How effective is rescue therapeutic plasma exchange in treatment of SARS‐Coronavirus‐2?

Maldonado, Ricardo; Leon, Jose I.; Dansby, Linda M.; Carter, Thomas B.; Radcliff, Lautrec; Diskin, Charles J.

doi:10.1111/1744-9987.13862

Cited by 3 publications

(6 citation statements)

References 39 publications

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“…After filtering the matching studies, we included in this systematic review 13 articles that used TPE as treatment in adult patients with severe COVID-19 [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. The included articles are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The main outcomes extracted from the studied papers observed a total of 485 severely ill patients treated with TPE, with a mortality rate of 18.1% (72 patients). However, the mortality rate is arguably lower than in patients without TPE treatment because only six studies had a control group for comparison [ 19 , 22 , 27 , 28 , 29 , 30 , 31 ], and their results were not always statistically significant. However, the duration of ICU admission was reported as significantly lower than in control groups, averaging six days compared with fourteen days among controls.…”

Section: Resultsmentioning

confidence: 99%

“…The mortality rate varied significantly, which is probably due to the severity of patients involved, from 0.0% in some of the studies [ 24 , 25 , 26 , 28 ] up to 60.0% in the study described by Matsushita et al [ 20 ] and an overall average of 18.1%. Lastly, only four studies reported the odds ratio for improvement after TPE compared with a control group [ 21 , 27 , 29 , 30 , 31 ], but data showed a significant improvement in clinical and inflammatory status of the patients from 17% to 32%.…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection

et al. 2023

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Background and Objectives: Due to the poor prognosis and the very high mortality rate associated with severe SARS-CoV-2 infections, various regimens have been tried to stop the evolution of the inflammatory cascade, such as immunomodulatory therapy and plasma clearance of the acute phase reactants involved. Therefore, the objective of this review was to analyze the effects of using therapeutic plasma exchange (TPE), also known as plasmapheresis, on the inflammatory markers of critically ill COVID-19 patients admitted to the intensive care unit (ICU). Materials and Methods: A thorough scientific database search was performed, and it included a review of articles published on PubMed, Cochrane Database, Scopus, and Web of Science from the beginning of the COVID-19 pandemic in March 2020 until September 2022 that focused on the treatment of SARS-CoV-2 infections using plasma exchange for patients admitted to the ICU. The current study included original articles, reviews, editorials, and short or special communications regarding the topic of interest. Results: A total of 13 articles were selected after satisfying the inclusion criterion of three or more patients enrolled with clinically severe COVID-19 that were eligible for TPE. From the included articles, it was observed that TPE was used as a last-resort salvage therapy that can be regarded as an alternative treatment method when the standard management for these patients fails. TPE significantly decreased the inflammatory status as measured by Interleukin-6 (IL-6), C-reactive protein (CRP), lymphocyte count, and D-dimers, as well as improving the clinical status measured with PaO2/FiO2 and duration of hospitalization. The pooled mortality risk reduction after TPE was 20%. Conclusions: There are sufficient studies and evidence to show that TPE reduces inflammatory mediators and improves coagulation function and the clinical/paraclinical status. Nevertheless, although it was shown that TPE decreases the severe inflammatory status without significant complications, the improvement of survival rate remains unclear.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection

et al. 2023

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“…This procedure has already been used during the COVID-19 pandemic with inconsistent results. Indeed, some studies highlighted a beneficial outcome on mortality ( 28 ) and others an improvement in terms of clinical features ( 29 , 30 ) without any obvious impact on mortality ( 31 , 32 ). However, very few studies investigated cellular responses to TPE and were limited to sepsis ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

The efficacy of therapeutic plasma exchange in COVID-19 patients on endothelial tightness in vitro is hindered by platelet activation

Ebermeyer

Héquet

Bérard

et al. 2023

Front. Cardiovasc. Med.

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Coronavirus disease (COVID)-19 is characterised in particular by vascular inflammation with platelet activation and endothelial dysfunction. During the pandemic, therapeutic plasma exchange (TPE) was used to reduce the cytokine storm in the circulation and delay or prevent ICU admissions. This procedure consists in replacing the inflammatory plasma by fresh frozen plasma from healthy donors and is often used to remove pathogenic molecules from plasma (autoantibodies, immune complexes, toxins, etc.). This study uses an in vitro model of platelet-endothelial cell interactions to assess changes in these interactions by plasma from COVID-19 patients and to determine the extent to which TPE reduces such changes. We noted that exposure of an endothelial monolayer to plasmas from COVID-19 patients post-TPE induced less endothelial permeability compared to COVID-19 control plasmas. Yet, when endothelial cells were co-cultured with healthy platelets and exposed to the plasma, the beneficial effect of TPE on endothelial permeability was somewhat reduced. This was linked to platelet and endothelial phenotypical activation but not with inflammatory molecule secretion. Our work shows that, in parallel to the beneficial removal of inflammatory factors from the circulation, TPE triggers cellular activation which may partly explain the reduction in efficacy in terms of endothelial dysfunction. These findings provide new insights for improving the efficacy of TPE using supporting treatments targeting platelet activation, for instance.

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“…A meta-analysis of several case reports and small series confirmed the beneficial effects of TPE in COVID-19 [ 45 ]. However, a newly published large-scale prospective study of the use of TPE in COVID-19 was not as positive [ 46 ]. They compared 42 patients with SARS-CoV-2 who had failed conventional therapy and were treated with TPE to a control group of 147 patients with acute renal failure from COVID-19 who received only hemodialysis: although there was a survival advantage (43.9% vs. 50.7%, P = 0.004), mortality was still greater than 40%.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy

Vrecko¹,

Večerić-Haler²

2022

J Hematol

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Coronavirus disease 2019 (COVID-19) has spread tremendously since its first appearance in December 2019. Infected individuals can experience a wide range of systemic complications, including thrombotic microangiopathy (TMA). Like the other forms of TMA, COVID-19-associated TMA is characterized by thrombocytopenia, hemolytic anemia, and organ failure (such as acute kidney injury). The role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in COVID-19-associated TMA is most probably dual: it can act either as a trigger to an underlying condition or as a cause of TMA. As opposed to the majority of other reported cases, it may be that in our case COVID-19 was the only cause of TMA. We present a case of a 32-year-old previously healthy man who was treated for acute kidney injury associated with TMA, which we believe was caused by COVID-19. Thrombotic thrombocytopenic purpura, as well as other possible known causes of typical and atypical hemolytic-uremic syndrome, was excluded. During his hospitalization, three negative nasopharyngeal swabs for SARS-CoV-2 were obtained, but serological tests showed the presence of IgG and IgA antibodies. After initial treatment known to be helpful in other forms of TMA (therapeutic plasma exchange and methylprednisolone), his renal function and platelet count recovered completely. Our case illustrates the importance of quickly recognizing this life-threatening complication of COVID-19 and using treatment that has been shown to be beneficial in other forms of TMA. Future studies of the pathophysiology and subsequent targeted treatment of this novel disease are needed.

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How effective is rescue therapeutic plasma exchange in treatment of SARS‐Coronavirus‐2?

Cited by 3 publications

References 39 publications

The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection

The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection

The efficacy of therapeutic plasma exchange in COVID-19 patients on endothelial tightness in vitro is hindered by platelet activation

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy

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