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.

CURB-65 as an initial prognostic score in Internal Medicine patients.

BACKGROUND: There are few validated tools to assess severity in patients admitted to an Internal Medicine service. The aim of this study was to evaluate if CURB-65 score, previously validated as mortality index in community acquired pneumonia, could also be used in those patients. METHODS: We analyzed prospectively all patients admitted to Hospital Sierrallana (Spain) from 1 March to 31 October 2010. Variables of the CURB-65 score (confusion, serum urea>7mmol/L (42mg/dl), respiratory rate≥30/min, systolic blood pressure<90mmHg and/or diastolic blood pressure≤60mmHg, and age≥65) and other clinical and epidemiological data and laboratory findings were recorded. Charlson comorbidity index was also estimated. Prognostic variables were identified using multiple logistic regression with 30days mortality as the outcome measure. RESULTS: 539 patients were studied (51% males; mean age: 78±14years; mortality 12%). A high CURB-65 score was a significant predictor of 30day mortality (p<0.001). Eighty-six percent of the patients who died had high CURB-65 score at admission, and none of them had low score. Sensitivity and specificity for high CURB-65 score were 86% and 70%, respectively, and negative predictive value was 97%. Receiver-operator characteristic curve showed an area under curve of 0.79 for CURB 65-score. Charlson index also correlated with mortality, but its performance was worse than that of CURB-65. CONCLUSION: Our findings suggest that CURB-65 score may be a simple and useful tool to help clinicians in establishing the prognosis of patients admitted to general Internal Medicine wards.