Convalescent plasma treatment for patients of 80 years and older with COVID-19 pneumonia

Background Older patients, frequently with multiple comorbidities, have a high mortality from COVID-19 infection. Convalescent plasma (CP) is a therapeutic option for these patients. Our objective is to retrospectively evaluate the efficacy and adverse events of CP treatment in this population group. Methods Forty one patients over 80 years old with COVID-19 pneumonia received CP added to standard treatment, 51.2% with high anti-SARS-CoV-2 IgG titers and 48.8% with low titers. Median time between the onset of symptoms and the infusion of plasma was 7 days (IQR 4–10). A similar group of 82 patients who received only standard treatment, during a period in which CP was not available, were selected as a control group. Results In-hospital mortality was 26.8% for controls and 14.6% for CP patients (P = 0.131) and ICU admission was 8.5% for controls and 4.9% for CP patients (P = 0.467). Mortality tended to be lower in the high-titer group (9.5%) than in the low-titer group (20%), and in patients transfused within the first 7 days of symptom onset (10%) than in patients transfused later (19.1%), although the differences were not statistically significant (P = 0.307 and P = 0.355 respectively). There was no difference in the length of hospitalization. No significant adverse events were associated with CP treatment. Conclusions Convalescent plasma treatment in patients over 80 years old with COVID-19 pneumonia was well tolerated but did not present a statistically significant difference in hospital mortality, ICU admission, or length of hospitalization. The results should be interpreted with caution as only half the patients received high-titer CP and the small number of patients included in the study limits the statistical power to detect significant differences. Trial registration CEIm Cantabria # 2020.127.

MO299RELATIONSHIP BETWEEN LOW-TITER PHOSPHOLIPASE A2 RECEPTOR ANTIBODY AND TREATMENT RESPONSE OF IDIOPATHIC MEMBRANOUS NEPHROPATHY

Background and Aims The circulating anti-Phospholipase A2 receptor (PLA2R) antibody has been widely detected since its discovery in 2009. It was suggested that the cut-off of serum PLA2R antibody (PLA2RsAb) should be reset at below 20 RU/mL to prove diagnostic efficacy. The correlation between low titer PLA2RsAb and treatment response has not been discussed. In this study, we focused on the low titer PLA2RsAb during follow-up of PLA2R-related IMN. Method We retrospectively enrolled 43 Chinese patients with biopsy-proved PLA2R-related IMN from March 2017 to October 2019. Baseline data were collected including age, gender, serum creatinine (Scr), albumin (Alb), 24h urine protein (24hUP), and PLA2RsAb at biopsy. PLA2RsAb was detected at one month, three months, six months and one year. The patients were stratified into three groups by the lowest PLA2RsAb titer during follow up. Low titer group was defined as anti-PLA2R antibody ＜2RU/mL (53.5%, n=23). Median titer group was defined as anti-PLA2R antibody >2 but ＜20RU/mL (32.6%, n=14). High titer group was defined as anti-PLA2R antibody >20RU/mL (13.9%, n=6). Complete remission (CR) was defined as 24hUP ＜0.3g/d. Partial remission (PR) was defined as 24hUP at the range of 0.3-3.5g/d and a reduction >50% of the baseline proteinuria. No remission (NR) was defined as absence of CR or PR at one-year. Results In the entire cohort, patients were 49 ± 16 years old with 28/15 male/female ratio. Baseline data of low, mid and high titer group were as follows: the median PLA2RsAb were 34.3(22.1, 314), 103(55.8, 361), 73.6(53.0, 215)RU/mL, P = 0.305; the median 24hUP were 6.8(3.5, 12.4), 6.4(5.6, 8.9), 4.9(3.4, 7.2)g/d, P = 0.493; the average Scr were 100.4 ± 60.0, 92.3 ± 29.2, 82.0 ± 21.9 umol/L, P = 0.681; the median Alb were 27.0 ± 5.7, 23.8 ± 5.8, 30.2 ± 3.3 g/L, P = 0.054. The rate of CR, PR, NR were 34.8% (8/23), 34.8% (8/23), 30.4% (7/23) in low titer group, 7.1% (1/14), 71.4% (10/14), 21.4% (3/14) in mid titer group, 0% (0/6), 66.7% (4/6), 33.3% (2/6) in high titer group, P = 0.119 Conclusion The correlation between low titer PLA2RsAb and treatment response showed no statistical significance.