ABSTRACT
The use of convalescent plasma in coronavirus disease 2019 (COVID-19) in the general population has not been shown to have a clear benefit. However, there are limited data available on its use in specific populations, such as in personswithhumanimmunodeficiencyvirus(HIV;PWH).The present case series study describes 12 hospitalized PWH who received convalescent plasma for severe COVID-19 between March 2020 and July 2020. Demographics, pre-existing comorbidities, HIV status, and COVID-19 management were reported and examined in a multivariate analysis. A high mortality rate of 58%, (7 out of 12 PWH) was observed in those receiving the convalescent plasma. By contrast, a brief review of 13 previously published cohorts of PWH hospitalized with COVID-19 revealed a cumulative mortality of 19% (85 of 439 PWH). In the present case series study, PWH had a significantly higher relative risk for in-hospital COVID-19-associated mortality compared with individuals without HIV (unadjusted range, 2.10-2.52;and adjusted range, 1.79-2.08;P<0.02 in all analyses). Covariate-adjustments were made for patient demographics, pre-existing co-morbidities, and mechanical ventilation needs. The high mortality rate of the present case series may be related to random sampling or an adverse effect of convalescent plasma in PWH and severe COVID-19. Additional research is thus required to investigate the risks and benefits of the use of COVID-19 convalescent plasma in PWH. © 2022 the Author(s).
ABSTRACT
Background/Case Studies: To date, convalescent plasma for the treatment of SARS-CoV-2 has shown effectiveness in severely ill patients in reducing mortality. While studies have demonstrated a low risk of serious adverse events, the comprehensive incidence and nature of the spectrum of transfusion reactions to convalescent plasma is unknown. Here, we retrospectively examine 427 inpatient convalescent plasma transfusions to determine incidence and types of reactions, as well as clinical parameters and risk factors associated with transfusion reactions. Study Design/Methods: Retrospective analysis was performed for 427 transfusions to 215 COVID-19 patients within the Mount Sinai Health System (MSHS), through eIND and EAP approval pathways by the FDA. Transfusions were blindly evaluated by two reviewers and adjudicated by a third reviewer in discordant cases. Patient demographics, clinical, and laboratory parameters were compared and analyzed. Statistical analysis was performed determine the significance of these parameters and univariate logistic regression analysis was performed to assess which independent variables were correlated with a transfusion reaction. Results/Findings: Fifty-five reactions from 427 transfusion events were identified (12.9% incidence), thirteen of which were attributed to transfusion (3.1% incidence). Reactions were classified as underlying COVID-19 (76%), febrile non-hemolytic (10.9%), transfusion-associated circulatory overload (9.1%), allergic (1.8%), and hypotensive (1.8%) reactions. Statistical analysis identified increased transfusion reaction risk for ABO blood group B, Sequential Organ Failure Assessment scores of 12-13, or a cancer diagnosis. A decreased risk was identified for patients in the age group of 80-89 years. Conclusions: Our findings support the use of convalescent plasma as a safe therapeutic option from a transfusion reaction perspective, in the setting of COVID-19. Further studies are needed to confirm the clinical significance of ABO group B, cancer diagnosis, age, and predisposing disease severity in the incidence of transfusion reaction events.