Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection.
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.
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.
Ivan Fn
IF
Hung
Kelvin Kw
KK
To
Cheuk-Kwong
CK
Lee
Kar-Lung
KL
Lee
Kenny
K
Chan
Wing-Wah
WW
Yan
Raymond
R
Liu
Chi-Leung
CL
Watt
Wai-Ming
WM
Chan
Kang-Yiu
KY
Lai
Chi-Kwan
CK
Koo
Tom
T
Buckley
Fu-Loi
FL
Chow
Kwan-Keung
KK
Wong
Hok-Sum
HS
Chan
Chi-Keung
CK
Ching
Bone Sf
BS
Tang
Candy Cy
CC
Lau
Iris Ws
IW
Li
Shao-Haei
SH
Liu
Kwok-Hung
KH
Chan
Che-Kit
CK
Lin
Kwok-Yung
KY
Yuen
D000328:Adult; D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology / Q000302:isolation & purification* / Q000472:pathogenicity; D007251:Influenza, Human / Q000401:mortality* / Q000628:therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000276:immunology*; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load
D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D016207:Cytokines
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