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

Abstract

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.

Exploratory Evaluation of Pre-Treatment Inflammation Profiles in Patients with Colorectal Cancer

“…We excluded patients with chemotherapy or radiotherapy before the surgery because their effects on systemic inflammation (either increased or decreased) were observed for months after treatment, and Zou et al mentioned that adjuvant chemotherapy appeared to be more effective in patients with CRC with high NLR or PLR [ 9 , 10 , 11 ]. Similarly, SARS-CoV-2 infection is associated with a systemic inflammatory response, besides the inflammation associated with the presence of colorectal cancer [ 12 ]; in other words, patients with a history of this infection prior to the intervention or patients who developed an infection during the hospital stay were excluded.…”

An Exploratory Assessment of Pre-Treatment Inflammatory Profiles in Gastric Cancer Patients

“…Inclusion and exclusion criteria were established for the study. Patients with a history of prior SARS CoV-2 infection or who developed infection during hospitalization were excluded due to the strong inflammatory response associated with the virus [13][14][15]. Additionally, as neoadjuvant chemotherapy and radiotherapy significantly impact the inflammatory system, patients who underwent these treatments were excluded based on studies indicating, for example, that a lower Systemic Immune-Inflammation Index (SII) is a positive prognostic factor in this context [16,17].…”