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

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TitleConvalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection
AuthorsHung, IFN5
To, KKW5
Lee, CK7
Lee, KL10
Chan, K9
Yan, WW9
Liu, R12
Watt, CL1
Chan, WM13
Lai, KY8
Koo, CK4
Buckley, T6
Chow, FL15
Wong, KK11
Chan, HS14
Ching, CK3
Tang, BSF16
Lau, CCY5
Li, IWS5
Liu, SH2
Chan, KH5
Lin, CK7
Yuen, KY5
Issue Date2011
PublisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
CitationClinical Infectious Diseases, 2011, v. 52 n. 4, p. 447-456 [How to Cite?]
DOI: http://dx.doi.org/10.1093/cid/ciq106
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.
ISSN1058-4838
2011 Impact Factor: 9.154
2011 SCImago Journal Rankings: 0.821
DOIhttp://dx.doi.org/10.1093/cid/ciq106
ISI Accession Number IDWOS:000286677800008
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.

ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorHung, IFN
dc.contributor.authorTo, KKW
dc.contributor.authorLee, CK
dc.contributor.authorLee, KL
dc.contributor.authorChan, K
dc.contributor.authorYan, WW
dc.contributor.authorLiu, R
dc.contributor.authorWatt, CL
dc.contributor.authorChan, WM
dc.contributor.authorLai, KY
dc.contributor.authorKoo, CK
dc.contributor.authorBuckley, T
dc.contributor.authorChow, FL
dc.contributor.authorWong, KK
dc.contributor.authorChan, HS
dc.contributor.authorChing, CK
dc.contributor.authorTang, BSF
dc.contributor.authorLau, CCY
dc.contributor.authorLi, IWS
dc.contributor.authorLiu, SH
dc.contributor.authorChan, KH
dc.contributor.authorLin, CK
dc.contributor.authorYuen, KY
dc.date.accessioned2011-05-24T02:12:40Z
dc.date.available2011-05-24T02:12:40Z
dc.date.issued2011
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.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationClinical Infectious Diseases, 2011, v. 52 n. 4, p. 447-456 [How to Cite?]
DOI: http://dx.doi.org/10.1093/cid/ciq106
dc.identifier.doihttp://dx.doi.org/10.1093/cid/ciq106
dc.identifier.epage456
dc.identifier.hkuros185095
dc.identifier.isiWOS:000286677800008
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.

dc.identifier.issn1058-4838
2011 Impact Factor: 9.154
2011 SCImago Journal Rankings: 0.821
dc.identifier.issue4
dc.identifier.openurl
dc.identifier.pmid21248066
dc.identifier.scopuseid_2-s2.0-79951821842
dc.identifier.spage447
dc.identifier.urihttp://hdl.handle.net/10722/133634
dc.identifier.volume52
dc.languageeng
dc.publisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
dc.publisher.placeUnited States
dc.relation.ispartofClinical Infectious Diseases
dc.relation.referencesReferences in Scopus
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 infection
dc.typeArticle
Author Affiliations
  1. Kwong Wah Hospital
  2. Hong Kong Hospital Authority
  3. Tseung Kwan O Hospital
  4. Tuen Mun Hospital
  5. The University of Hong Kong
  6. Princess Margaret Hospital Hong Kong
  7. Hong Kong Red Cross Blood Transfusion Service
  8. Queen Elizabeth Hospital Hong Kong
  9. Pamela Youde Nethersole Eastern Hospital
  10. United Christian Hospital Hong Kong
  11. North District Hospital Hong Kong
  12. Ruttonjee Hospital Hong Kong
  13. Queen Mary Hospital Hong Kong
  14. Alice Ho Miu Ling Nethersole Hospital
  15. Caritas Medical Centre Hong Kong
  16. Hong Kong Sanatorium and Hospital