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Efficacy of therapeutic plasma exchange in severe COVID-19 disease: A meta-analysis
Satya Prakash1, Ansuman Sahu1, Suman Sudha Routray1
1Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.
Insights
Therapeutic plasma exchange (TPE) significantly reduces mortality in severe COVID-19 patients. This treatment did not impact intensive care unit (ICU) length of stay compared to standard care.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Immunology
Background:
- Severe COVID-19 is associated with a cytokine storm, a hyperinflammatory state.
- Therapeutic plasma exchange (TPE) is explored as a method to mitigate this storm.
- This meta-analysis evaluates TPE's efficacy in reducing mortality for severe COVID-19.
Approach:
- A comprehensive literature search was conducted across major databases (PubMed, Cochrane, ICTRP).
- A random-effect model analyzed mortality and ICU length of stay data from six studies (382 participants).
- Risk of bias, publication bias, and certainty of evidence were assessed using established tools.
Key Points:
- TPE demonstrated a significant reduction in mortality risk (RR 0.38, 95% CI: 0.28-0.52) in severe COVID-19.
- The certainty of evidence for mortality reduction was moderate.
- No significant difference in ICU length of stay was observed between TPE and standard care (SMD 0.08, 95% CI: -0.38, 0.55).
Conclusions:
- Therapeutic plasma exchange shows a significant survival benefit for patients with severe COVID-19.
- TPE does not significantly alter the duration of intensive care unit stays.
- Further research may explore optimal timing and patient selection for TPE in severe COVID-19.
Background And Objectives:
Therapeutic plasma exchange (TPE) has been used in severe COVID-19 disease to eliminate the cytokine storm. This meta-analysis aims to assess the effectiveness of TPE in reducing mortality in severe COVID-19 disease compared to standard treatment.
Materials And Methods:
A comprehensive literature search was performed in PubMed, the Cochrane database and the International Clinical Trial Registry Platform (ICTRP). The random-effect model was used to calculate the risk ratio and standardized mean difference (SMD) as pooled effect size for the difference in mortality and length of the intensive care unit (ICU) stay. The risk of bias and publication bias were assessed in R version 4.1.0. The certainty of the evidence was calculated using the GradePro tool.
Results:
The database identified 382 participants from six studies, including one randomized control trial. Egger's test did not detect any publication bias (p = 0.178). The random model analysis for mortality evaluated a risk ratio of 0.38 (95% CI: 0.28-0.52) with a significant reduction in the TPE group. The certainty of the evidence was moderate, with a risk ratio of 0.34 (95% CI: 0.24-0.49). Length of ICU stays between TPE versus standard care showed an SMD of 0.08 (95% CI: -0.38, 0.55) and was not significant.
Conclusion:
The length of ICU stay in the TPE group was not different from standard care. However, this meta-analysis revealed a significant benefit of TPE in reducing mortality in severe COVID-19 disease compared to standard treatment.
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