Outcomes of convalescent plasma transfusion for SARS-CoV2 patients in the intensive care unit

ABSTRACT

Background: SARS-CoV2 is a grave illness and few therapeutic agents have yielded benefit or reduced mortality. Administration of convalescent plasma (CP) in viral illnesses in the past, including SARS, before day 14, has been associated with a shorter hospital course. In the present study, we are interested in determining the benefit of administering CP to critically ill patients in the intensive care unit, and the impact on mortality and other clinical markers. Methods: 5 critically ill patients with confirmed SARS-CoV2 infection were observed in the uncontrolled case series study. Mechanically ventilated patients with severe ARDS (PaO2/FiO2 < 100) were eligible to receive CP transfusion. We reviewed daily vital signs, inflammatory markers, PaO2/FiO2 ratio and SOFA scores before and after CP transfusions. SARS-CoV2 PCR viral load testing was completed on day 0 of transfusion and repeated on day 3 and 6. Complications during the hospitalization and 30-day mortality were assessed. Results: All 5 patients were mechanically ventilated at the time of transfusion and between day 7 to 31 of their illness. Following plasma transfusion, body temperature and inflammatory markers remained elevated in four patients (figure 1). SOFA score and PaO2/FiO2 ratios continued to worsen in three and four patients respectively (figure 2). SARS-CoV2 PCR remained positive in 4 patients. 4 of the 5 patients had died at the end of the follow up period. One patient was successfully extubated on day 29 (table 1) and discharged after a long hospital course. Conclusion: In our patient cohort, the administration of CP did not improve laboratory markers or clinical outcomes. Some notable limitations of this study are the small sample size, and that the patients received CP late in their disease course. Further investigation is necessary to draw definitive conclusions about the utility of CP in the treatment of SARS-CoV2. (Table Presented).