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Compassionate use of convalescent plasma for treatment of moderate and severe pneumonia in COVID-19 patients and association with IgG antibody levels in donated plasma.
Maor, Yasmin; Cohen, Daniel; Paran, Nir; Israely, Tomer; Ezra, Vered; Axelrod, Ofra; Shinar, Eilat; Izak, Marina; Rahav, Galia; Rahimi-Levene, Naomi; Bazofin, Baruch M; Gelman, Ram; Dicker, Dror; Brosh-Nissimov, Tal; Megged, Orli; Dahan, David; Benov, Avi; Paz, Alona; Edward, Kaykov; Moran, Amit; Rogowski, Ori; Sorkine, Patrick; Mayo, Ami; Zimhony, Oren; Chen, Jacob.
  • Maor Y; Infectious Disease Unit, Wolfson Medical Center, Holon, Israel.
  • Cohen D; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Paran N; School of Public Health, Tel Aviv University, Tel Aviv, Israel.
  • Israely T; Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel.
  • Ezra V; Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel.
  • Axelrod O; Medical directorate, Ministry of Health, Jerusalem, Israel.
  • Shinar E; Ministry of Health, Jerusalem, Israel.
  • Izak M; Magen David Adom, National Blood Services, Ramat Gan, Israel.
  • Rahav G; Magen David Adom, National Blood Services, Ramat Gan, Israel.
  • Rahimi-Levene N; Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel.
  • Bazofin BM; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Gelman R; Shamir (Assaf Harofeh) Medical Center, Medical Director of the Blood Bank, Zerifin 703301, Israel.
  • Dicker D; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Brosh-Nissimov T; Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
  • Megged O; Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
  • Dahan D; Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel.
  • Benov A; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Paz A; Internal Medicine D and Obesity Clinic Hasharon Hospital-Rabin Medical center, Petah Tiqva, Israel.
  • Edward K; Infectious Diseases Unit, Assuta Ashdod University Hospital, Ashdod, Israel.
  • Moran A; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
  • Rogowski O; Pediatric Infectious diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
  • Sorkine P; Respiratory ICU, Meir Medical Center, Kfar Saba, Israel.
  • Mayo A; Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel.
  • Zimhony O; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
  • Chen J; Infectious Unit, Bnei Zion Medical Center, Haifa, Israel.
EClinicalMedicine ; 26: 100525, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-753681
ABSTRACT

BACKGROUND:

We assessed outcome of patients with moderate and severe COVID-19 following treatment with convalescent plasma (CP) and the association with IgG levels in transfused CP.

METHODS:

A prospective cohort study. Primary outcome was improvement at day 14 defined as alive, not on mechanical ventilation, and moderate, mild, or recovered from COVID-19. Antibody levels in CP units were unknown at the time of treatment. IgG against the spike protein S1 was subsequently measured by ELISA. Neutralizing antibodies titers were determined in a subset. Outcome was assessed in relation to the mean antibody level transfused to the patients (≤4.0 versus >4.0).

FINDINGS:

Of 49 patients, 11 (22.4%) had moderate, 38 (77.6%) had severe disease, 28 were ventilated. At day 14, 24 (49.0%) patients improved, 9 (18.4%) died, and 13 (26.5%) were ventilated. In 14/98 (14.3%) CP units IgG was < 1.1 (cutoff calibration) and in 60 (61.2%) ≤4.0. IgG level and neutralizing antibody titer were correlated (0.85 p < 0.001). In patients receiving ≤4.0 antibody levels, 11/30 improved (36.7%) versus 13/19 (68.4%) in patients receiving >4.0 odds ratio (OR) 0.267 [95% confidence interval (CI) 0.079-0.905], P = 0.030. In patients diagnosed >10 days prior to treatment, 4/14 (22.4%) improved in the ≤4.0 antibody group, versus 6/7 (85.7%) in the >4.0 antibody group, OR 0.048 (95% CI, 0.004-0.520), P = 0.007. No serious adverse events were reported.

INTERPRETATION:

Treatment with CP with higher levels of IgG against S1 may benefit patients with moderate and severe COVID-19. IgG against S1 level in CP predicts neutralization antibodies titers.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: EClinicalMedicine Year: 2020 Document Type: Article Affiliation country: J.eclinm.2020.100525

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: EClinicalMedicine Year: 2020 Document Type: Article Affiliation country: J.eclinm.2020.100525