Article (Scientific journals)
Convalescent Plasma for Covid-19–Induced ARDS in Mechanically Ventilated Patients
Misset, Benoît; Piagnerelli, Michael; Hoste, Eric et al.
2023In New England Journal of Medicine, 389 (17), p. 1590-1600
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Keywords :
General Medicine
Abstract :
[en] BACKGROUND Passive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (Covid-19). Minimal data are avail- able regarding the use of convalescent plasma in patients with Covid-19–induced acute respiratory distress syndrome (ARDS). METHODS In this open-label trial, we randomly assigned adult patients with Covid-19–induced ARDS who had been receiving invasive mechanical ventilation for less than 5 days in a 1:1 ratio to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone. Randomization was stratified according to the time from tracheal intubation to inclusion. The primary outcome was death by day 28. RESULTS A total of 475 patients underwent randomization from September 2020 through March 2022. Overall, 237 patients were assigned to receive convalescent plasma and 238 to receive standard care. Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group. Glucocorticoids were administered to 466 patients (98.1%). At day 28, mortality was 35.4% in the convalescent-plasma group and 45.0% in the standard-care group (P = 0.03). In a prespecified analysis, this effect was observed mainly in patients who underwent randomization 48 hours or less after the initiation of invasive mechanical ventilation. Serious adverse events did not differ substantially between the two groups. CONCLUSIONS The administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with Covid-19–induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28. This effect was mainly observed in patients who underwent randomization 48 hours or less after ventilation initiation. (Funded by the Belgian Health Care Knowl- edge Center; ClinicalTrials.gov number, NCT04558476.)
Disciplines :
Anesthesia & intensive care
Author, co-author :
Misset, Benoît  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Piagnerelli, Michael;  CHU-Charleroi Marie-Curie Hospital > Department of Intensive Care Medicine
Hoste, Eric;  Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Gent, Belgium
Dardenne, Nadia  ;  Université de Liège - ULiège > Département des sciences de la santé publique
Grimaldi, David;  Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles - Erasme, Université Libre de Bruxelles, Brussels, Belgium
Michaux, Isabelle;  Department of Intensive Care, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
De Waele, Elisabeth;  Department of Intensive Care Medicine, Vrije Universiteit Brussel Brussels University Hospital, Jette, Belgium
Dumoulin, Alexander;  Department of Intensive Care Medicine, Delta General Hospital, Roeselare, Belgium
Jorens, Philippe G. ;  Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
van der Hauwaert, Emmanuel;  Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden, Belgium
Vallot, Frédéric;  Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai, Belgium
Lamote, Stoffel;  Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk, Belgium
Swinnen, Walter;  Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde, Belgium
De Schryver, Nicolas;  Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies, Belgium
Fraipont, Vincent;  Department of Intensive Care Medicine, Citadelle General Hospital, Liege, Belgium
de Mey, Nathalie;  Department of Intensive Care Medicine, OLV General Hospital, Aalst, Belgium
Dauby, Nicolas;  Division of Infectious Diseases, Saint Pierre University Hospital, Brussels, Belgium
Layios, Nathalie  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Mesland, Jean-Baptiste;  Department of Intensive Care Medicine, Saint-Luc University Hospital, Brussels, Belgium
Meyfroidt, Geert ;  Department of Intensive Care Medicine, University Hospitals Leuven, Belgium
Moutschen, Michel  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des maladies infectieuses - médecine interne
Compernolle, Veerle;  Blood Services from the Red Cross, Mechelen, Belgium, and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Gothot, André ;  Centre Hospitalier Universitaire de Liège - CHU > > Service d'hématologie biologique et immuno-hématologie
Desmecht, Daniel ;  Université de Liège - ULiège > Département de morphologie et pathologie (DMP) > Pathologie spéciale et autopsies
Pereira, Isabel ;  Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Bactériologie, mycologie, parasitologie, virologie et microbiologie
Garigliany, Mutien-Marie  ;  Université de Liège - ULiège > Département de morphologie et pathologie (DMP) > Pathologie générale et autopsies
Najdovski, Tomé ;  Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biologie de la coagulation et de l'hémostase ; Blood Services from the Red Cross, Suarlée, Belgium
BERTRAND, Axelle ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Donneau, Anne-Françoise ;  Université de Liège - ULiège > Département des sciences de la santé publique
Laterre, Pierre-François;  Department of Intensive Care Medicine, Saint-Luc University Hospital, Brussels, Belgium
More authors (20 more) Less
Language :
English
Title :
Convalescent Plasma for Covid-19–Induced ARDS in Mechanically Ventilated Patients
Publication date :
26 October 2023
Journal title :
New England Journal of Medicine
ISSN :
0028-4793
eISSN :
1533-4406
Publisher :
Massachusetts Medical Society
Volume :
389
Issue :
17
Pages :
1590-1600
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
KCE - Belgian Health Care Knowledge Centre [BE]
Available on ORBi :
since 29 October 2023

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