Convalescent plasma therapy and mortality in COVID-19 patients admitted to the ICU: a prospective observational study

Hatzl, Stefan; Posch, Florian; Sareban, Nazanin; Stradner, Martin; Rosskopf, Konrad; Reisinger, Alexander C.; Eller, Philipp; Schörghuber, Michael; Toller, Wolfgang; Sloup, Zdenka; Prüller, Florian; Gütl, Katharina; Pilz, Stefan; Rosenkranz, Alexander R.; Greinix, Hildegard T.; Krause, Robert; Schlenke, Peter; Schilcher, Gernot

BACKGROUND: This study aimed to quantify the potential survival benefit of convalescent plasma therapy (CVP) in critically ill patients with acute respiratory failure related to coronavirus disease-2019 (COVID-19). METHODS: This is a single-center prospective observational cohort study in COVID-19 patients with acute respiratory failure. Immediately after intensive care unit (ICU) admission patients were allocated to CVP treatment following pre-specified criteria to rapidly identify those patients potentially susceptible for this treatment. A propensity score adjustment [inverse probability of treatment weighted (IPTW) analysis] was implemented to account rigorously for imbalances in prognostic variables between the treatment groups. RESULTS: We included 120 patients of whom 48 received CVP. Thirty percent were female with a median age of 66 years [25th–75th percentile 54–75]. Eighty-eight percent of patients presented with severe acute respiratory failure as displayed by a median paO(2)/FiO(2) ratio (Horowitz Index) of 92 [77–150]. All patients required any kind of ventilatory support with more than half of them (52%) receiving invasive ventilation. Thirty-day ICU overall survival (OS) was 69% in the CVP group and 54% in the non-CVP group (log-rank p = 0.049), respectively. After weighing the time-to-event data for the IPTW, the favorable association between CVP and OS became even stronger (log-rank p = 0.035). Moreover, an exploratory analysis showed an overall survival benefit of CVP therapy for patients with non-invasive ventilation (Hazard ratio 0.12 95% CI 0.03–0.57, p = 0.007) CONCLUSION: Administration of CVP in patients with acute respiratory failure related to COVID-19 is associated with improved ICU survival rates. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-021-00867-9.