Massimo Franchini, Mario Cruciani, Carlo Mengoli, Arturo Casadevall, Claudia Glingani, Michael J Joyner, Liise-Anne Pirofski, Jonathon W Senefeld, Shmuel Shoham, David J Sullivan, Matteo Zani, Daniele Focosi
{"title":"住院 COVID-19 患者的康复血浆和死亡率预测因素：系统回顾和荟萃分析。","authors":"Massimo Franchini, Mario Cruciani, Carlo Mengoli, Arturo Casadevall, Claudia Glingani, Michael J Joyner, Liise-Anne Pirofski, Jonathon W Senefeld, Shmuel Shoham, David J Sullivan, Matteo Zani, Daniele Focosi","doi":"10.1016/j.cmi.2024.07.020","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients.</p><p><strong>Objectives: </strong>To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect.</p><p><strong>Data sources: </strong>Electronic databases were searched for studies published from January 2020 to January 2024.</p><p><strong>Study eligibility criteria: </strong>Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19.</p><p><strong>Participants: </strong>Hospitalized patients with COVID-19.</p><p><strong>Interventions: </strong>CCP versus no CCP.</p><p><strong>Assessment of risk of bias: </strong>Cochrane risk of bias tool for RCTs.</p><p><strong>Methods of data synthesis: </strong>The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence.</p><p><strong>Results: </strong>Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61-0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90-1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity.</p><p><strong>Conclusions: </strong>In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1514-1522"},"PeriodicalIF":10.9000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Convalescent plasma and predictors of mortality among hospitalized patients with COVID-19: a systematic review and meta-analysis.\",\"authors\":\"Massimo Franchini, Mario Cruciani, Carlo Mengoli, Arturo Casadevall, Claudia Glingani, Michael J Joyner, Liise-Anne Pirofski, Jonathon W Senefeld, Shmuel Shoham, David J Sullivan, Matteo Zani, Daniele Focosi\",\"doi\":\"10.1016/j.cmi.2024.07.020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients.</p><p><strong>Objectives: </strong>To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect.</p><p><strong>Data sources: </strong>Electronic databases were searched for studies published from January 2020 to January 2024.</p><p><strong>Study eligibility criteria: </strong>Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19.</p><p><strong>Participants: </strong>Hospitalized patients with COVID-19.</p><p><strong>Interventions: </strong>CCP versus no CCP.</p><p><strong>Assessment of risk of bias: </strong>Cochrane risk of bias tool for RCTs.</p><p><strong>Methods of data synthesis: </strong>The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence.</p><p><strong>Results: </strong>Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61-0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90-1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity.</p><p><strong>Conclusions: </strong>In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.</p>\",\"PeriodicalId\":10444,\"journal\":{\"name\":\"Clinical Microbiology and Infection\",\"volume\":\" \",\"pages\":\"1514-1522\"},\"PeriodicalIF\":10.9000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Microbiology and Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cmi.2024.07.020\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cmi.2024.07.020","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Convalescent plasma and predictors of mortality among hospitalized patients with COVID-19: a systematic review and meta-analysis.
Background: Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients.
Objectives: To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect.
Data sources: Electronic databases were searched for studies published from January 2020 to January 2024.
Study eligibility criteria: Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19.
Participants: Hospitalized patients with COVID-19.
Interventions: CCP versus no CCP.
Assessment of risk of bias: Cochrane risk of bias tool for RCTs.
Methods of data synthesis: The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence.
Results: Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61-0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90-1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity.
Conclusions: In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.
期刊介绍：
Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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