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Published on: September 15, 2023
Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective
Sultan Mehmood Kamran1, Zill-E-Humayun Mirza1, Arshad Naseem2
1Department of Pulmonology, Pak Emirates Military Hospital (PEMH), Rawalpindi, Pakistan.
Insights
Therapeutic plasma exchange (TPE) significantly improved survival and reduced hospitalization for patients with COVID-19 cytokine release syndrome (CRS). Early TPE intervention within 12 days of illness showed the best outcomes, highlighting its potential in managing severe COVID-19 complications.
Area of Science:
- Critical Care Medicine
- Immunology
- Infectious Diseases
Background:
- Cytokine release syndrome (CRS) is a critical factor in COVID-19 pathophysiology.
- Therapeutic plasma exchange (TPE) is explored for its potential to remove pathogenic cytokines and mitigate CRS.
Purpose of the Study:
- To evaluate the effectiveness of TPE in treating COVID-19 patients with CRS compared to standard care.
- To assess the impact of TPE on survival rates, hospitalization duration, and CRS resolution.
Main Methods:
- Retrospective propensity score-matched (PSM) analysis of 280 hospitalized COVID-19 patients with CRS.
- 90 patients were selected via 1:1 PSM, equally divided into TPE and control groups.
- Primary outcome: 28-day overall survival; Secondary outcomes: hospitalization duration, CRS resolution, viral clearance.
Main Results:
- TPE group showed significantly superior 28-day survival (91.1%) compared to controls (61.5%).
- TPE significantly reduced hospitalization duration (10 vs. 15 days) and CRS resolution time (6 vs. 12 days).
- Early TPE (within 12 days) was associated with 0% mortality, while later TPE had 17.9% mortality.
Conclusions:
- Early TPE administration is linked to improved survival and faster recovery in COVID-19 patients with CRS.
- TPE offers a potential therapeutic strategy to manage severe CRS in COVID-19.
- This study highlights the benefit of timely TPE intervention for better patient outcomes.
Background:
Cytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by removing the pathogenic cytokines is hypothesized to dampen CRS.
Objective:
To evaluate the outcomes of the patients with COVID-19 having CRS being treated with TPE compared to controls on the standard of care.
Methodology:
Retrospective propensity score-matched analysis in a single centre from 1st April to 31st July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS initially. PSM was used to minimize bias from non-randomized treatment assignment. Using PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was done for disease severity, routine standard care and advanced supportive care. Many other Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on Polymerase chain reaction testing.
Results:
After PS-matching, the selected cohort had a median age of 60 years (range 32-73 in TPE, 37-75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days (range 3-22 days' TPE and 3-20 days controls), p = 0.266. Disease severity in both groups was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival was significantly superior in the TPE group (91.1%), 95% CI 78.33-97.76; as compared to PS-matched controls (61.5%), 95% CI 51.29-78.76 (log rank 0.002), p<0.001. Median duration of hospitalization was significantly reduced in the TPE treated group (10 days vs 15 days) (p< 0.01). CRS resolution time was also significantly reduced in the TPE group (6 days vs. 12 days) (p< 0.001). In 71 patients who underwent TPE, the mortality was 0 (n = 43) if TPE was done within the first 12 days of illness while it was 17.9% (deaths 5, n = 28 who received it after 12th day (p = 0.0045).
Conclusion:
An earlier use of TPE was associated with improved overall survival, early CRS resolution and time to discharge compared to SOC for COVID-19 triggered CRS in this selected cohort of PS-matched male patients from one major hospital in Pakistan.
