{"doi":"10.1371/journal.pone.0254453","title":"Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19","abstract":"BACKGROUND: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. RESEARCH QUESTION: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? STUDY DESIGN AND METHODS: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. RESULTS: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P = 0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P = 0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P = 0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P = 0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. INTERPRETATION: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.","journal":"PLoS ONE","year":2021,"id":159855,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":39,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9408,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":671341,"name":"Michael V. Gormally","orcid":"0000-0002-0414-4234","position":1,"is_corresponding":false},{"id":517793,"name":"Fangyong Li","orcid":"0000-0003-3171-7592","position":2,"is_corresponding":false},{"id":671342,"name":"Sabrina L. Browning","orcid":"0000-0002-9812-0654","position":3,"is_corresponding":false},{"id":671343,"name":"Miriam M. Treggiari","orcid":"0000-0003-4639-3682","position":4,"is_corresponding":false},{"id":671838,"name":"Alyssa Morrison","orcid":null,"position":5,"is_corresponding":false},{"id":623428,"name":"Maudry Laurent-Rolle","orcid":"0000-0002-1446-0142","position":6,"is_corresponding":false},{"id":371391,"name":"Yanhong Deng","orcid":"0000-0002-4333-468X","position":7,"is_corresponding":false},{"id":369614,"name":"Jeanne E. Hendrickson","orcid":"0000-0002-7928-3132","position":8,"is_corresponding":false},{"id":106679,"name":"Christopher A. Tormey","orcid":"0000-0003-1785-2245","position":9,"is_corresponding":false},{"id":671344,"name":"Mahalia S. Desruisseaux","orcid":"0000-0003-2060-412X","position":10,"is_corresponding":false},{"id":671340,"name":"Neima Briggs","orcid":"0000-0002-5583-7057","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-18T23:44:39.550981Z","pmid":"34320004","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}