Efficacy of therapeutic plasma exchange in patients with Crimean‐Congo hemorrhagic fever

Abstract

Objective To examine the efficacy of therapeutic plasma exchange (TPE) in patients critically ill with Crimean‐Congo hemorrhagic fever (CCHF). Methods Patients with CCHF received supportive treatment (ST) or TPE. After laboratory and clinical evaluations, the patients were divided into mild, moderate, and severe CCHF groups according to the severity score index (SSI). To assess the efficacy of TPE, the incubation period, time of admission to hospital, hospitalization duration, mortality rate and times to recovery of the platelet count and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were compared between patients receiving ST and TPE. Result A total of 119 confirmed CCHF cases was analyzed. The median SSIs were 7 in the TPE group and 5 in the ST group. The SSI stages, median incubation times and admission times were similar in the two groups. However, the duration of hospitalization was longer in the TPE group. The overall mortality rates were 9% (3 of 33 patients) in the TPE group and 16% (5 of 31 patients) in the ST group; the difference was significant. The platelet count recovered after a median of 6 (4‐7) days in the ST group. Conclusion The mortality rate was lower in the TPE group than in the ST group, but the duration of hospitalization and the time to platelet recovery were longer in the TPE group than in the ST group. TPE did not contribute significantly to the prognosis of patients with intermediate‐severity CCHF. However, TPE might be efficacious in patients with severe CCHF.

Crimean-Congo Hemorrhagic Fever Beyond Ribavirin

“…Table 1 shows the study type, methods, outcomes, and the country of the studies that analyzed the use of plasma exchange for the treatment of CCHF [13][14][15][16].…”

“…Results showed that the mortality rate was lower in the TPE group than in the ST group, but the duration of hospitalization and the time to platelet recovery were longer in the TPE group. In patients with intermediate severity, the TPE was not helpful; however, it might be useful in a severe disease presentation [ 13 ].…”

“…The clinical trial showed decreased mortality with TPE therapy, but hospitalization days and platelet recovery were longer compared to ST [ 13 ]. Additionally, in the case report where ribavirin and TPE were used, a positive outcome was seen [ 15 ].…”

“…In the other case reports, patients who received plasma exchange survived without any sequelae to their health. One case report received ribavirin along with TPE providing a good outcome as well [ 13 , 14 ]. This combination treatment can be an excellent tool to decrease the viral load and therefore improve recovery possibly.…”

“…This combination treatment can be an excellent tool to decrease the viral load and therefore improve recovery possibly. We can conclude that TPE can be defined as a good adjunct to conventional antiviral therapy in severe CCHF cases [ 13 - 16 ].…”