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Efficacy of plasma exchange in children with severe hemophagocytic syndrome: a prospective randomized controlled
Yuan-Hong Yuan1, Hui Zhang, Zheng-Hui Xiao1
1Emergency Center, Hunan Children's Hospital, Changsha 410007,China.
Insights
Plasma exchange (PE) is an effective adjuvant therapy for children with severe hemophagocytic syndrome (HPS). PE improves clinical outcomes and shortens pediatric intensive care unit (PICU) stays, offering a valuable treatment option.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Immunology
Background:
- Hemophagocytic syndrome (HPS) is a life-threatening hyperinflammatory condition.
- Effective adjuvant therapies for severe HPS in children are crucial.
Purpose of the Study:
- To evaluate the efficacy and clinical utility of plasma exchange (PE) as an adjuvant treatment for pediatric severe HPS.
Main Methods:
- A prospective randomized controlled trial involving 40 children with severe HPS.
- Comparison between a group receiving PE plus conventional treatment and a group receiving conventional treatment alone.
- Assessment of clinical symptoms, laboratory markers, treatment outcomes, and prognosis.
Main Results:
- The PE group showed significant improvements in C-reactive protein, procalcitonin, serum protein, alanine aminotransferase, and total bilirubin levels compared to the conventional group.
- The PE group experienced a shorter pediatric intensive care unit (PICU) length of stay and a higher treatment response rate.
- No significant differences were observed in total hospital stay or 3-month mortality between the groups.
Conclusions:
- Plasma exchange serves as an effective adjuvant therapy for children diagnosed with severe HPS.
- PE can ameliorate clinical manifestations, improve key laboratory markers, and reduce PICU hospitalization duration.
- PE presents a potential optional adjuvant therapeutic strategy for severe HPS in pediatric patients.
Objectives:
To investigate the efficacy and application value of plasma exchange as an adjuvant therapy in children with hemophagocytic syndrome (HPS).
Methods:
A prospective randomized controlled trial was designed. Forty children with severe HPS were enrolled, who were treated in the pediatric intensive care unit (PICU) of Hunan Children's Hospital from October 2018 to October 2020. The children were randomly divided into a plasma exchange group and a conventional treatment group using a random number table, with 20 children in each group. The children in the conventional treatment group received etiological treatment and conventional symptomatic supportive treatment, and those in the plasma exchange group received plasma exchange in addition to the treatment in the conventional treatment group. The two groups were compared in terms of general information, clinical symptoms and signs before and after treatment, main laboratory markers, treatment outcome, and prognosis.
Results:
Before treatment, there were no significant differences between the two groups in gender, age, course of the disease before admission, etiological composition, pediatric critical illness score, involvement of organ or system functions, and laboratory markers (P>0.05). After 7 days of treatment, both groups had remission and improvement in clinical symptoms and signs. After treatment, the plasma exchange group had significantly lower levels of C-reactive protein, procalcitonin, and serum protein levels than the conventional treatment group (P<0.05). The plasma exchange group also had significantly lower levels of alanine aminotransferase and total bilirubin than the conventional treatment group (P<0.05). The length of stay in the PICU in the plasma exchange group was significantly shorter than that in the conventional treatment group (P<0.05). The plasma exchange group had a significantly higher treatment response rate than the conventional treatment group (P<0.05). There were no significant differences between the two groups in the total length of hospital stay and 3-month mortality rate (P>0.05).
Conclusions:
Plasma exchange as an adjuvant therapy is effective for children with severe HPS. It can improve clinical symptoms and signs and some laboratory markers and shorten the length of stay in the PICU, and therefore, it may become an optional adjuvant therapy for children with severe HPS.
