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Pina T, Lewis M, Garrison C, Razatos A. Using Automation to Manage Donor Engagement and Fine-Tune Supply and Demand During the First Year of the COVID-19 Pandemic. Transfus Apher Sci 2022; 61:103420. [PMID: 35277354 PMCID: PMC8897834 DOI: 10.1016/j.transci.2022.103420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
Background Methods Results Conclusions
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Sivapalan P, Ulrik CS, Lapperre TS, Bojesen RD, Eklöf J, Browatzki A, Wilcke JT, Gottlieb V, Håkansson KEJ, Tidemandsen C, Tupper O, Meteran H, Bergsøe C, Brøndum E, Bødtger U, Bech Rasmussen D, Graff Jensen S, Pedersen L, Jordan A, Priemé H, Søborg C, Steffensen IE, Høgsberg D, Klausen TW, Frydland MS, Lange P, Sverrild A, Ghanizada M, Knop FK, Biering-Sørensen T, Lundgren JD, Jensen JUS. Azithromycin and hydroxychloroquine in hospitalised patients with confirmed COVID-19: a randomised double-blinded placebo-controlled trial. Eur Respir J 2022; 59:2100752. [PMID: 34083403 PMCID: PMC8186006 DOI: 10.1183/13993003.00752-2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Combining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodulatory effects, with the latter also having in vitro antiviral properties. This may improve outcomes in patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS Placebo-controlled double-blind randomised multicentre trial. Patients aged ≥18 years, admitted to hospital for ≤48 h (not intensive care) with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription PCR test were recruited. The intervention was 500 mg daily azithromycin for 3 days followed by 250 mg daily azithromycin for 12 days combined with 200 mg twice-daily hydroxychloroquine for all 15 days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14 days (DAOH14). RESULTS After randomisation of 117 patients, at the first planned interim analysis, the data and safety monitoring board recommended stopping enrolment due to futility, based on pre-specified criteria. Consequently, the trial was terminated on 1 February 2021. 61 patients received the combined intervention and 56 patients received placebo. In the intervention group, patients had a median (interquartile range) 9.0 (3-11) DAOH14 versus 9.0 (7-10) DAOH14 in the placebo group (p=0.90). The primary safety outcome, death from all causes on day 30, occurred for one patient in the intervention group versus two patients receiving placebo (p=0.52), and readmittance or death within 30 days occurred for nine patients in the intervention group versus six patients receiving placebo (p=0.57). CONCLUSIONS The combination of azithromycin and hydroxychloroquine did not improve survival or length of hospitalisation in patients with COVID-19.
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Affiliation(s)
- Pradeesh Sivapalan
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Charlotte Suppli Ulrik
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | | | - Rasmus Dahlin Bojesen
- Dept of Surgery, Slagelse Hospital, Slagelse, Denmark
- Dept of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Josefin Eklöf
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Andrea Browatzki
- Dept of Respiratory and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Jon Torgny Wilcke
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Vibeke Gottlieb
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Kjell Erik Julius Håkansson
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Casper Tidemandsen
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Oliver Tupper
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Howraman Meteran
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Christina Bergsøe
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Eva Brøndum
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Uffe Bødtger
- Dept of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Sidse Graff Jensen
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Lars Pedersen
- Dept of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Alexander Jordan
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | - Helene Priemé
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
| | - Christian Søborg
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
| | - Ida E. Steffensen
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
| | - Dorthe Høgsberg
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
| | | | - Martin Steen Frydland
- Dept of Respiratory Medicine, Respiratory Research Unit, Hvidovre and Amager University Hospital, Hvidovre, Denmark
| | - Peter Lange
- Dept of Medicine, Section of Respiratory Medicine, Herlev Hospital, Herlev, Denmark
- Institute of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Asger Sverrild
- Dept of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Muhzda Ghanizada
- Dept of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Filip K. Knop
- Center for Clinical Metabolic Research, Gentofte University Hospital, Hellerup, Denmark
- Dept of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens D. Lundgren
- Dept of Infectious Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Dept of Internal Medicine, Pulmonary Medicine Section, Gentofte University Hospital, Hellerup, Denmark
- Dept of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sarkar S, Khanna P, Singh AK. Convalescent Plasma-A Light at the End of the Tunnel: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2021; 25:1292-1300. [PMID: 34866829 PMCID: PMC8608648 DOI: 10.5005/jp-journals-10071-24023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In the absence of a definitive therapy during this ongoing unprecedented crisis, coronavirus disease-2019 (COVID-19) pandemic, convalescent plasma transfusion (CPT) has shown some promising results. This review summarizes the existing evidence of the efficacy of CPT in COVID-19 patients based upon scientific publications to date. We have included only the randomized controlled trials (RCTs) through an extensive screening of electronic databases up to July 31, 2021. In 19 RCTs, with a total of 16,476 COVID-19 patients we found low-quality evidence of significant reduction in mortality (odds ratio (OR) = 0.80; 95% confidence interval (CI): 0.66-0.96, I2 = 40%), better clinical outcome when applied <7 days (OR = 2.13, 95% CI 1.28-3.53, I2 = 0%), and improved viral clearance (OR = 2.6, 95% CI: 1.3-5.45, I2 = 74%). Meta-regression analysis found that as a covariate, intubation on admission (p = 0.007) had a significant impact. However, there was any significant reduction neither in duration for clinical improvement (MD = -0.79, 95% CI: -2.76-1.18, I2 = 98%), nor in total period of hospital stay (MD = 0.02, 95% CI: -0.75-0.78, I2 = 81%). Early application of CPT is still relevant in reducing morbidity and mortality in critically ill patients and is too early to write it off as a potential therapeutic modality for COVID-19 patients. HOW TO CITE THIS ARTICLE Sarkar S, Khanna P, Singh AK. Convalescent -Plasma-A Light at the End of the Tunnel: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2021;25(11):1292-1300.
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Affiliation(s)
- Soumya Sarkar
- Department of Anesthesia, Pain Medicine and Critical Care, AIIMS, Delhi, India
| | - Puneet Khanna
- Department of Anesthesia, Pain Medicine and Critical Care, AIIMS, Delhi, India
| | - Akhil K Singh
- Department of Anesthesia, Pain Medicine and Critical Care, AIIMS, Delhi, India
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Arnold Egloff SA, Junglen A, Restivo JS, Wongskhaluang M, Martin C, Doshi P, Schlauch D, Fromell G, Sears LE, Correll M, Burris HA, LeMaistre CF. Convalescent plasma associates with reduced mortality and improved clinical trajectory in patients hospitalized with COVID-19. J Clin Invest 2021; 131:e151788. [PMID: 34464352 DOI: 10.1172/jci151788] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUNDEvidence supporting convalescent plasma (CP), one of the first investigational treatments for coronavirus disease 2019 (COVID-19), has been inconclusive, leading to conflicting recommendations. The primary objective was to perform a comparative effectiveness study of CP for all-cause, in-hospital mortality in patients with COVID-19.METHODSThe multicenter, electronic health records-based, retrospective study included 44,770 patients hospitalized with COVID-19 in one of 176 HCA Healthcare-affiliated community hospitals. Coarsened exact matching (1:k) was employed, resulting in a sample of 3774 CP and 10,687 comparison patients.RESULTSExamination of mortality using a shared frailty model, controlling for concomitant medications, date of admission, and days from admission to transfusion, demonstrated a significant association of CP with lower mortality risk relative to the comparison group (adjusted hazard ratio [aHR] = 0.71; 95% CI, 0.59-0.86; P < 0.001). Examination of patient risk trajectories, represented by 400 clinico-demographic features from our real-time risk model (RTRM), indicated that patients who received CP recovered more quickly. The stratification of days to transfusion revealed that CP within 3 days after admission, but not within 4 to 7 days, was associated with a significantly lower mortality risk (aHR = 0.53; 95% CI, 0.47-0.60; P < 0.001). CP serology level was inversely associated with mortality when controlling for its interaction with days to transfusion (HR = 0.998; 95% CI, 0.997-0.999; P = 0.013), yet it did not reach univariable significance.CONCLUSIONSThis large, diverse, multicenter cohort study demonstrated that CP, compared with matched controls, is significantly associated with reduced risk of in-hospital mortality. These observations highlight the utility of real-world evidence and suggest the need for further evaluation prior to abandoning CP as a viable therapy for COVID-19.FUNDINGThis research was supported in whole by HCA Healthcare and/or an HCA Healthcare-affiliated entity, including Sarah Cannon and Genospace.
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Affiliation(s)
- Shanna A Arnold Egloff
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA
| | - Angela Junglen
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA.,Genospace, Boston, Massachusetts, USA
| | - Joseph Sa Restivo
- HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA
| | | | - Casey Martin
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA.,Genospace, Boston, Massachusetts, USA
| | - Pratik Doshi
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA.,Genospace, Boston, Massachusetts, USA
| | - Daniel Schlauch
- Sarah Cannon, Nashville, Tennessee, USA.,Genospace, Boston, Massachusetts, USA
| | - Gregg Fromell
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA
| | - Lindsay E Sears
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA
| | - Mick Correll
- Sarah Cannon, Nashville, Tennessee, USA.,Genospace, Boston, Massachusetts, USA
| | - Howard A Burris
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA
| | - Charles F LeMaistre
- Sarah Cannon, Nashville, Tennessee, USA.,HCA Healthcare, HCA Research Institute (HRI), Nashville, Tennessee, USA
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Lamb CC, Haddad F, Owens C, Lopez-Yunez A, Carroll M, Moncrieffe J. Updated Clinical Evaluation of the CLUNGENE ® Rapid COVID-19 Antibody Test. Healthcare (Basel) 2021; 9:1124. [PMID: 34574897 PMCID: PMC8470863 DOI: 10.3390/healthcare9091124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 antibody testing has been shown to be predictive of prior COVID-19 infection and an effective testing tool. The CLUNGENE® SARS-COV-2 VIRUS (COVID-19) IgG/IgM Rapid Test Cassette was evaluated for its utility to aide healthcare professionals. METHOD Two studies were performed by using the CLUNGENE® Rapid Test. (1) An expanded Point-of-Care (POC) study at two clinical sites was conducted to evaluate 99 clinical subjects: 62 positive subjects and 37 negative subjects were compared to RT-PCR, PPA, and NPA (95% CI). Sensitivity was calculated from blood-collection time following symptom onset. (2) A cross-reactivity study was performed to determine the potential for false-positive results from other common infections. RESULTS The specificity of subjects with confirmed negative COVID-19 by RT-PCR was 100% (95% CI, 88.4-100.0%). The sensitivity of subjects with confirmed positive COVID-19 by RT-PCR was 96.77% (95% CI, 88.98-99.11%). In the cross-reactivity study, there were no false-positive results due to past infections or vaccinations unrelated to the SARS-CoV-2 virus. CONCLUSION There is a need for a rapid, user-friendly, and inexpensive on-site monitoring system for diagnosis. The CLUNGENE® Rapid Test is a useful diagnostic test that provides results within 15 min, without high-complexity laboratory instrumentation.
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Affiliation(s)
- Christopher C. Lamb
- Weatherhead School of Management, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA
- Silberman College of Business, Fairleigh Dickinson University, 1000 River Rd., Teaneck, NJ 07666, USA
- BioSolutions Services LLC, 92 Irving Avenue, Englewood Cliffs, NJ 07632, USA
| | - Fadi Haddad
- Fellow of the Infectious Disease Society of America (IDSA), 4040 Wilson Boulevard, Suite 300, Arlington, VA 22203, USA
- Fadi Haddad, MD, Inc., 8860 Center Dr. Suite 320, La Mesa, CA 91942, USA;
- Sharp Grossmont Hospital, 5555 Grossmont Center Dr., La Mesa, CA 91942, USA
| | - Christopher Owens
- Alivio Medical Center, Indianapolis, IN 46219, USA; (C.O.); (A.L.-Y.)
| | | | - Marion Carroll
- MedComp Sciences, LLC, 20503 MacHost Road, Zachary, LA 70791, USA; (M.C.); (J.M.)
| | - Jordan Moncrieffe
- MedComp Sciences, LLC, 20503 MacHost Road, Zachary, LA 70791, USA; (M.C.); (J.M.)
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