Öz

Amaç:

Bu çalışmada yoğun bakım ünitesinde (YBÜ) kritik koronavirüs hastalığı-2019 (COVİD- 19) hastalarında standart tedaviye eklenen konvelesan plazma (CP) uygulamasının mortaliteye olan etkisi araştırıldı.

Gereç ve Yöntem:

Retrospektif kohort şeklinde planlanan bu çalışma 1 Nisan 2020-1 Kasım 2020 tarihleri arasında Marmara Üniversitesi Tıp Fakültesi Hastanesi, Pandemi YBÜ’de, 255 kritik COVİD- 19 hastasının verileri değerlendirilerek gerçekleştirildi.

Bulgular:

Hastalar standart tedavi alan hastalar (153; %60,0) ve CP alan hastalar (102; %40,0) olarak 2 gruba ayrıldılar. YBÜ mortalite oranı CP alan hastalarda (38; %37,3), almayanlara göre (79; %51,6) daha düşük bulundu (p<0,05). Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi-II (APACHE-II) skoru ≤10 olan [olasılık oranı (OR): 0,251; güven aralığı (CI) %95: 0,063-0,994, p=0,049)] ve APACHE-II skoru 11-14 olan (OR): 0,237; %95: 0,066-0,844, p=0,026 hastalarda CP tedavisinin YBÜ mortalite olasılığını düşürdüğü belirlendi. APACHE-II skoru 15 ve üzerinde olan hastalarda CP transfüzyonunun mortaliteyi düşürmediği saptandı. Ayrıca CP transfüzyonundaki her bir günlük gecikmenin mortalite olasılığını 1,3 kat arttırdığı (OR: 1,369; CI %95: 1,155-1,622, p<0,001) belirlendi.

Sonuç:

YBÜ’de takip edilen COVİD-19 hastalarında standart tedaviye ek olarak CP kullanımı mortaliteyi düşürmektedir.

Anahtar Kelimeler: Konvelesan plazma, COVİD-19, SARS-CoV-2, yoğun bakım ünitesi, mortalite

Referanslar

  1. World Health Organization (2019). WHO Rolling updates on coronavirus disease (COVID-19) [online].Website https://www.who.int/emergencies/diseases/novel-coronavirus-2019 [accessed 01 August 2022].
  2. Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, et al. COVID-19: towards controlling of a pandemic. Lancet 2020;395:1015-8.
  3. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA 2020;324:782-93.
  4. Ravula U, Chunchu SR, Gente VK. Whole blood derived covid convalescent plasma: An economical option among developing countries. Transfus Apher Sci 2021;60:103045.
  5. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020;323:2052-9.
  6. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:343-6.
  7. Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet 2020;396:1071-8.
  8. Libster R, Pérez Marc G, Wappner D, Coviello S, Bianchi A, Braem V, et al. Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults. N Engl J Med 2021;384:610-8.
  9. Agarwal A, Mukherjee A, Kumar G, Chatterjee P, Bhatnagar T, Malhotra P, et al. Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial). BMJ 2020;371:m3939.
  10. Simonovich VA, Burgos Pratx LD, Scibona P, Beruto MV, Vallone MG, Vázquez C, et al. A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia. N Engl J Med 2021;384:619-29.
  11. Salazar E, Christensen PA, Graviss EA, Nguyen DT, Castillo B, Chen J, et al. Treatment of Coronavirus Disease 2019 Patients with Convalescent Plasma Reveals a Signal of Significantly Decreased Mortality. Am J Pathol 2020;190:2290-303.
  12. Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang J, et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. JAMA 2020;324:460-70.
  13. Cunningham AC, Goh HP, Koh D. Treatment of COVID-19: old tricks for new challenges. Crit Care 2020;24:91.
  14. Arabi YM, Hajeer AH, Luke T, Raviprakash K, Balkhy H, Johani S, et al. Feasibility of Using Convalescent Plasma Immunotherapy for MERS-CoV Infection, Saudi Arabia. Emerg Infect Dis 2016;22:1554-61.
  15. Wong SS, Yuen KY. The management of coronavirus infections with particular reference to SARS. J Antimicrob Chemother 2008;62:437-41.
  16. Joyner MJ, Bruno KA, Klassen SA, Kunze KL, Johnson PW, Lesser ER, et al. Safety Update: COVID-19 Convalescent Plasma in 20,000 Hospitalized Patients. Mayo Clin Proc 2020;95:1888-97.
  17. Duan K, Liu B, Li C, Zhang H, Yu T, Qu J, et al. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. Proc Natl Acad Sci U S A 2020;117:9490-6.
  18. Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA 2020;323:1582-9.
  19. Recommendations for Investigational COVID-19 Convalescent Plasma. US FDA (2020). [online]. Website https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma [accessed 26 May 2020].
  20. Lu CC, Chen MY, Lee WS, Chang YL. Potential therapeutic agents against COVID-19: What we know so far. J Chin Med Assoc 2020;83:534-6.
  21. Republic of Turkey Ministry of Health, Directorate General of Public Health COVID-19 (SARS-CoV-2 infection) Guide (2020): COVID-19 adult patient management and treatment [online]. Website https://covid19.saglik.gov.tr/TR-66301/covid-19-rehberi.html [accessed 06 September 2021].
  22. Republic of Turkey Ministry of Health, General Directorate of Health Services, Department of Blood and Blood Products, COVID-19 Immune (Convalesan) Plasma Supply And Clinical Use Guide [online]. Website https://shgmkanhizmetleridb.saglik.gov.tr/Eklenti/39167/0/covid-19-immun-plazma-rehberi-v5.pdf [accessed 06 September 2021].
  23. Wang C, Li W, Drabek D, Okba NMA, van Haperen R, Osterhaus ADME, et al. A human monoclonal antibody blocking SARS-CoV-2 infection. Nat Commun 2020;11:2251.
  24. Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. Lancet Infect Dis 2020;20:398-400.
  25. Recommendations for Investigational COVID-19 Convalescent Plasma [Internet]. US-FDA. 2020. [cited 2020 Sep 3]. Available from: https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma.
  26. Devarasetti PK, Rajasekhar L, Baisya R, Sreejitha KS, Vardhan YK. A review of COVID-19 convalescent plasma use in COVID-19 with focus on proof of efficacy. Immunol Res 2021;69:18-25.
  27. Klassen SA, Senefeld JW, Johnson PW, Carter RE, Wiggins CC, Shoham S, et al. Evidence favoring the efficacy of convalescent plasma for COVID-19 therapy. medRxiv 2020
  28. Piechotta V, Chai KL, Valk SJ, Doree C, Monsef I, Wood EM, et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev 2020;7:CD013600.
  29. Wang Y, Huo P, Dai R, Lv X, Yuan S, Zhang Y, et al. Convalescent plasma may be a possible treatment for COVID-19: A systematic review. Int Immunopharmacol 2021;91:107262.
  30. Casadevall A, Dadachova E, Pirofski LA. Passive antibody therapy for infectious diseases. Nat Rev Microbiol 2004;2:695-703.
  31. Wenjing L, Yuanzheng F, Li JY, Tang LV, Yu H. Safety and efficacy of convalescent plasma therapy in severely and critically ill patients with COVID-19: a systematic review with meta-analysis. Aging (Albany NY) 2020;13:1498-509.
  32. Joyner MJ, Senefeld JW, Klassen SA, Mills JR, Johnson PW, Theel ES, et al. Effect of Convalescent Plasma on Mortality among Hospitalized Patients with COVID-19: Initial three-month experience. medRxiv 2020: 2020.08.12.20169359.
  33. Wang L, Lv Q, Zhang X, Jiang B, Liu E, Xiao C, et al. The utility of MEWS for predicting the mortality in the elderly adults with COVID-19: a retrospective cohort study with comparison to other predictive clinical scores. PeerJ 2020;8:e10018.
  34. Bastard P, Rosen LB, Zhang Q, Michailidis E, Hoffmann HH, Zhang Y, et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science 2020;370:eabd4585.

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Nasıl atıf yapılır?

1.
Sabaz MS, Gül F, Bilgili B, Kaplan ST, Doruk Oktay B, Cinel İ. Yoğun Bakım Ünitesinde Konvelesan Plazma İnfüzyonunun COVİD-19 Hastalarının Mortalitesi Üzerinde Etkisi: Retrospektif Bir Kohort Çalışması. Turk J Intensive Care. 2022;20:135-146. https://doi.org/10.4274/tybd.galenos.2022.63634