The Coronavirus disease 2019(COVID-19) pandemic has significantly affected healthcare worldwide. The disease is associated with rapid virus spread, a high surge of cases, followed by large numbers of critically-ill patients with respiratory failure in need of intensive care unit (ICU) beds and mechanical ventilation. Researchers and clinicians worldwide were in search of potential treatments to aid the recovery of COVID-19 patients. One of the proposed treatments was convalescent plasma due to its history of previous viral infections.
Several studies had shown that convalescent plasma had proven its benefits in the treatment of virus infection before COVID-19, therefore the Indonesian Food and Drug Authority (FDA) released a recommendation for the use of convalescent plasma on May 15th, 2020. Since then, convalescent plasma had been widely used throughout the country on COVID-19 patients, mostly on those who contracted severe and life-threatening COVID-19 in the ICU setting and moderately ill patients. Even though several trials with large sample sizes had been published earlier showed no improvement after the administration of convalescent plasma, it is still frequently used in countries with limited resources due to its high availability and safety. Therefore, we conducted a study to find the benefits and disadvantages of convalescent plasma for mortality in ICU, length of stay (LoS) in ICU, and increasing need for oxygen.
This study is a retrospective study at Dr. Soetomo General Hospital, Surabaya, Indonesia. Data were obtained from daily morning reports of COVID-19 ICU patients. The inclusion criteria of plasma convalescent recipients were patients, who tested positive using RT-PCR for SARS-CoV-2 on samples taken from nasopharyngeal and oropharyngeal swabs, aged 18 years old or older, male or nonpregnant female, and received 300 ml of convalescent plasma twice during ICU hospitalization. The control group was all patients, who were admitted to our COVID-19 ICU during the study period, and who did not receive convalescent plasma during hospitalization.
This study included 179 critically-ill patients hospitalized in our COVID-19 ICU from May to November 2020, with a mortality rate 55.3% (n = 99). The control group were 131 samples, and the treatment group was 48 samples. The percentage of male patients was larger in both groups. Mean age of patients in both groups was around 50 years old (51.2 ± 11.6 and 49.5 ± 11.4 in the control and CP groups, respectively). Almost half of the patients were healthcare workers (doctors, nurses, dentists, radiographers, and transporters). Most patients experienced fever and mild respiratory symptoms (e.g., sore throat, cough, stuffy and runny nose) as first recognized symptoms. Most patients did not know who they came in contact with. Around half of the patients who did not receive CP were intubated on admission, but 78.1% of patients who received CP did not receive mechanical ventilation on their first day in the COVID-19 ICU.
The researchers did a post-doc analysis of patients’ length of stay in the ICU by separating those who survived and those who died during their ICU stay. The length of stay in the ICU for the treatment group was longer than the deceased control group, with a median length of stay (LoS) of eleven days (IQR=5) versus seven days (IQR=5) (U=434; p<0.001). Patients whose condition improved and discharged to a lower level of care also showed similar results with patients receiving convalescent plasma who stayed longer in the ICU, with a median LoS of nine (IQR = 4.5) days versus six (IQR = 7) days with significant difference (U = 400; p=0.004).
The median number of days of ICU admission was eight days after onset, and almost half of these patients presented in our ICU in life-threatening conditions requiring mechanical ventilation. The result of this study is likely due to the late administration of convalescent plasma. The mean number of days of convalescent plasma administration in our study was 11 days after onset. According to a multicenter study in the US, the 7-day and 30-day mortality rates of patients who received convalescent plasma at least four days after diagnosis were significantly higher than those who received it within three days after diagnosis.
Another thing that can affect the outcome is the patient’s disease’s high severity because Dr Soetomo Hospital is the highest referral hospital in East Java. As double-blind randomized control was not carried out, only patients with better prognoses were selected for the convalescent plasma treatment, given the limited stock of convalescent plasma at the time this study was taken. Variations in antibody titers contained in convalescent plasma in the study might also affect the effectiveness of convalescent plasma.
The study concluded that convalescent plasma showed no effect in reducing ICU mortality and in improving oxygen support requirements. However, this study showed that convalescent plasma significantly lengthened patients’ length of stay in the ICU, Therefore, the convalescent plasma therapy to patients with severe and life-threatening COVID-19 should factor the cost effectiveness.
Author: Bambang Pujo Semedi, dr., SpAn., KIC
Details of the research can be viewed here:
https://www.hindawi.com/journals/ccrp/2022/1594342/
Semedi BP, Ramadhania NN, Tambunan BA, Bintoro SUY, Soedarsono S, Prakoeswa CRS. Prolonged ICU Stay in Severe and Critically-Ill COVID-19 Patients Who Received Convalescent Plasma Therapy. Crit Care Res Pract. 2022;2022.
