The association between therapeutic plasma exchange and the risk of mortality among patients critically ill with COVID-19: a meta-analysis

Wardhani, Shinta Oktya; Fajar, Jonny Karunia; Soegiarto, Gatot; Wulandari, Laksmi; Maliga, Helnida Anggun; Ilmawan, Muhammad; Merysa, Risna; Simamora, Arlentina Bentivolia; Aini, Qurrata; Noviantari, Komang; Lestari, Ayu; Harnila, Maria Yoheni; Syafi’i, Imam; Djianzonie, Jane A; Siagian, Nenci; Nining, Sri; Hanim, Risyda Zakiyah; Wahyuni, Wahyuni; Aulia, Fitri; Juliansyah, Juliansyah; Mahmud, Reflin; Tamara, Fredo; Mahendra, Aditya Indra; Wowor, Amanda C; Baladraf, Fikri; Hadinata, Ponda Hernest; Ikkeputri, Adhityari; Nadya, Hana; Kartini, Dessy Aprilia; Husnah, Milda; Nainu, Firzan; Harapan, Harapan

doi:10.12688/f1000research.74972.1

Cited by 4 publications

(7 citation statements)

References 27 publications

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“…Among the patients, 29 were men, and 31 were women. The mean age of the patients was 67.3 + 12 years (24-90 years), and the mean body mass index (BMI) was 25.5 ± 3 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), consisting of 25.8 ± 2.9 in the male and 25.2 ± 3.1 in the female patients (P = 0.47). The mean hemoglobin level was 12.9 ± 1.6 g/dl in the men and 11.7 ± 1.5 g/dl in the women (P = 0.008).…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Red Blood Cell Exchange as Adjunctive Treatment for Hypoxemia and Survival Rate of Patients With Severe Coronavirus-2 Disease: An Open-Labeled Phase 2 Randomized Clinical Trial

et al. 2022

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BackgroundSevere acute respiratory syndrome (SARS) coronavirus-2 may infect red blood cells (RBCs) and impact oxygenation. We aimed to evaluate the efficacy of RBC exchange as an adjunctive treatment for hypoxemia and the survival rate of patients with severe coronavirus disease 2019 (COVID-19).MethodsIn a randomized clinical trial, we divided sixty patients with severe COVID-19 into two groups. The intervention group received the standard treatment of severe COVID-19 with RBC exchange three to four times in 2 days. The control group only received the standard treatment. Our primary outcomes were improving hypoxemia in 7 days, recovery or discharge, and death in 28 days. We conducted Chi-square test, independent samples t-test, and Fisher’s exact test to analyze the results. The ethical committee of Aja University of Medical Sciences approved the study (IR.AJAUMS.REC.1399.054), and the Iranian clinical trial registration organization registered it (IRCT20160316027081N2).ResultsTwenty-nine men and thirty-one women with a mean age of 67.5 years entered the study. The frequency of hypertension and diabetes mellitus was 86.7 and 68.3%, respectively. The most common symptoms of severe COVID-19 were dyspnea (91.6%), cough (75%), and fever (66.6%). Our results showed that hypoxemia improved in 21 of the 30 patients (70%) in the intervention group and 10 of the 30 patients (33.3%) in the control group (P < 0.004). The recovery and discharge rates were 19 of 30 patients (63.3%) in the intervention group and 2 of 30 patients (6.7%) in the control group (P < 0.001).ConclusionThe RBC exchange improved the oxygenation and survival rate in patients with severe COVID-19.

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Section: Resultsmentioning

confidence: 99%

Efficacy of Red Blood Cell Exchange as Adjunctive Treatment for Hypoxemia and Survival Rate of Patients With Severe Coronavirus-2 Disease: An Open-Labeled Phase 2 Randomized Clinical Trial

et al. 2022

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“…The aim of this meta‐analysis was not to investigate the impact of TPE on mortality, ICU stays, and mechanical ventilation only but also to explore the impact of TPE on the key disease pathogenesis mediators such as IL‐6, ferritin, D‐dimer, LDH, and other disease biomarkers. Furthermore, the study includes a larger number of studies and therefore, more patients than the two previously reported systematic reviews 26,27 . A comparison between this study and the two previously published systematic reviews is shown in (Table 4).…”

Section: Discussionmentioning

confidence: 97%

“…However, published studies are conflicting and inconsistent. The published meta‐analyses had different results and had not evaluated all outcomes that should be evaluated, although the small number of studies included 26,27 . Moreover, multiple studies were published and not included in the previous meta‐analyses.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of therapeutic plasma exchange in patients with severe COVID‐19: A systematic review and meta‐analysis

Abdelwahab

Diab

Elsaeidy

et al. 2023

Reviews in Medical Virology

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We conducted this systematic review and meta‐analysis to evaluate the existing evidence and to quantitatively synthesise evidence on the impact of therapeutic plasma exchange (TPE) on severe COVID‐19 patients. This systematic review and meta‐analysis protocol was prospectively registered on PROSPERO (CRD42022316331). We systemically searched six electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, http://clinicaltrial.gov, and Cochrane Central Register of Controlled Trials) from inception until 1 June 2022. We included studies comparing patients who received TPE versus those who received the standard treatment. For risk of bias assessment, we used the Cochrane risk of bias assessment tool, the ROBINS1 tool, and the Newcastle Ottawa scale for RCTs, non‐RCTs, and observational studies, respectively. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as risk ratio in the random effect model with the corresponding 95% confidence intervals (CI). Thirteen studies (one randomized controlled trials (RCT) and 12 non‐RCTs) were included in the meta‐analysis, with a total of 829 patients. There is a moderate‐quality evidence from one RCT that TPE reduces the lactic dehydrogenase (LDH) levels (SMD −1.09, 95% CI [−1.59 to −0.60]), D‐dimer (SMD −0.86, 95% CI [−1.34 to −0.37]), and ferritin (SMD −0.70, 95% CI [−1.18 to −0.23]), and increases the absolute lymphocyte count (SMD 0.54, 95% CI [0.07–1.01]), There is low‐quality evidence from mixed‐design studies that TPE was associated with lower mortality (relative risk 0.51, 95% CI [0.35–0.74]), lower IL‐6 (SMD −0.91, 95% CI [−1.19 to −0.63]), and lower ferritin (SMD −0.51, 95% CI [−0.80 to −0.22]) compared to the standard control. Among severely affected COVID‐19 patients, TPE might provide benefits such as decreasing the mortality rate, LDH, D‐dimer, IL‐6, and ferritin, in addition to increasing the higher absolute lymphocyte count. Further well‐designed RCTs are needed.

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“…Increasing evidence supports the incremental efficacy of corticosteroids alone or in combination with tocilizumab/JAKi in moderate to severe and critical COVID-19 [ 4 , 35 , 36 ]. Therapeutic plasma exchange also appears to have potential benefits in reducing the risk of mortality among critically ill COVID-19 patients [ 37 ]. Of this therapeutic arsenal, tocilizumab is the most studied drug in the setting of severe COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab

Ramón

Zaragozá

Torres

et al. 2022

JCM

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Among the IL-6 inhibitors, tocilizumab is the most widely used therapeutic option in patients with SARS-CoV-2-associated severe respiratory failure (SRF). The aim of our study was to provide evidence on predictors of poor outcome in patients with COVID-19 treated with tocilizumab, using machine learning (ML) techniques. We conducted a retrospective study, analyzing the clinical, laboratory and sociodemographic data of patients admitted for severe COVID-19 with SRF, treated with tocilizumab. The extreme gradient boost (XGB) method had the highest balanced accuracy (93.16%). The factors associated with a worse outcome of tocilizumab use in terms of mortality were: baseline situation at the start of tocilizumab treatment requiring invasive mechanical ventilation (IMV), elevated ferritin, lactate dehydrogenase (LDH) and glutamate-pyruvate transaminase (GPT), lymphopenia, and low PaFi [ratio between arterial oxygen pressure and inspired oxygen fraction (PaO2/FiO2)] values. The factors associated with a worse outcome of tocilizumab use in terms of hospital stay were: baseline situation at the start of tocilizumab treatment requiring IMV or supplemental oxygen, elevated levels of ferritin, glutamate-oxaloacetate transaminase (GOT), GPT, C-reactive protein (CRP), LDH, lymphopenia, and low PaFi values. In our study focused on patients with severe COVID-19 treated with tocilizumab, the factors that were weighted most strongly in predicting worse clinical outcome were baseline status at the start of tocilizumab treatment requiring IMV and hyperferritinemia.

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The association between therapeutic plasma exchange and the risk of mortality among patients critically ill with COVID-19: a meta-analysis

Cited by 4 publications

References 27 publications

Efficacy of Red Blood Cell Exchange as Adjunctive Treatment for Hypoxemia and Survival Rate of Patients With Severe Coronavirus-2 Disease: An Open-Labeled Phase 2 Randomized Clinical Trial

Efficacy of Red Blood Cell Exchange as Adjunctive Treatment for Hypoxemia and Survival Rate of Patients With Severe Coronavirus-2 Disease: An Open-Labeled Phase 2 Randomized Clinical Trial

Efficacy of therapeutic plasma exchange in patients with severe COVID‐19: A systematic review and meta‐analysis

Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab

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