Kocaeli Med J. 2022; 11(3): 79-91 | DOI: 10.5505/ktd.2022.34735

Is Convalescent Plasma Just a Theoretical Therapeutic Option for Critically Ill Patients with COVID 19: A Retrospective Cohort Study

Kemal Tolga Saraçoðlu¹, Fulya Çiyiltepe¹, Elif Bombacý¹, Yeliz Bilir¹, Ayten Saraçoðlu², Recep Demirhan^3
1Clinic of Anesthesiology and Intensive Care, Health Sciences University Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
²Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
³Clinic of Thoracic Surgery, Health Sciences University Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey

INTRODUCTION: The intensivists seek solutions for critically ill COVID-19 patients. Thus far, there is no specific treatment for SARS-CoV-2 infection because of the absence of evidence. The aim of this study is to describe our first clinical experience with convalescent plasma transfusion in severe COVID-19 patients.
METHODS: The study was conducted from 22 March to 1 June 2020. Adult patients diagnosed with COVID-19 using a polymerase chain reaction and thorax Computerized Tomography were included. The COVID-19 patients were treated in designated Intensive Care Units of our university hospital. The data of critically ill patients who met the plasma transfusion criteria were analyzed. Clinical outcomes were compared before and after treatment for both dead and alive patients.
RESULTS: During the outbreak 401 COVID-19 patients were admitted to the intensive care unit. Convalescent plasma treatment was given to 24 patients. Twenty one patients ended up with death and 3 patients were alive. The duration of ICU stay was 19.10±8.10 days in dead patients, while alive patients stayed 7.67±1.53 days (p=0.026). There was no significant change in mechanical ventilator parameters, SOFA scores and acute phase reactants before and after treatment. There was a significant relationship between the delay of plasma treatment and the time of the death (p=0.006).
DISCUSSION AND CONCLUSION: A positive effect of convalescent plasma treatment on the survival rate, mechanical ventilator parameters, SOFA or acute phase reactants was not revealed. Reporting objective opinion on this subject without randomized controlled studies carries the risk of giving patients false hope for success

Keywords: COVID-19, convalescent plasma, intensive care unit

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Konvelesan Plazma, COVID 19'lu Kritik Hastalar için Sadece Teorik bir Terapötik Seçenek midir: Retrospektif bir Kohort Çalýþmasý

Kemal Tolga Saraçoðlu¹, Fulya Çiyiltepe¹, Elif Bombacý¹, Yeliz Bilir¹, Ayten Saraçoðlu², Recep Demirhan^3
1Saðlýk Bilimleri Üniversitesi Kartal Dr. Lütfi Kýrdar Þehir Hastanesi, Anesteziyoloji ve Yoðun Bakým Kliniði, Ýstanbul, Türkiye
²Marmara Üniversitesi Pendik Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Yoðun Bakým Anabilim Dalý, Ýstanbul, Türkiye
³Saðlýk Bilimleri Üniversitesi Kartal Dr. Lütfi Kýrdar Þehir Hastanesi, Göðüs Cerrahisi Kliniði, Ýstanbul, Türkiye

GÝRÝÞ ve AMAÇ: Yoðun bakým uzmanlarý, kritik durumdaki COVID-19 hastalarý için çözümler arar. Þimdiye kadar, kanýt bulunmadýðýndan SARS-CoV-2 enfeksiyonu için spesifik bir tedavi yoktur. Bu çalýþmanýn amacý, þiddetli COVID-19 hastalarýnda konvelesan plazma transfüzyonu ile ilk klinik deneyimimizi tanýmlamaktýr.
YÖNTEM ve GEREÇLER: Çalýþma 22 Mart - 1 Haziran 2020 tarihleri arasýnda gerçekleþtirildi. Polimeraz zincir reaksiyonu ve Toraks Bilgisayarlý Tomografi kullanýlarak COVID-19 tanýsý konan yetiþkin hastalar dahil edildi. COVID-19 hastalarý üniversite hastanemizin belirlenmiþ Yoðun Bakým Ünitelerinde tedavi altýna alýndý. Plazma transfüzyon kriterlerini karþýlayan kritik hastalarýn verileri analiz edildi. Klinik sonuçlar, hem ölü hem de canlý hastalar için tedavi öncesi ve sonrasý karþýlaþtýrýldý.
BULGULAR: Salgýn sýrasýnda 401 COVID-19 hastasý yoðun bakým ünitesine alýndý. 24 hastaya konvelesan plazma tedavisi verildi. Yirmi bir hasta ölümle sonuçlandý ve 3 hasta hayattaydý. Yoðun bakýmda kalýþ süresi ölü hastalarda 19,10±8,10 gün, yaþayan hastalarda 7,67±1,53 gün idi (p=0,026). Tedavi öncesi ve sonrasý mekanik ventilatör parametrelerinde, SOFA skorlarýnda ve akut faz reaktanlarýnda anlamlý bir deðiþiklik olmadý. Plazma tedavisinin gecikmesi ile ölüm zamaný arasýnda anlamlý bir iliþki vardý (p=0,006).
TARTIÞMA ve SONUÇ: Konvelesan plazma tedavisinin saðkalým oraný, mekanik ventilatör parametreleri, SOFA veya akut faz reaktanlarý üzerinde olumlu bir etkisi ortaya çýkmadý. Randomize kontrollü çalýþmalar olmadan bu konuda objektif görüþ bildirmek, hastalara baþarý için yanlýþ umut verme riskini taþýr.

Anahtar Kelimeler: COVID-19, konvelesan plazma, yoðun bakým ünitesi

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