ORIGINAL ARTICLE

Convalescent plasma as an adjunctive treatment for severe and critically ill COVID-19

Damai Santosa , Muchlis Achsan Udji Sofro, Retnaningsih Retnaningsih, Eko Adhi Pangarsa, Budi Setiawan, Nur Farhanah, Fathur Nur Kholis, Thomas Handoyo, Sofyan Rahardjo, Like Rahayu Nindhita, Iva Puspitasari, Ridho M. Naibaho, Retty Kharismasari, Ika Kartiyani, Vina Yunarvika, Daniel Rizky, Suhartono Suhartono

Damai Santosa
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia. Email: [email protected]

Muchlis Achsan Udji Sofro
Division of Infection and Tropical Disease, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Retnaningsih Retnaningsih
Department of Neurology, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia ; Intensive Care Department, Dr. Kariadi Hospital, Semarang, Indonesia

Eko Adhi Pangarsa
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Budi Setiawan
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Nur Farhanah
Division of Infection and Tropical Disease, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Fathur Nur Kholis
Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Thomas Handoyo
Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Sofyan Rahardjo
Pulmonology Department, Dr. Kariadi Hospital, Semarang, Indonesia

Like Rahayu Nindhita
Department of Clinical Laboratory, Blood Transfusion Unit, Dr. Kariadi Hospital, Semarang, Indonesia

Iva Puspitasari
Department of Clinical Microbiology, Dr. Kariadi Hospital, Semarang, Indonesia

Ridho M. Naibaho
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Retty Kharismasari
Division of Infection and Tropical Disease, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Ika Kartiyani
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Vina Yunarvika
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Daniel Rizky
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro and Dr. Kariadi Hospital, Semarang, Indonesia

Suhartono Suhartono
Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
Online First: September 14, 2021 | Cite this Article
Santosa, D., Sofro, M., Retnaningsih, R., Pangarsa, E., Setiawan, B., Farhanah, N., Kholis, F., Handoyo, T., Rahardjo, S., Nindhita, L., Puspitasari, I., Naibaho, R., Kharismasari, R., Kartiyani, I., Yunarvika, V., Rizky, D., Suhartono, S. 2021. Convalescent plasma as an adjunctive treatment for severe and critically ill COVID-19. Bali Medical Journal 10(3): 851-859. DOI:10.15562/bmj.v10i3.2590


Introduction: The historical treatment of convalescent plasma was successful against RNA viruses. However, the significance of COVID-19 convalescent plasma therapy has not been clinically proven consistently in most studies and the available data showed contradictory results so far. Our study aims to evaluate the role of convalescent plasma therapy as an adjunctive treatment for severe and critically ill COVID-19 patients.

Methods: This study was an open-label, non-randomized comparative clinical trial that was conducted at Dr. Kariadi Hospital, Semarang, Indonesia. This study sample are hospitalized severe and critically ill COVID-19 patients were assigned with a 2:1 ratio to receive convalescent plasma and local standard of care. The primary outcome was the clinical status 30 days after the intervention

Results: A total of 73 patients received convalescent plasma and 38 patients received local standards of care. Both of the groups had similar clinical ordinal scales (median was 5, p=0.65), while patients in the study groups had significantly higher SOFA scores and P/F ratio. The control group had a worse overall mortality rate (61.1% vs 18.4%) with a hazard ratio of 3.5 (95%CI, 2.1-5.9) compared to the study group. From the subgroup analysis, we found that patients in the study group without mechanical ventilation support had the best survival rate compared to other groups HR: 0.0047 (95%CI, 0.01-0.19). The clinical outcome 7 days after convalescent plasma infusion was also significantly improved in the study group (median baseline & day-7, 5 & 3, p<0.001). From the multivariate analysis of therapeutic variables, convalescent plasma was the most significant variable for survival outcome (OR=0.089, 95%CI, 0.029-0.27; p<0.001). There was one case of anaphylactic shock and was excluded.

Conclusions: The convalescent plasma administration significantly improved clinical outcomes and overall survival rates compared to those who received local standards of care.

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