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THE THERAPEUTIC EFFICACY OF PLASMAPHERESIS FOR SEPSIS WITH MULTIPLE ORGAN FAILURE: A PROPENSITY SCORE-MATCHED
Danyang Yan1, Run Yao1, Xi Xie1
1Department of Blood Transfusion, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan Province, China.
Abstract:
Background: Despite advancements in sepsis treatment, mortality remains high. Plasmapheresis (PE) targeting multiple pathways simultaneously seems to be a potential treatment option, but evidence is insufficient. We aimed to investigate the efficacy of PE for sepsis with multiple organ failure (MOF). Method: Septic patients with MOF were identified from the Medical Information Mart for Intensive Care IV database. Patients who received PE were matched with those receiving conventional therapy via propensity score matching. Regression analyses evaluated the association between PE and outcomes. The Kaplan-Meier (KM) method was used to analyze the survival probability. The generalized additive mixed model investigated early indexes changes' association with treatment modalities and 28-day mortality. Results: Nine hundred six septic patients with MOF were enrolled. After propensity score matching, PE and conventional groups consisted of 60 cases each. Plasmapheresis was associated with a reduced risk of 28-day mortality (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.27-0.94), 1-year mortality (HR, 0.44; 95% CI, 0.26-0.74), and in-hospital mortality (HR, 0.38; 95% CI, 0.20-0.71). The KM curves demonstrated significant differences in survival probability between groups. Compared with the conventional group, the sequential organ failure assessment, norepinephrine dosage, prothrombin time, actate dehydrogenase, total bilirubin, white blood cells, and immature granulocytes in the PE group significantly decreased over time, while platelets, red blood cells, and hemoglobin significantly increased over time. Conclusions: Plasmapheresis demonstrated an association with reduced risks of 28-day, in-hospital and 1-year mortality in septic patients with MOF. Moreover, plasmapheresis might exhibit the potential to improve outcomes by improving organ function, hemodynamics, and restoring several indicators, such as coagulation, anemia, and inflammation.
Insights
Plasmapheresis (PE) may reduce mortality in septic patients with multiple organ failure (MOF). This study found PE associated with lower 28-day, in-hospital, and 1-year mortality rates.
Area of Science:
- Critical Care Medicine
- Nephrology
- Hematology
Background:
- Sepsis with multiple organ failure (MOF) has high mortality despite treatment advancements.
- Plasmapheresis (PE) is a potential therapy targeting multiple pathways, but evidence is limited.
Purpose of the Study:
- To investigate the efficacy of plasmapheresis in septic patients with MOF.
- To evaluate the association between PE and patient outcomes, including mortality and organ function.
Main Methods:
- Retrospective analysis of septic patients with MOF from the MIMIC-IV database.
- Propensity score matching to compare patients receiving PE versus conventional therapy.
- Survival analysis using Kaplan-Meier curves and regression models.
Main Results:
- Plasmapheresis was associated with significantly reduced 28-day, 1-year, and in-hospital mortality.
- Kaplan-Meier analysis showed improved survival probability in the PE group.
- PE improved Sequential Organ Failure Assessment scores and normalized inflammatory markers.
Conclusions:
- Plasmapheresis shows promise in reducing mortality for septic patients with MOF.
- PE may improve organ function, hemodynamics, and indicators of coagulation, anemia, and inflammation.
