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Article: Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection

TitleConvalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection
Authors
Issue Date2011
PublisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
Citation
Clinical Infectious Diseases, 2011, v. 52 n. 4, p. 447-456 How to Cite?
AbstractBackground: 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. © The Author 2011.
Persistent Identifierhttp://hdl.handle.net/10722/133634
ISSN
2014 Impact Factor: 8.886
2014 SCImago Journal Rankings: 4.341
ISI Accession Number ID
Funding AgencyGrant Number
Ted Sun Foundation
Food and Health Bureau
Hospital Authority of the Hong Kong Special Administrative Region
Funding Information:

This work was supported by the Ted Sun Foundation; the Research Fund for the Control of Infectious Diseases of the Food and Health Bureau; and the Hospital Authority of the Hong Kong Special Administrative Region.

References

 

DC FieldValueLanguage
dc.contributor.authorHung, IFNen_HK
dc.contributor.authorTo, KKWen_HK
dc.contributor.authorLee, CKen_HK
dc.contributor.authorLee, KLen_HK
dc.contributor.authorChan, Ken_HK
dc.contributor.authorYan, WWen_HK
dc.contributor.authorLiu, Ren_HK
dc.contributor.authorWatt, CLen_HK
dc.contributor.authorChan, WMen_HK
dc.contributor.authorLai, KYen_HK
dc.contributor.authorKoo, CKen_HK
dc.contributor.authorBuckley, Ten_HK
dc.contributor.authorChow, FLen_HK
dc.contributor.authorWong, KKen_HK
dc.contributor.authorChan, HSen_HK
dc.contributor.authorChing, CKen_HK
dc.contributor.authorTang, BSFen_HK
dc.contributor.authorLau, CCYen_HK
dc.contributor.authorLi, IWSen_HK
dc.contributor.authorLiu, SHen_HK
dc.contributor.authorChan, KHen_HK
dc.contributor.authorLin, CKen_HK
dc.contributor.authorYuen, KYen_HK
dc.date.accessioned2011-05-24T02:12:40Z-
dc.date.available2011-05-24T02:12:40Z-
dc.date.issued2011en_HK
dc.identifier.citationClinical Infectious Diseases, 2011, v. 52 n. 4, p. 447-456en_HK
dc.identifier.issn1058-4838en_HK
dc.identifier.urihttp://hdl.handle.net/10722/133634-
dc.description.abstractBackground: 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. © The Author 2011.en_HK
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/en_HK
dc.relation.ispartofClinical Infectious Diseasesen_HK
dc.subject.meshAntibodies, Neutralizing - blood-
dc.subject.meshImmunotherapy - methods-
dc.subject.meshInfluenza A Virus, H1N1 Subtype - immunology - isolation and purification - pathogenicity-
dc.subject.meshInfluenza, Human - mortality - therapy - virology-
dc.subject.meshPlasma - immunology-
dc.titleConvalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infectionen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1058-4838&volume=52&issue=4&spage=447&epage=456&date=2011&atitle=Convalescent+plasma+treatment+reduced+mortality+in+patients+with+severe+pandemic+influenza+A+(H1N1)+2009+virus+infection-
dc.identifier.emailHung, IFN:ivanhung@hkucc.hku.hken_HK
dc.identifier.emailTo, KKW:kelvinto@hkucc.hku.hken_HK
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_HK
dc.identifier.authorityHung, IFN=rp00508en_HK
dc.identifier.authorityTo, KKW=rp01384en_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1093/cid/ciq106en_HK
dc.identifier.pmid21248066en_HK
dc.identifier.scopuseid_2-s2.0-79951821842en_HK
dc.identifier.hkuros185095en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-79951821842&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume52en_HK
dc.identifier.issue4en_HK
dc.identifier.spage447en_HK
dc.identifier.epage456en_HK
dc.identifier.eissn1537-6591-
dc.identifier.isiWOS:000286677800008-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridHung, IFN=7006103457en_HK
dc.identifier.scopusauthoridTo, KKW=14323807300en_HK
dc.identifier.scopusauthoridLee, CK=36087620900en_HK
dc.identifier.scopusauthoridLee, KL=36025355300en_HK
dc.identifier.scopusauthoridChan, K=36915710700en_HK
dc.identifier.scopusauthoridYan, WW=55230359500en_HK
dc.identifier.scopusauthoridLiu, R=16307490900en_HK
dc.identifier.scopusauthoridWatt, CL=7005965559en_HK
dc.identifier.scopusauthoridChan, WM=36338834700en_HK
dc.identifier.scopusauthoridLai, KY=36091351800en_HK
dc.identifier.scopusauthoridKoo, CK=35946195400en_HK
dc.identifier.scopusauthoridBuckley, T=7101745369en_HK
dc.identifier.scopusauthoridChow, FL=36024951200en_HK
dc.identifier.scopusauthoridWong, KK=37096564500en_HK
dc.identifier.scopusauthoridChan, HS=36842414700en_HK
dc.identifier.scopusauthoridChing, CK=37121490100en_HK
dc.identifier.scopusauthoridTang, BSF=8908243000en_HK
dc.identifier.scopusauthoridLau, CCY=8398162900en_HK
dc.identifier.scopusauthoridLi, IWS=24464179500en_HK
dc.identifier.scopusauthoridLiu, SH=36126580000en_HK
dc.identifier.scopusauthoridChan, KH=7406034307en_HK
dc.identifier.scopusauthoridLin, CK=12752556900en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK

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