COVID-19危重症患者恢复期血浆治疗的有效性:来自孟加拉国一家专用ICU的早期经验

Journal of the Bangladesh Society of Anaesthesiologists Pub Date : 2021-01-31 DOI:10.3329/jbsa.v34i1.67568

S. A. Al Momen, A. Akhter, Md. Harun Ur Rashid, R. Sultana, Md Zahedul Islam

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引用次数: 0

摘要

在没有针对SARS-CoV-2病毒的特异性治疗的情况下，重症监护病房对COVID-19重症患者的管理包括支持护理、重新使用药物和恢复人类恢复期血浆治疗(CPT)等老策略。CPT似乎是被动抗体转移的一种有吸引力的治疗选择，但疗效仍存在争议。目的:探讨恢复期血浆治疗对达卡库尔米托拉综合医院重症监护室收治的covid -19危重症患者的治疗效果。研究方法:将2020年5月1日至9月30日在达卡Kurmitola综合医院ICU收治的所有患者纳入本回顾性观察性队列研究。本方案经医院伦理与科学委员会批准。收集所有参与者的临床和治疗资料;在ICU住院期间接受血浆治疗和未接受血浆治疗的患者之间观察CPT与死亡率的相关性。采用基于Windows的统计软件包SPSS version 25进行统计分析。结果:在规定时间内，库米托拉综合医院ICU共收治新冠肺炎危重患者228例。其中男性160例(70%)，女性68例(30%)。平均年龄57.97岁(95% CI 56.23 ~ 59.70)。主要合并症为阻塞性气道疾病160例(70.17%)，高血压117例(51.31%)，糖尿病103例(45.17%)。只有53例(23.25%)患者在ICU期间接受了dcpt。生存组从症状出现之日起接受CPT治疗的中位天数为12 (IQR 10-14)天，非生存组为18 (IQR 16-19)天(p<0.0001)。CPT组全因死亡率为29例(54.7%)，非CPT组为115例(65.7%)(p=0.146)。CPT组的生存优势比为0.757 (95% CI 0.528 ~ 1.085)。结论:本回顾性横断面研究提示，在ICU收治的危重型COVID-19患者中使用恢复期血浆的疗效与死亡率获益存在矛盾。JBSA 2021;34 (1): 26-31

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Effectiveness of Convalescent Plasma Therapy in Critically Ill COVID-19 Patients: Early Experience from a Dedicated ICU of Bangladesh

Introduction: The management of severe or critical COVID-19 patients in the ICU includes supportivecare as well as repurposed drugs and revival of old strategies like human convalescent plasma therapy(CPT) in the absence of specific therapy against SARS-CoV-2 virus. CPT appears to be an attractivetreatment option as passive antibody transfer, but efficacy remains controversial. Objectives: To determine the effectiveness of convalescent plasma therapy in management of criticallyillCOVID-19 patients admitted at the dedicated intensive care unit of Kurmitola General Hospital, Dhaka. Study Method: All patients admitted in the ICU of Kurmitola General Hospital, Dhaka from 1st May to30th September 2020 were included in this retrospective observational cohort study. The protocolwasapproved by the Ethical and Scientific Committee of the hospital. The clinical and treatment data ofall participants were collected; and the association of CPT and mortality benefit was observed betweenthe patients who received plasma therapy during ICU stay and who didn’t. The statistical analysis wasperformed using the Windows based statistical software package SPSS version 25. Results: A total of 228 critically illCOVID-19 patients were admitted to the ICU of Kurmitola GeneralHospital in the specified time period. Among them, 160 (70%) were male and 68 (30%) females. Mean agewas 57.97 (95% CI 56.23-59.70) years. Important co-morbidities were obstructive airway diseases 160(70.17%), hypertension 117 (51.31%) and diabetes mellitus 103 (45.17%). Only 53 (23.25%) patients receivedCPT during ICU stay. The median day of receiving CPT from the day of symptom onset was 12 (IQR 10-14) days in the survivor group and 18 (IQR 16-19) days in the non-survivor group (p<0.0001). All-causeICU mortality was 29 (54.7%) in CPT group vs. 115 (65.7%) in Non-CPT group (p=0.146). The odds ratioof survival in CPT group was 0.757 (95% CI 0.528-1.085). Conclusion: This retrospective cross-sectional study suggested that the efficacy of use of convalescentplasma in critical or severe COVID-19 patients admitted to ICU is conflicting for mortality benefit. JBSA 2021; 34(1): 26-31

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Journal of the Bangladesh Society of Anaesthesiologists

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