Clinical outcome of severe COVID-19 patients transfused with convalescent plasma in Malaysia

ABSTRACT

Background: The Coronavirus Disease 2019 (COVID-19) pandemic was first detected in Wuhan, China. It is caused by a novel coronavirus known as Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-Cov-2). The pandemic presents a challenge to the healthcare system worldwide due to widespread infection and limited definitive therapeutic options available. The previous research suggested that convalescent plasma (CP) may be effective against infection. Aims: To investigate the effect of CP transfusion in the clinical outcome of severe COVID-19 patients. Methods: A cross-sectional study was conducted among severe COVID-19 adult patients admitted to six public hospitals across Malaysia from 1st August 2020 to 28th February 2021. A total of 53 patients received CP transfusion along with the standard care (intervention group) and another 53 patients received standard care only (control group) were recruited. An age, gender and comorbidity between the two groups were manually matched approximately at a 11 ratio. Each patient (intervention group) received at least a unit (approximately 250 ml) ABO-compatible CP over 1 or 2 h infusion. Another unit of CP was transfused after 24 h in 18 patients (34.0%) after being assessed by a treating physician. The convalescent plasma was collected from an individual who was recovered from COVID-19 infection, negative for COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) and fulfilled the eligibility criteria for blood donation according to the national guideline. The anti-COVID-19 antibody was tested before the donation. However, the anti-COVID-19 neutralizing antibody (nAb) titre was not determined. The median interval between CP transfusion and severe COVID-19 staging was 2 days. The data were analysed using International Business Machines Corporation (IBM) Statistical Package for the Social Science (SPSS) Statistics Version 26 IBM, New York, USA. Results: The demographics of selected patients were male (60.4%), Malay race (83.0%), and has one or more comorbidity (74.5%). The commonest comorbidities were hypertension (47.2%), followed by diabetes mellitus (44.3%), dyslipidaemia (16.0%), and cardiovascular disease (16.0%). The commonest symptoms upon admission were cough (63.2%), followed by fever (60.4%), and shortness of breath (17.0%). The patients in the intervention group received a shorter duration of oxygen supplementation (median 12 vs. 14 days, p = 0.030) and a shorter duration of mechanical ventilation (median 6 vs. 10 days, p = 0.048). The difference in the mechanical ventilation rate, length of intensive care unit (ICU) stay, length of hospital stay, and mortality rate across both groups was not statistically significant (p = 0.492, 0.793, 0.614 and 0.374). The prevalence of adverse transfusion reactions was 5.7%. Summary/Conclusions: CP transfusion is safe and seems to be effective in the treatment of severe COVID-19 patients. However, a randomized-controlled trial with a larger sample size is necessary at the national level to ascertain the benefits of CP transfusion among severe COVID-19 patients.