To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19.On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization.Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio [OR], 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82).During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course. 

Rates Among Hospitalized Patients With COVID-19 Treated With Convalescent Plasma: A Systematic Review and Meta-Analysis

Abstract IMPORTANCE. Many hospitalized patients with COVID-19 have been treated with convalescent plasma. However, it is uncertain whether this therapy lowers mortality and if so, if the mortality benefit is larger among specific subgroups, such as recipients of plasma with high antibody content and patients treated early in the disease course. OBJECTIVE. To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19. DATA SOURCES. On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature. STUDY SELECTION. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3,841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of five reviewers. DATA EXTRACTION AND SYNTHESIS. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using inverse-variance random-effects model. MAIN OUTCOMES AND MEASURES. Prespecified end point was all-cause mortality during hospitalization. RESULTS. Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses demonstrated that transfusion of COVID-19 convalescent plasma was associated with a significant decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio (OR), 0.87 [95% CI, 0.76-1.00]) and matched cohort studies (OR, 0.77 [95% CI, 0.64-0.94]). Meta-analysis of subgroups revealed two important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared to convalescent plasma containing low antibody levels (OR, 0.85 [95% CI, 0.73 to 0.99]). Second, earlier treatment with COVID-19 convalescent plasma was associated with a significant decrease in mortality compared with the later treatment cohort (OR, 0.63 [95% CI, 0.48 to 0.82]). CONCLUSIONS AND RELEVANCE. COVID-19 convalescent plasma use was associated with a 13% reduced risk in mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.

/pdf/mortality-rates-among-hospitalized-patients-with-covid-19-3rqj6z66.pdf

Mortality rates among hospitalized patients with COVID-19 treated with convalescent plasma: A Systematic review and meta-analysis


 
 Maintenance hemodialysis (MHD) patients constitute a distinctive population characterized by unique traits, such as hemodialysis-related immune disturbances, and increased vulnerability to infections, heart failure, particularly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite considerable research on MHD patients with coronavirus disease 2019 (COVID-19), there is limited information available on the clinical characteristics and outcomes of unvaccinated adult MHD patients infected with the SARS-CoV-2 Omicron variant.
 
 
 
 A retrospective investigation was conducted in a cohort of 427 unvaccinated MHD patients diagnosed with SARS-CoV-2 Omicron infection. The clinical symptoms, laboratory results, and treatment regimens were comprehensively examined. Multivariate regression identified independent risk factors for disease severity, and two-month follow-up assessments were conducted.
 
 
 
 The cohort exhibited a spectrum of disease severity, with 37.5% classified as mild, 35.3% as common, 22.5% as severe, and 4.7% as critical. Serum C-reactive protein level, procalcitonin level, and bicarbonate concentration are related to the severity of the disease. Tailored treatment strategies—including nutritional support, hemodialysis management, anti-bacterial interventions, and more—were implemented. There was a 5.6% mortality rate, with a higher prevalence of deaths in the critical subtype. Independent risk factors for disease severity included fever, age, cycle threshold values (Ct values) of ORF1ab gene, and arterial oxygen partial pressure. Follow-up assessments revealed a median duration of 11 days for the negative nucleic acid of SARS-CoV-2. Twelve patients presented a second positive ORF1ab gene during follow-up but remained asymptomatic.
 
 
 
 These findings suggest the intricate clinical characteristics and outcomes of MHD patients with the SARS-CoV-2 Omicron infection. Tailored treatment strategies, continuous surveillance, and understanding prognostic factors are imperative for managing this high-risk population. Further research is warranted to validate these findings.


Clinical Characteristics of 427 Unvaccinated Chinese Adult Patients with Maintenance Hemodialysis Infected with the SARS-CoV-2 Omicron Variant: A Retrospective Study

Abstract To analyze the clinical characteristics and outcomes of unvaccinated adult patients on maintenance hemodialysis infected with SARS-CoV-2 Omicron subvariant BA.5.2.The clinical data of 427 maintenance hemodialysis patients infected with SARS-CoV-2 Omicron subvariant BA.5.2 in our hospital were retrospectively collected. The patients were grouped according to the severity of the disease and compared. The clinical outcome and two-month follow-up were analyzed.These results suggest that CRP level, procalcitonin level, and bicarbonate concentration are related to the severity of disease caused by SARS-CoV-2 omicron BA.5.2 infection in unimmunized MHD patients. In addition, the co-bacterial infection may be an important cause of severe illness. Therefore, strengthen the treatment of critically ill patients, and actively and effectively control infection and secondary infection; Effective vaccination is the key to improving clinical outcomes to prevent the conversion of ordinary patients to severe and critical cases. Fever, age, ORF1ab gene value, and arterial oxygen partial pressure may be independent risk factors for disease severity in COVID-19 patients. 

Clinical Characteristics of 427 Unvaccinated Chinese Adult Patients with Maintenance Hemodialysis infected with SARS-CoV-2 Omicron subvariant BA.5.2

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), induces coughing, vomiting, or fever. The occurrence, duration, and severity of these symptoms vary from person to person, which makes symptoms of the COVID-19 infection ranging from those of a mild cold to death in severe cases. The cause of these differences can be found in individual characteristics of the patient. Age, former diseases of the patient, and they medications they took can such characteristics. As the SARS-CoV-2 affects the lung, diseases related to the lung such as chronic obstructive pulmonary disease, lung cancer, cystic fibrosis, pulmonary fibrosis, moderate to severe asthma, pulmonary hypertension, and pulmonary embolism are especially more dangerous to the human body when infected by the SARS-CoV-2. In this paper, through various methods including comparing the characteristics of mutant viruses and subunits of COVID-19, we aimed to describe the risk factors and deterioration of COVID-19 and the strain of SARS-CoV-2 during the COVID-19 pandemic. 

/pdf/the-emerging-pandemic-recent-sars-cov-2-jti5i4kf.pdf

The emerging pandemic recent: SARS-CoV-2

Background: Identification of the predictors of coronavirus disease 2019 (COVID-19)-related death in hemodialysis patients plays a key role in the management of these patients. In this regard, the present study aimed to evaluate the predictors of death among COVID-19 infected hemodialysis patients in Hamadan province, Iran. Study design: A cross-sectional study. Methods: This cross-sectional study investigated 50 COVID-19 infected hemodialysis patients who were confirmed by polymerase chain reaction (PCR) test and referred to hemodialysis wards of hospitals located in Hamadan province, Iran, from March 2019 and January 2020. In order to compare the demographic characteristics and clinical variables between survived and deceased patients, the independent student t test and chi-square test were applied. Results: Out of 50 confirmed COVID-19 hemodialysis patients, 27 (54%) cases were male, 38 (76%) subjects were urban residents, and 4 (8%) individuals were smokers. A significant relationship was observed between patients’ gender, age, acute respiratory distress syndrome (ARDS) status, and body mass index (BMI) with the treatment outcome (P<0.05). A significantly higher level of serum albumin was observed in the survived patients (3.49±0.37 vs. 3.17±0.42, P = 0.030). Moreover, in terms of lactate dehydrogenase (LDH) level, a significantly higher level of LDH was observed in the patients who died (1471.1±1484.89 vs. 670.86±268.85, P = 0.005). Conclusions: It can be concluded that some demographic characteristics of the patients, including age, gender, ARDS status, BMI, co-morbidities, and laboratory signs and symptoms are associated with disease outcomes in COVID-19 infected hemodialysis patients. Therefore, awareness about the predictors of death in these patients can help make better and direct clinical decisions and inform health officials about the risk of COVID-19 mortality among hemodialysis patients.

Predictors of COVID-19 Mortality in Hemodialysis Patients, Hamadan Province, Iran

Background: Due to the critical condition of COVID-19, it is necessary to evaluate the efficacy of administrating convalescent plasma to COVID-19 patients. Therefore, we decided to design a clinical trial to investigate the effect of convalescent plasma of patients recovered from COVID-19 on the treatment outcome of COVID-19-infected patients. Materials and Methods: In this parallel randomized controlled clinical trial, patients in the intervention group received standard treatment plus convalescent plasma of patients recovered from COVID-19. We allocated 60 patients to each treatment group through balanced block randomization. Then, COVID-19 outcomes, vital signs, and biochemical parameters were compared between the two treatment groups by the independent t test and ANCOVA. Results: The mean age (SD) of the patients in the intervention and standard treatment groups was 52.84 (15.77) and 55.15 (14.34) years, respectively. Although patients in the intervention group reported more hospitalization days (11.45±5.86 vs. 10.42±6.79), death rates (26.67% vs. 18.13%), ICU admission (45 vs. 41.67%), and ARDS (11.67% vs. 3.33%), these differences were not statistically significant (P>0.05). Moreover, the two groups were homogenous in vital signs and biochemical parameters before and after treatment (P>0.05). Conclusion: The present study indicated that convalescent plasma therapy has no significant effect on the survival, hospitalization, and ICU admission of COVID-19 patients.

Effect of Convalescent Plasma Therapy on Clinical Improvement of COVID-19 Patients: A Randomized Clinical Trial

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Predictors of COVID-19 Mortality in Hemodialysis Patients, Hamadan Province, Iran

Effect of Convalescent Plasma Therapy on Clinical Improvement of COVID-19 Patients: A Randomized Clinical Trial