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Convalescent Plasma Antibody Levels and the Risk of Death from Covid-19 #MMPMID33523609
Joyner MJ; Carter RE; Senefeld JW; Klassen SA; Mills JR; Johnson PW; Theel ES; Wiggins CC; Bruno KA; Klompas AM; Lesser ER; Kunze KL; Sexton MA; Diaz Soto JC; Baker SE; Shepherd JRA; van Helmond N; Verdun NC; Marks P; van Buskirk CM; Winters JL; Stubbs JR; Rea RF; Hodge DO; Herasevich V; Whelan ER; Clayburn AJ; Larson KF; Ripoll JG; Andersen KJ; Buras MR; Vogt MNP; Dennis JJ; Regimbal RJ; Bauer PR; Blair JE; Paneth NS; Fairweather D; Wright RS; Casadevall A
N Engl J Med 2021[Mar]; 384 (11): 1015-1027 PMID33523609show ga
BACKGROUND: Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. METHODS: In a retrospective study based on a U.S. national registry, we determined the anti-SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti-SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. RESULTS: Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti-SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). CONCLUSIONS: Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti-SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT04338360.).
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N+Engl+J+Med 2021 ; 384 (11): 1015-1027
