Significantly Decreased Mortality in a Large Cohort of Coronavirus Disease 2019 (COVID-19) Patients Transfused Early with Convalescent Plasma Containing High-Titer Anti–Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Spike Protein IgG

Eric Salazar, Paul A. Christensen, Edward A. Graviss, Duc T. Nguyen, Brian Castillo, Jian Chen, Bevin V. Lopez, Todd N. Eagar, Xin Yi, Picheng Zhao, John Rogers, Ahmed Shehabeldin, David Joseph, Faisal Masud, Christopher Leveque, Randall J. Olsen, David W. Bernard, Jimmy Gollihar, James M. Musser

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Coronavirus disease 2019 (COVID-19) convalescent plasma has emerged as a promising therapy and has been granted Emergency Use Authorization by the US Food and Drug Administration for hospitalized COVID-19 patients. We recently reported results from interim analysis of a propensity score–matched study suggesting that early treatment of COVID-19 patients with convalescent plasma containing high-titer anti-spike protein receptor binding domain (RBD) IgG significantly decreases mortality. We herein present results from a 60-day follow-up of a cohort of 351 transfused hospitalized patients. Prospective determination of enzyme-linked immunosorbent assay anti-RBD IgG titer facilitated selection and transfusion of the highest titer units available. Retrospective analysis by the Ortho VITROS IgG assay revealed a median signal/cutoff ratio of 24.0 for transfused units, a value far exceeding the recent US Food and Drug Administration–required cutoff of 12.0 for designation of high-titer convalescent plasma. With respect to altering mortality, our analysis identified an optimal window of 44 hours after hospitalization for transfusing COVID-19 patients with high-titer convalescent plasma. In the aggregate, the analysis confirms and extends our previous preliminary finding that transfusion of COVID-19 patients soon after hospitalization with high-titer anti-spike protein RBD IgG present in convalescent plasma significantly reduces mortality.

Original languageEnglish (US)
Pages (from-to)90-107
Number of pages18
JournalAmerican Journal of Pathology
Volume191
Issue number1
Early online dateNov 4 2020
DOIs
StatePublished - Jan 2021

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Neutralizing/immunology
  • Antibodies, Viral/immunology
  • COVID-19/mortality
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Immunization, Passive
  • Immunoglobulin G/immunology
  • Kaplan-Meier Estimate
  • Linear Models
  • Male
  • Middle Aged
  • Propensity Score
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk
  • SARS-CoV-2
  • Spike Glycoprotein, Coronavirus/immunology
  • Treatment Outcome

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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