Convalescent plasma antibody levels and the risk of death from covid-19

Michael J. Joyner; Rickey E. Carter; Jonathon W. Senefeld; Stephen A. Klassen; John R. Mills; Patrick W. Johnson; Elitza S. Theel; Chad C. Wiggins; Katelyn A. Bruno; Allan M. Klompas; Elizabeth R. Lesser; Katie L. Kunze; Matthew A. Sexton; Juan C. Diaz Soto; Sarah E. Baker; John R.A. Shepherd; Noud van Helmond; Nicole C. Verdun; Peter Marks; Camille M. van Buskirk; Jeffrey L. Winters; James R. Stubbs; Robert F. Rea; David O. Hodge; Vitaly Herasevich; Emily R. Whelan; Andrew J. Clayburn; Kathryn F. Larson; Juan G. Ripoll; Kylie J. Andersen; Matthew R. Buras; Matthew N.P. Vogt; Joshua J. Dennis; Riley J. Regimbal; Philippe R. Bauer; Janis E. Blair; Nigel S. Paneth; De Lisa Fairweather; R. Scott Wright; Arturo Casadevall

doi:10.1056/NEJMoa2031893

Convalescent plasma antibody levels and the risk of death from covid-19

Michael J. Joyner, Rickey E. Carter, Jonathon W. Senefeld, Stephen A. Klassen, John R. Mills, Patrick W. Johnson, Elitza S. Theel, Chad C. Wiggins, Katelyn A. Bruno, Allan M. Klompas, Elizabeth R. Lesser, Katie L. Kunze, Matthew A. Sexton, Juan C. Diaz Soto, Sarah E. Baker, John R.A. Shepherd, Noud van Helmond, Nicole C. Verdun, Peter Marks, Camille M. van BuskirkJeffrey L. Winters, James R. Stubbs, Robert F. Rea, David O. Hodge, Vitaly Herasevich, Emily R. Whelan, Andrew J. Clayburn, Kathryn F. Larson, Juan G. Ripoll, Kylie J. Andersen, Matthew R. Buras, Matthew N.P. Vogt, Joshua J. Dennis, Riley J. Regimbal, Philippe R. Bauer, Janis E. Blair, Nigel S. Paneth, De Lisa Fairweather, R. Scott Wright, Arturo Casadevall

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

54 Scopus citations

Abstract

BACKGROUND Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. METHODS In a retrospective study based on a U.S. national registry, we determined the anti–SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti–SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. RESULTS Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti–SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). CONCLUSIONS Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti–SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels.

Original language	English (US)
Pages (from-to)	1015-1027
Number of pages	13
Journal	New England Journal of Medicine
Volume	384
Issue number	11
DOIs	https://doi.org/10.1056/NEJMoa2031893
State	Published - Mar 18 2021

ASJC Scopus subject areas

General Medicine

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10.1056/NEJMoa2031893

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Joyner, M. J., Carter, R. E., Senefeld, J. W., Klassen, S. A., Mills, J. R., Johnson, P. W., Theel, E. S., Wiggins, C. C., Bruno, K. A., Klompas, A. M., Lesser, E. R., Kunze, K. L., Sexton, M. A., Diaz Soto, J. C., Baker, S. E., Shepherd, J. R. A., van Helmond, N., Verdun, N. C., Marks, P., ... Casadevall, A. (2021). Convalescent plasma antibody levels and the risk of death from covid-19. New England Journal of Medicine, 384(11), 1015-1027. https://doi.org/10.1056/NEJMoa2031893

Joyner, MJ, Carter, RE, Senefeld, JW, Klassen, SA, Mills, JR, Johnson, PW, Theel, ES, Wiggins, CC, Bruno, KA, Klompas, AM, Lesser, ER, Kunze, KL, Sexton, MA, Diaz Soto, JC, Baker, SE, Shepherd, JRA, van Helmond, N, Verdun, NC, Marks, P, van Buskirk, CM, Winters, JL, Stubbs, JR, Rea, RF, Hodge, DO, Herasevich, V, Whelan, ER, Clayburn, AJ, Larson, KF, Ripoll, JG, Andersen, KJ, Buras, MR, Vogt, MNP, Dennis, JJ, Regimbal, RJ, Bauer, PR, Blair, JE, Paneth, NS, Fairweather, DL, Wright, RS & Casadevall, A 2021, 'Convalescent plasma antibody levels and the risk of death from covid-19', New England Journal of Medicine, vol. 384, no. 11, pp. 1015-1027. https://doi.org/10.1056/NEJMoa2031893

@article{a207df1848ac4cbd90e065e650554511,

title = "Convalescent plasma antibody levels and the risk of death from covid-19",

abstract = "BACKGROUND Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. METHODS In a retrospective study based on a U.S. national registry, we determined the anti–SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti–SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. RESULTS Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti–SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). CONCLUSIONS Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti–SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels.",

author = "Joyner, {Michael J.} and Carter, {Rickey E.} and Senefeld, {Jonathon W.} and Klassen, {Stephen A.} and Mills, {John R.} and Johnson, {Patrick W.} and Theel, {Elitza S.} and Wiggins, {Chad C.} and Bruno, {Katelyn A.} and Klompas, {Allan M.} and Lesser, {Elizabeth R.} and Kunze, {Katie L.} and Sexton, {Matthew A.} and {Diaz Soto}, {Juan C.} and Baker, {Sarah E.} and Shepherd, {John R.A.} and {van Helmond}, Noud and Verdun, {Nicole C.} and Peter Marks and {van Buskirk}, {Camille M.} and Winters, {Jeffrey L.} and Stubbs, {James R.} and Rea, {Robert F.} and Hodge, {David O.} and Vitaly Herasevich and Whelan, {Emily R.} and Clayburn, {Andrew J.} and Larson, {Kathryn F.} and Ripoll, {Juan G.} and Andersen, {Kylie J.} and Buras, {Matthew R.} and Vogt, {Matthew N.P.} and Dennis, {Joshua J.} and Regimbal, {Riley J.} and Bauer, {Philippe R.} and Blair, {Janis E.} and Paneth, {Nigel S.} and Fairweather, {De Lisa} and Wright, {R. Scott} and Arturo Casadevall",

note = "Publisher Copyright: Copyright {\textcopyright} 2021 Massachusetts Medical Society.",

year = "2021",

month = mar,

day = "18",

doi = "10.1056/NEJMoa2031893",

language = "English (US)",

volume = "384",

pages = "1015--1027",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "11",

}

TY - JOUR

T1 - Convalescent plasma antibody levels and the risk of death from covid-19

AU - Joyner, Michael J.

AU - Carter, Rickey E.

AU - Senefeld, Jonathon W.

AU - Klassen, Stephen A.

AU - Mills, John R.

AU - Johnson, Patrick W.

AU - Theel, Elitza S.

AU - Wiggins, Chad C.

AU - Bruno, Katelyn A.

AU - Klompas, Allan M.

AU - Lesser, Elizabeth R.

AU - Kunze, Katie L.

AU - Sexton, Matthew A.

AU - Diaz Soto, Juan C.

AU - Baker, Sarah E.

AU - Shepherd, John R.A.

AU - van Helmond, Noud

AU - Verdun, Nicole C.

AU - Marks, Peter

AU - van Buskirk, Camille M.

AU - Winters, Jeffrey L.

AU - Stubbs, James R.

AU - Rea, Robert F.

AU - Hodge, David O.

AU - Herasevich, Vitaly

AU - Whelan, Emily R.

AU - Clayburn, Andrew J.

AU - Larson, Kathryn F.

AU - Ripoll, Juan G.

AU - Andersen, Kylie J.

AU - Buras, Matthew R.

AU - Vogt, Matthew N.P.

AU - Dennis, Joshua J.

AU - Regimbal, Riley J.

AU - Bauer, Philippe R.

AU - Blair, Janis E.

AU - Paneth, Nigel S.

AU - Fairweather, De Lisa

AU - Wright, R. Scott

AU - Casadevall, Arturo

PY - 2021/3/18

Y1 - 2021/3/18

N2 - BACKGROUND Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. METHODS In a retrospective study based on a U.S. national registry, we determined the anti–SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti–SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. RESULTS Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti–SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). CONCLUSIONS Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti–SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels.

AB - BACKGROUND Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. METHODS In a retrospective study based on a U.S. national registry, we determined the anti–SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti–SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. RESULTS Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti–SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). CONCLUSIONS Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti–SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels.

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JO - New England Journal of Medicine

JF - New England Journal of Medicine

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Convalescent plasma antibody levels and the risk of death from covid-19

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