New research analyzes COVID-19 outcomes, testing, and experimental treatments
A retrospective report looked at serologic antibody testing, while two case series reports described use of convalescent plasma in critically ill patients with COVID-19 in China.
A study published by Clinical Infectious Diseases on April 2 identified characteristics of patients hospitalized with COVID-19 that were associated with better outcomes. Among the 102 adult patients in China, the ICU admission rate was 17.6% and the mortality rate was 16.7% (35.3% among ICU patients vs. 14.1% among non-ICU patients). Patients who survived were younger, were more commonly health care workers, and had fewer comorbidities or complications. There were no differences in mortality by whether patients received antimicrobial or glucocorticoid drug treatment.
Another study of 173 Chinese patients with COVID-19 looked at antibodies to the virus (total, IgM, and IgG) and found that rates of all three rapidly increased between one week and two weeks after symptom onset, during which time the detectability of the virus by RNA decreased. The results provide “strong empirical support for the routine application of serological testing in the diagnosis and management of COVID-19,” as well as suggest that high total antibody titer may be an independent marker of risk for critical illness, the authors said, in results published by Clinical Infectious Diseases on March 28.
A case series of five Chinese patients given convalescent plasma transfusion was published by JAMA on March 27. All five patients were on mechanical ventilation and had received antiviral agents and methylprednisolone. During follow-up, three of the patients were discharged from the hospital (with lengths of stay of 51 to 55 days), and two were in stable condition at 37 days after transfusion. An accompanying editorial highlighted the limitations of this nonrandomized research and described how this intervention could be further tested and, if successful, implemented.
Another case series of four patients treated with convalescent plasma was published by CHEST on March 31. All four eventually recovered from COVID-19. “However, the relative contributions of supportive care, investigational therapies, and patient's immune-response on survival could not be determined. Whether convalescent plasma and/or supportive care provide any clinical benefit is unknown,” concluded the authors, who called for a clinical trial.
Potential interactions between COVID-19 and angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers were explored by two Viewpoints published by JAMA Cardiology on April 3. Based on their biological analyses of cardiovascular aging and renin angiotensin system blocking, both articles concluded there is reason to suspect the drugs may have beneficial effects in patients with the disease and called for additional research.