Use of Convalescent Plasma in COVID-19 Patients: Guayaquil, Ecuador Experience.

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Hubei province, China in December 2019; pneumonia caused by the SARS-CoV-2 is named coronavirus disease 2019 (COVID-19).¹ Several antiviral and anti-inflammatory therapies have been proposed such as hydroxychloroquine, remdesivir, interferon, IL-6 inhibitors, and convalescent plasma. Convalescent plasma has been used during outbreaks of Ebola, Middle East respiratory syndrome coronavirus, H5N1 avian influenza, and H1N1 influenza with mixed results. It has demonstrated reduce respiratory tract viral load, serum cytokine response, hospital stay, and mortality². There is no specific treatment for COVID-19, however, evidence shows the use of convalescent plasma transfusion could be beneficial in patients infected with SARS-CoV-2, especially at the early stage of the disease^3,4.

Objectives

The objective of this study was to describe the overall survival in patients treated with convalescent plasma transfusion versus the standard treatment at the time of the admission.

Materials and Methods

This study was performed in 3 hospitals from Guayaquil, Ecuador from April 1st until August 1st. We implemented a protocol using convalescent plasma in patients that had clinical features of severe COVID-19 infection. Convalescent plasma came from donors who had recovered from SARS-CoV-2 infection confirmed by a RT-PCR in the nasopharyngeal swab, being asymptomatic at least 15 days before the donation. We included in this cohort 78 patients who received 300mL of convalescent plasma, all patients were receiving standard treatment at the time of administration. We matched the experimental group with 65 controls selected randomly from the same day of admission.

Results

The median age was 58 and 62 years old in the case and control group, respectively. The median hospitalization stay was 15 days. The survival rate of patients who received convalescent plasma was higher than those who received standard treatment (64.1% vs 46.2%; p= 0.001). We analyzed mortality rate in patients who required mechanical ventilation at the time of plasma transfusion, the mortality rate was lower in CP transfused COVID-19 patients than the control group (53.8% vs 85.3%, p= 0.001). All patients who were not mechanical ventilation when administrated convalescent plasma transfusion have successfully recovered. None of the patients had no adverse reactions related to the transfusion.

Conclusions

The administration of convalescent plasma is an encouraging therapeutic option, in a developing country like ours, despite many adversities we are currently using this modality as an option in selected patients, specially in those that are in the early stages of the disease. In which many studies are demonstrating a higher benefit. Our results show the reduction of mortality rate in patients with SARS-CoV-2 infection treated with convalescent plasma, there are cofound factors that may underpower our study. But the adverse effect profile make these treatment a valid option in early stage severe life threading disease. we are encouraged by the initial reports to continue investigations of convalescent plasma and its benefits, while specific antiviral drugs or the vaccine against SARS-CoV-2 are being developed.