tedavi grubu (≤ 7 gün) ve geç tedavi grubu (>7 gün) olarak iki gruba ayrıldı. Hastaların demogra- fik özellikleri, kan grupları, komorbiditeleri, tedavileri, laboratuvar değerleri [tedavi öncesi (TÖ), tedavi sonrası 1. Gün (TS1), tedavi sonrası 3. Gün (TS3)] ve sonlanımları (mortalite) karşılaştırıldı. Bulgular: Belirlenen kriterleri karşılayan 152 hasta oldu. Erken (n=82) ve geç (n=70) tedavi grupları arasında demografik özellikler, komorbidite, tedaviler, mortalite, yoğun bakım yatış süreleri açı- sından fark tespit edilmedi. Laboratuvarda TÖ ve TS1’de, erken te- davi grubunda ferritin değeri geç tedavi grubuna göre daha yüksek bulundu (p=0,023, p=0,015). Geç tedavi grubunda, TS3’de C reaktif protein değeri, erken tedavi grubuna göre düşüktü (p=0,011). Te- davinin 1. günü ile 3. günü arasındaki değişim incelendiğinde fer- ritin ve fibrinojen değerlerindeki değişiminin geç tedavi grubunda erken tedavi grubuna göre daha fazla olduğu görüldü (p=0,014, p=0,049). Gruplar arasında, diğer laboratuvar değerlerinde farklı- lık saptanmadı. Erken ve geç dönem tedavi alanlar arasında sonla- nım açısından fark bulunmadı. Sonuç: Çalışmamızda konvalesan plazma verilme zamanının sonla- nım üzerine etkisinin olmadığını gördük. Laboratuvar sonuçlarında bulunan farklılığın kontrollü çalışmalar ile tekrar değerlendirilmesi gerektiği görüşündeyiz.

Comparison of Early and Late Administration of Convalescent Plasma for the Treatment of COVID-19 Patients Hospitalized in Intensive Care Unit Retrospectively

Objective: We aimed to compare laboratory and outcome of the patients who were hospitalized in the intensive care unit with the diagnosis of Coronavirus Disease-19 (COVID-19) and transfused convalescent plasma based on timing of treatment. Methods: Patients administered 200 mL of convalescent plasma were analysed retrospectively. Based on symptoms’ onset, pa- tients were divided into two groups as early (≤ 7 days) and late (> 7 days) plasma treatment groups. Patients’ characteristics, comorbi- dities, treatments, laboratory (pre-transfusion, day 1 and day 3 af- ter transfusion) and outcome were evaluated according to groups. Results: A total of 152 patients matched criteria. There was no difference between the early (n=82) and late (n=70) treatment groups in terms of demographic characteristics, comorbidities, treatments, outcomes. Ferritin levels were higher in the early tre- atment group than in the late treatment group on before transfu- sion and day 1 (p=0.023, p=0.015). C reactive protein value was lower in the late treatment group on day 3 (p=0.011). Compa- ring the rate of change between day 1 and day 3 of treatment, it was observed that the changes in ferritin and fibrinogen values were higher in the late group than in the early group (p=0.014, p=0.049). There was no difference between the groups in other laboratory values and outcome. Conclusion: In our study, we observed that the timing of convales- cent plasma had no significant effect on outcome. However, more evidence was needed to prove the difference in laboratory results.

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1. Bloch EM, Shoham S, Casadevall A, et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest 2020;130(6):2757-65.
2. Sun M, Xu Y, He H, et al. A potentially effective treatment for COVID-19: A systematic review and meta-analysis of convalescent plasma therapy in treating severe infectious disease. Int J Infect Dis 2020;98:334-46.
3. Piechotta V, Iannizzi C, Chai KL, et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: A living systematic review. Cochrane Database Syst Rev 2021;5(5):CD013600.
4. Biernat MM, Kolasińska A, Kwiatkowski J, et al. Early administration of convalescent plasma improves survival in patients with hematological malignancies and COVID-19. Viruses 2021;13(3):436.
5. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, 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.
6. Vegivinti CTR, Pederson JM, Saravu K, et al. Efficacy of convalescent plasma therapy for COVID-19: A systematic review and meta-analysis. J Clin Apher 2021;36(3):470-82.
7. TC Sağlık Bakanlığı, Sağlık Hizmetleri Genel Müdürlüğü, Kan ve Kan Ürünleri Dairesi Başkanlığı, COVID-19 İmmün (Konvalesan) Plazma Tedarik ve Kullanım Klavuzu, 5. Sürüm, Ekim 2020. Available from: https://shgm.saglik.gov.tr/ Eklenti/39179/0/covid-19-immun-konvalesan-plazma- tedarik-ve-klinik-kullanim-rehberipdf.pdf. Available date: 5/11/2020
8. World Health Organization, Publications, Therapeutics and COVID-19: Living guideline, March 2022, Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV- therapeutics-2022.2. Available date:3/3/2022
9. RECOVERY Collaborative Group. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): A randomised controlled, open-label, platform trial. Lancet 2021;397(10289):2049-59.
10. Korley FK, Durkalski-Mauldin V, Yeatts SD, et al. Early convalescent plasma for high-risk outpatients with COVID-19. N Engl J Med 2021;385(21):1951-60.
11. Li L, Zhang W, Hu Y, 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.
12. Joyner MJ, Senefeld JW, Klassen SA, et al. Effect of convalescent plasma on mortality among hospitalized patients with COVID-19: Initial three-month experience. medRxiv 2020;2020.08.12.20169359.
13. Salazar E, Christensen PA, Graviss EA, et al. Treatment of Coronavirus Disease 2019 patients with convalescent plasma reveals a signal of significantly decreased mortality. Am J Pathol 2020;190(11):2290-303.
14. Briggs N, Gormally MV, Li F, et al. Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19. PLoS One 2021;16(7): e0254453.
15. Hassan Nashaat HA, Anani M, Attia FM. Convalescent plasma in COVID-19: Renewed focus on the timing and effectiveness of an old therapy. Blood Res 2022;57(1):6-12.
16. Libster R, Pérez Marc G, Wappner D, et al. Early high-titer plasma therapy to prevent severe COVID-19 in older adults. N Engl J Med 2021;384(7):610-8.
17. Salazar E, Christensen PA, Graviss EA, et al. Significantly decreased mortality in a large cohort of Coronavirus Disease 2019 (COVID-19) patients transfused early with convalescent plasma containing high-titer anti-severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) spike protein IgG. Am J Pathol 2021;191(1):90-107.
18. Fazeli A, Sharifi S, Behdad F, et al. Early high-titer convalescent plasma therapy in patients with moderate and severe COVID-19. Transfus Apher Sci 2022;61(2):103321.
19. Duan K, Liu B, Li C, et al. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. Proc Natl Acad Sci U S A 2020;117(17):9490-6.
20. Salazar E, Perez KK, Ashraf M, et al. Treatment of Coronavirus Disease 2019 (COVID-19) patients with convalescent plasma. Am J Pathol 2020;190(8):1680-90.
21. Rasheed AM, Fatak DF, Hashim HA, et al. The therapeutic potential of convalescent plasma therapy on treating critically-ill COVID-19 patients residing in respiratory care units in hospitals in Baghdad, Iraq. Infez Med 2020;28(3):357- 66.
22. Balcells ME, Rojas L, Le Corre N, et al. Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial. PLoS Med 2021;18(3):e1003415.
23. Kocayiğit H, Demir G, Karacan A, et al. Effects on mortality of early vs late administration of convalescent plasma in the treatment of COVID-19. Transfus Apher Sci 2021;60(4):103148.
24. Akay Cizmecioglu H, Goktepe MH, Demircioglu S, et al. Efficacy of convalescent plasma therapy in severe COVID-19 patients. Transfus Apher Sci 2021;60(4):103158.
25. Ray JG, Schull MJ, Vermeulen MJ, Park AL. Association between ABO and Rh blood groups and SARS-CoV-2 infection or severe COVID-19 illness: A Population-based cohort study. Ann Intern Med 2021;174(3):308-15.
26. Mahapatra S, Rattan R, Mohanty CBK. Convalescent plasma therapy in the management of COVID-19 patients-the newer dimensions. Transfus Clin Biol 2021;28(3):246-53.