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Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection.
Clin Infect Dis. 2011 Feb 15; 52(4):447-56.CI

Abstract

BACKGROUND

Experience from treating patients with Spanish influenza and influenza A(H5N1) suggested that convalescent plasma therapy might be beneficial. However, its efficacy in patients with severe pandemic influenza A(H1N1) 2009 virus (H1N1 2009) infection remained unknown.

METHODS

During the period from 1 September 2009 through 30 June 2010, we conducted a prospective cohort study by recruiting patients aged ≥ 18 years with severe H1N1 2009 infection requiring intensive care. Patients were offered treatment with convalescent plasma with a neutralizing antibody titer of ≥ 1:160, harvested by apheresis from patients recovering from H1N1 2009 infection. Clinical outcome was compared with that of patients who declined plasma treatment as the untreated controls.

RESULTS

Ninety-three patients with severe H1N1 2009 infection requiring intensive care were recruited. Twenty patients (21.5%) received plasma treatment. The treatment and control groups were matched by age, sex, and disease severity scores. Mortality in the treatment group was significantly lower than in the nontreatment group (20.0% vs 54.8%; P = .01). Multivariate analysis showed that plasma treatment reduced mortality (odds ratio [OR], .20; 95% confidence interval [CI], .06-.69; P = .011), whereas complication of acute renal failure was independently associated with death (OR, 3.79; 95% CI, 1.15-12.4; P = .028). Subgroup analysis of 44 patients with serial respiratory tract viral load and cytokine level demonstrated that plasma treatment was associated with significantly lower day 3, 5, and 7 viral load, compared with the control group (P < .05). The corresponding temporal levels of interleukin 6, interleukin 10, and tumor necrosis factor α (P < .05) were also lower in the treatment group.

CONCLUSIONS

Treatment of severe H1N1 2009 infection with convalescent plasma reduced respiratory tract viral load, serum cytokine response, and mortality.

Authors+Show Affiliations

Infectious Disease Division, Queen Mary Hospital, State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21248066

Citation

Hung, Ivan Fn, et al. "Convalescent Plasma Treatment Reduced Mortality in Patients With Severe Pandemic Influenza a (H1N1) 2009 Virus Infection." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 52, no. 4, 2011, pp. 447-56.
Hung IF, To KK, Lee CK, et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis. 2011;52(4):447-56.
Hung, I. F., To, K. K., Lee, C. K., Lee, K. L., Chan, K., Yan, W. W., Liu, R., Watt, C. L., Chan, W. M., Lai, K. Y., Koo, C. K., Buckley, T., Chow, F. L., Wong, K. K., Chan, H. S., Ching, C. K., Tang, B. S., Lau, C. C., Li, I. W., ... Yuen, K. Y. (2011). Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 52(4), 447-56. https://doi.org/10.1093/cid/ciq106
Hung IF, et al. Convalescent Plasma Treatment Reduced Mortality in Patients With Severe Pandemic Influenza a (H1N1) 2009 Virus Infection. Clin Infect Dis. 2011 Feb 15;52(4):447-56. PubMed PMID: 21248066.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. AU - Hung,Ivan Fn, AU - To,Kelvin Kw, AU - Lee,Cheuk-Kwong, AU - Lee,Kar-Lung, AU - Chan,Kenny, AU - Yan,Wing-Wah, AU - Liu,Raymond, AU - Watt,Chi-Leung, AU - Chan,Wai-Ming, AU - Lai,Kang-Yiu, AU - Koo,Chi-Kwan, AU - Buckley,Tom, AU - Chow,Fu-Loi, AU - Wong,Kwan-Keung, AU - Chan,Hok-Sum, AU - Ching,Chi-Keung, AU - Tang,Bone Sf, AU - Lau,Candy Cy, AU - Li,Iris Ws, AU - Liu,Shao-Haei, AU - Chan,Kwok-Hung, AU - Lin,Che-Kit, AU - Yuen,Kwok-Yung, Y1 - 2011/01/19/ PY - 2011/1/21/entrez PY - 2011/1/21/pubmed PY - 2011/4/27/medline SP - 447 EP - 56 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 52 IS - 4 N2 - BACKGROUND: Experience from treating patients with Spanish influenza and influenza A(H5N1) suggested that convalescent plasma therapy might be beneficial. However, its efficacy in patients with severe pandemic influenza A(H1N1) 2009 virus (H1N1 2009) infection remained unknown. METHODS: During the period from 1 September 2009 through 30 June 2010, we conducted a prospective cohort study by recruiting patients aged ≥ 18 years with severe H1N1 2009 infection requiring intensive care. Patients were offered treatment with convalescent plasma with a neutralizing antibody titer of ≥ 1:160, harvested by apheresis from patients recovering from H1N1 2009 infection. Clinical outcome was compared with that of patients who declined plasma treatment as the untreated controls. RESULTS: Ninety-three patients with severe H1N1 2009 infection requiring intensive care were recruited. Twenty patients (21.5%) received plasma treatment. The treatment and control groups were matched by age, sex, and disease severity scores. Mortality in the treatment group was significantly lower than in the nontreatment group (20.0% vs 54.8%; P = .01). Multivariate analysis showed that plasma treatment reduced mortality (odds ratio [OR], .20; 95% confidence interval [CI], .06-.69; P = .011), whereas complication of acute renal failure was independently associated with death (OR, 3.79; 95% CI, 1.15-12.4; P = .028). Subgroup analysis of 44 patients with serial respiratory tract viral load and cytokine level demonstrated that plasma treatment was associated with significantly lower day 3, 5, and 7 viral load, compared with the control group (P < .05). The corresponding temporal levels of interleukin 6, interleukin 10, and tumor necrosis factor α (P < .05) were also lower in the treatment group. CONCLUSIONS: Treatment of severe H1N1 2009 infection with convalescent plasma reduced respiratory tract viral load, serum cytokine response, and mortality. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/21248066/full_citation L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciq106 DB - PRIME DP - Unbound Medicine ER -