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Therapeutic plasma exchange in adults with severe COVID-19 infection
Faryal Khamis1, Ibrahim Al-Zakwani2, Sabria Al Hashmi3
1Infection Diseases Unit, Royal Hospital, Muscat, Oman.
Insights
Therapeutic plasma exchange (TPE) in severe COVID-19 patients showed higher extubation rates and lower mortality within 28 days compared to controls. Further randomized trials are needed to confirm these promising findings for COVID-19 treatment.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Hematology
Background:
- Severe COVID-19 can lead to acute respiratory distress syndrome (ARDS) and pneumonia.
- Limited treatment options exist for critically ill COVID-19 patients.
Purpose of the Study:
- To evaluate the therapeutic efficacy of plasma exchange (TPE) in severe COVID-19 patients.
- To compare outcomes of TPE treatment versus standard care in a case series.
Main Methods:
- A case series of 31 critically ill COVID-19 patients (adult men and non-pregnant women) was conducted.
- Therapeutic plasma exchange (TPE) was administered to patients in the intensive care unit (ICU) with ARDS or severe pneumonia.
- Univariate statistical analysis was employed to compare outcomes between TPE and non-TPE groups.
Main Results:
- 35% of patients received TPE. The TPE group exhibited significantly higher extubation rates (73% vs. 20%) and reduced 14- and 28-day mortality (0% vs. 35%).
- While all-cause mortality was marginally lower in the TPE group (9.1% vs. 45%), laboratory and ventilatory parameters improved post-TPE.
- The TPE group showed a statistically significant improvement in extubation rates (p=0.018).
Conclusions:
- Therapeutic plasma exchange (TPE) may be associated with improved clinical outcomes in severe COVID-19 patients.
- The study suggests potential benefits of TPE in managing critical COVID-19, including improved respiratory function and survival.
- Randomized controlled trials are essential to establish definitive conclusions on the effectiveness of TPE for COVID-19.
Objective:
To evaluate the therapeutic use of plasma exchange in COVID-19 patients compared to controls.
Methods:
A case series of critically ill adult men and non-pregnant women, ≥18 years of age, with laboratory-confirmed COVID-19, was studied at the Royal Hospital, Oman, from April 17 to May 11, 2020. Therapeutic plasma exchange (TPE) was performed on patients admitted to the intensive care unit (ICU) with confirmed or imminent acute respiratory distress syndrome (ARDS) or severe pneumonia. The analysis was performed using univariate statistics.
Results:
A total of 31 COVID-19 patients were included with an overall mean age of 51±15 years (range: 27-76 years); 90% (n=28) were males, and 35% (n=11) of the patients had TPE as a mode of treatment. The TPE group was associated with higher extubation rates than the non-TPE cohort (73% versus 20%; p=0.018). Additionally, patients on TPE had a lower 14 days (0 versus 35%; p=0.033) and 28 days (0 versus 35%; p=0.033) post plasma exchange mortality compared to patients not on TPE. However, all-cause mortality was only marginally lower in the TPE group compared to the non-TPE group (9.1% versus 45%; p=0.055; power=66%). Laboratory and ventilatory parameters also improved post TPE (n = 11).
Conclusions:
The use of TPE in severe COVID-19 patients has been associated with improved outcomes, however, randomized controlled clinical trials are warranted to draw final, conclusive findings.
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