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Franchini M, Glingani C, Morandi M, Corghi G, Cerzosimo S, Beduzzi G, Storti A, Di Stasi V, Rastrelli G, Vignozzi L, Mengoli C, Garuti M, Beccaria M, Inglese F, Caruso B, Petilino RA, Amato M, Nicchio M, Pagani M, Bellani A, Castelli G, Casari S, De Donno G. Safety and Efficacy of Convalescent Plasma in Elderly COVID-19 Patients: The RESCUE Trial. Mayo Clin Proc Innov Qual Outcomes 2021; 5:403-412. [PMID: 33585799 PMCID: PMC7869678 DOI: 10.1016/j.mayocpiqo.2021.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the safety and efficacy of convalescent plasma (CP) transfusion in elderly people with moderate to severe coronavirus disease 2019 (COVID-19) living in a long-term care facility (LTCF). Patients and Methods Twenty-two consecutive elderly patients with COVID-19 infection living in an LTCF in Lombardy, Italy, who were given CP during May 15 to July 31, 2020, were enrolled in a prospective cohort study. Their clinical, instrumental, and laboratory parameters were assessed following the CP treatment. The overall mortality rate in this group was compared with that recorded in other LTCFs in Lombardy during the 3-month period from March to May 2020. Results Of the 22 patients enrolled, 68.2% (n=15) received 1 CP unit, 27.3% (n=6) received 2 units, and 4.5% (n=1) received 3 units. Of the CP units transfused, 76.7% (23/30) had a neutralizing antibody titer of 1:160 or greater. No adverse reactions were recorded during or after CP administration. Improvements in clinical, functional, radiologic, and laboratory parameters during the 14 days after CP transfusion were observed in all 19 patients who survived. Viral clearance was achieved in all patients by the end of follow-up (median, 66 days; interquartile range, 48-80 days). The overall mortality rate was 13.6% (3/22), which compared favorably with that in the control group (38.3% [281/733]; P=.02) and corresponded to a 65% reduction in mortality risk. Conclusion Early administration of CP with an adequate anti-severe acute respiratory syndrome coronavirus 2 antibody titer to elderly symptomatic patients with COVID-19 infection in an LTCF was safe and effective in eliminating the virus, restoring patients' immunity, and blocking the progression of COVID-19 infection, thereby improving patients' survival. Trial Registration ClinicalTrials.gov: NCT04569188.
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Key Words
- COVID-19, coronavirus disease 2019
- CP, convalescent plasma
- CRP, C-reactive protein
- Fio2, fraction of inspired oxygen
- IL-6, interleukin 6
- IQR, interquartile range
- ISS, Italian National Institute of Health
- LTCF, long-term care facility
- NNT, number needed to treat
- NS, not significant
- PCR, polymerase chain reaction
- RESCUE, Real-time Evaluation of Safety and Efficacy of Convalescent Plasma Units Transfused to Elderly Patients With COVID-19
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Mario Morandi
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | | | - Sara Cerzosimo
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Gloria Beduzzi
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Andrea Storti
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Vincenza Di Stasi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Giulia Rastrelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Linda Vignozzi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Carlo Mengoli
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | | | | | | | | | | | - Massimo Amato
- Emergency Department, Carlo Poma Hospital, Mantova, Italy
| | | | - Mauro Pagani
- Department of Medicine, Ospedale Destra Secchia, Carlo Poma Hospital, Mantova, Italy
| | - Angela Bellani
- Department of Frailty, Carlo Poma Hospital, Mantova, Italy
| | - Gianpaolo Castelli
- Department of Anesthesiology and Intensive Care, Carlo Poma Hospital, Mantova, Italy
| | - Salvatore Casari
- Unit of Infectious Diseases, Carlo Poma Hospital, Mantova, Italy
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Rodriguez-Nava G, Yanez-Bello MA, Trelles-Garcia DP, Chung CW, Chaudry S, Khan AS, Friedman HJ, Hines DW. Clinical Characteristics and Risk Factors for Death of Hospitalized Patients With COVID-19 in a Community Hospital: A Retrospective Cohort Study. Mayo Clin Proc Innov Qual Outcomes 2020; 5:1-10. [PMID: 33173851 PMCID: PMC7643617 DOI: 10.1016/j.mayocpiqo.2020.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective To describe the clinical characteristics, outcomes, and risk factors for death of patients with coronavirus disease 2019 (COVID-19) in a community hospital setting. Patients and Methods This single-center retrospective cohort study included 313 adult patients with laboratory-confirmed COVID-19 admitted to a community hospital in Cook County, Illinois, from March 1, 2020, to May 25, 2020. Demographics, medical history, underlying comorbidities, symptoms, signs, laboratory findings, imaging studies, management, and progression to discharge or death data were collected and analyzed. Results Of 313 patients, the median age was 68 years (interquartile range, 59.0-78.5 years; range, 19-98 years), 182 (58.1%) were male, 119 (38%) were white, and 194 (62%) were admitted from a long-term care facility (LTCF). As of May 25, 2020, there were 212 (67.7%) survivors identified, whereas 101 (32.3%) nonsurvivors were identified. Multivariable Cox regression analysis showed increasing hazards of inpatient death associated with older age (hazard ratio [HR] 1.02; 95% CI, 1.01-1.04), LTCF residence (HR, 3.23; 95% CI, 1.68-6.20), and quick Sequential Organ Failure Assessment scores (HR, 2.59; 95% CI, 1.78-3.76). Conclusion In this single-center retrospective cohort study of 313 adult patients hospitalized with COVID-19 illness in a community hospital in Cook County, Illinois, older patients, LTCF residents, and patients with high quick Sequential Organ Failure Assessment scores were found to have worse clinical outcomes and increased risk of death.
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Affiliation(s)
- Guillermo Rodriguez-Nava
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, IL
- Correspondence: Address to Guillermo Rodriguez-Nava, MD, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL 60202. @G_ROD_11
| | | | | | - Chul Won Chung
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, IL
| | - Sana Chaudry
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, IL
| | - Aimen S. Khan
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, IL
| | - Harvey J. Friedman
- Co-Director, Critical Care Units, AMITA Health Saint Francis Hospital, Evanston, IL
- Clinical Associate Professor of Medicine, University of Illinois College of Medicine, Chicago
| | - David W. Hines
- Department of Infectious Diseases and Infection Control, AMITA Health Saint Francis Hospital, Evanston, IL
- Metro Infectious Disease Consultants, LLC, Burr Ridge, IL
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