Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions
The high mortality risk in severe SARS-CoV-2 infections is tightly correlated to the extreme elevation of inflammatory markers. This acute accumulation of inflammatory proteins can be cleared using plasma exchange (TPE), commonly known as plasmapheresis, although the available data on performing TPE...
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| Format: | Article |
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MDPI AG
2023-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/5/1743 |
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| author | Tamara Mirela Porosnicu Dorel Sandesc Daniel Jipa Ciprian Gindac Cristian Oancea Felix Bratosin Roxana Manuela Fericean Shiva Charana Kodimala Ciprian Nicolae Pilut Laura Alexandra Nussbaum Ioan Ovidiu Sirbu |
| author_facet | Tamara Mirela Porosnicu Dorel Sandesc Daniel Jipa Ciprian Gindac Cristian Oancea Felix Bratosin Roxana Manuela Fericean Shiva Charana Kodimala Ciprian Nicolae Pilut Laura Alexandra Nussbaum Ioan Ovidiu Sirbu |
| author_sort | Tamara Mirela Porosnicu |
| collection | DOAJ |
| description | The high mortality risk in severe SARS-CoV-2 infections is tightly correlated to the extreme elevation of inflammatory markers. This acute accumulation of inflammatory proteins can be cleared using plasma exchange (TPE), commonly known as plasmapheresis, although the available data on performing TPE in COVID-19 patients is limited regarding the optimal treatment protocol. The purpose for this study was to examine the efficacy and outcomes of TPE based on different treatment methods. A thorough database search was performed to identify patients from the Intensive Care Unit (ICU) of the Clinical Hospital of Infectious Diseases and Pneumology between March 2020 and March 2022 with severe COVID-19 that underwent at least one session of TPE. A total of 65 patients satisfied the inclusion criteria and were eligible for TPE as a last resort therapy. Of these, 41 patients received 1 TPE session, 13 received 2 TPE sessions, and the remaining 11 received more than 2 TPE sessions. It was observed that IL-6, CRP, and ESR decreased significantly after all sessions were performed in all three groups, with the highest decrease of IL-6 in those who received >2 TPE sessions (from 305.5 pg/mL to 156.0 pg/mL). Interestingly, there was a significant increase in leucocyte levels after TPE, but there was no significant difference in MAP changes, SOFA score, APACHE 2 score, or the PaO2/FiO2 ratio. The ROX index was significantly higher among the patients who underwent more than two TPE sessions, with an average of 11.4, compared to 6.5 in group 1 and 7.4 in group 2, which increased significantly after TPE. Nevertheless, the mortality rate was very high (72.3%), and the Kaplan–Meier analysis identified no significant difference in survival according to the number of TPE sessions. TPE can be used as last resort salvage therapy that can be regarded as an alternative treatment method when the standard management of these patients fails. It significantly decreases the inflammatory status measured via IL-6, CRP, and WBC, as well as demonstrating an improvement of the clinical status measured via PaO2/FiO2, and duration of hospitalization. However, the survival rate does not seem to change with the number of TPE sessions. Based on the survival analysis, one session of TPE as last resort treatment in patients with severe COVID-19 proved to have the same effect as repeated TPE sessions of 2 or more. |
| first_indexed | 2024-03-11T07:20:22Z |
| format | Article |
| id | doaj.art-37cb9582ce3b4cb58f949735e15a90e2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T07:20:22Z |
| publishDate | 2023-02-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-37cb9582ce3b4cb58f949735e15a90e22023-11-17T07:57:50ZengMDPI AGJournal of Clinical Medicine2077-03832023-02-01125174310.3390/jcm12051743Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE SessionsTamara Mirela Porosnicu0Dorel Sandesc1Daniel Jipa2Ciprian Gindac3Cristian Oancea4Felix Bratosin5Roxana Manuela Fericean6Shiva Charana Kodimala7Ciprian Nicolae Pilut8Laura Alexandra Nussbaum9Ioan Ovidiu Sirbu10Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaDepartment of Anesthesia and Intensive Care, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaIntensive Care Unit, “Pius Brinzeu” Emergency Clinical Hospital, 300041 Timisoara, RomaniaIntensive Care Unit, “Pius Brinzeu” Emergency Clinical Hospital, 300041 Timisoara, RomaniaCenter for Research and Innovation in Precision Medicine of Respiratory Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaDepartment XIII, Discipline of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaDepartment XIII, Discipline of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaMediCiti Institute of Medical Sciences, NTR University of Health Sciences, Hyderabad 501401, IndiaDepartment of Microbiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaDepartment of Neurosciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaCenter for Complex Network Sciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, RomaniaThe high mortality risk in severe SARS-CoV-2 infections is tightly correlated to the extreme elevation of inflammatory markers. This acute accumulation of inflammatory proteins can be cleared using plasma exchange (TPE), commonly known as plasmapheresis, although the available data on performing TPE in COVID-19 patients is limited regarding the optimal treatment protocol. The purpose for this study was to examine the efficacy and outcomes of TPE based on different treatment methods. A thorough database search was performed to identify patients from the Intensive Care Unit (ICU) of the Clinical Hospital of Infectious Diseases and Pneumology between March 2020 and March 2022 with severe COVID-19 that underwent at least one session of TPE. A total of 65 patients satisfied the inclusion criteria and were eligible for TPE as a last resort therapy. Of these, 41 patients received 1 TPE session, 13 received 2 TPE sessions, and the remaining 11 received more than 2 TPE sessions. It was observed that IL-6, CRP, and ESR decreased significantly after all sessions were performed in all three groups, with the highest decrease of IL-6 in those who received >2 TPE sessions (from 305.5 pg/mL to 156.0 pg/mL). Interestingly, there was a significant increase in leucocyte levels after TPE, but there was no significant difference in MAP changes, SOFA score, APACHE 2 score, or the PaO2/FiO2 ratio. The ROX index was significantly higher among the patients who underwent more than two TPE sessions, with an average of 11.4, compared to 6.5 in group 1 and 7.4 in group 2, which increased significantly after TPE. Nevertheless, the mortality rate was very high (72.3%), and the Kaplan–Meier analysis identified no significant difference in survival according to the number of TPE sessions. TPE can be used as last resort salvage therapy that can be regarded as an alternative treatment method when the standard management of these patients fails. It significantly decreases the inflammatory status measured via IL-6, CRP, and WBC, as well as demonstrating an improvement of the clinical status measured via PaO2/FiO2, and duration of hospitalization. However, the survival rate does not seem to change with the number of TPE sessions. Based on the survival analysis, one session of TPE as last resort treatment in patients with severe COVID-19 proved to have the same effect as repeated TPE sessions of 2 or more.https://www.mdpi.com/2077-0383/12/5/1743therapeutic plasma exchangeplasmapheresisSARS-CoV-2COVID-19 |
| spellingShingle | Tamara Mirela Porosnicu Dorel Sandesc Daniel Jipa Ciprian Gindac Cristian Oancea Felix Bratosin Roxana Manuela Fericean Shiva Charana Kodimala Ciprian Nicolae Pilut Laura Alexandra Nussbaum Ioan Ovidiu Sirbu Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions Journal of Clinical Medicine therapeutic plasma exchange plasmapheresis SARS-CoV-2 COVID-19 |
| title | Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions |
| title_full | Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions |
| title_fullStr | Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions |
| title_full_unstemmed | Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions |
| title_short | Assessing the Outcomes of Patients with Severe SARS-CoV-2 Infection after Therapeutic Plasma Exchange by Number of TPE Sessions |
| title_sort | assessing the outcomes of patients with severe sars cov 2 infection after therapeutic plasma exchange by number of tpe sessions |
| topic | therapeutic plasma exchange plasmapheresis SARS-CoV-2 COVID-19 |
| url | https://www.mdpi.com/2077-0383/12/5/1743 |
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