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Treatment with therapeutic plasma exchange in severe COVID-19 pneumonia: A case report and review of the literature.

ABSTRACT: The role of various therapeutic approaches on the clinical improvement in patients with severe COVID-19 is being researched. Few published studies show positive outcomes after the use of therapeutic plasma exchange (TPE). However, additional clinical evidence is required to understand better the role of therapeutic plasma exchange in severe COVID-19 patients. Thereby, we report a case of a 57-year-old female with laboratory-confirmed COVID-19 who was included in clinical trial NCT04592705. Prompt treatment with TPE facilitated improved clinical-laboratory parameters and speedy recovery and prevented further deterioration of the condition or complications. Successful therapeutic strategies in our case suggest that TPE as a therapeutic option in critically ill COVID-19 patients could prevent the disease from worsening and reduce the need for mechanical ventilation and intensive supportive care in these patients.

SUBMITTER: Talalaev M

PROVIDER: S-EPMC8776342 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Treatment with therapeutic plasma exchange in severe COVID-19 pneumonia: A case report and review of the literature.

Talalaev Michael M Pandav Krunal K Mehendale Meghana M Gonzalez Lilian L Yatzkan Maria Campos MC Yatzkan George D GD Perez-Fernandez Javier J

Respiratory medicine case reports 20220121

The role of various therapeutic approaches on the clinical improvement in patients with severe COVID-19 is being researched. Few published studies show positive outcomes after the use of therapeutic plasma exchange (TPE). However, additional clinical evidence is required to understand better the role of therapeutic plasma exchange in severe COVID-19 patients. Thereby, we report a case of a 57-year-old female with laboratory-confirmed COVID-19 who was included in clinical trial NCT04592705. Promp ...[more]

PMID: 35079567

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Project description:BackgroundThere is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs and vaccines. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill patients with COVID-19 is still provisional, and further investigations are needed to confirm its eventual beneficial effects.AimsTo assess the effect of TPE on the risk of mortality in patients with COVID-19-associated pneumonia, using three statistical procedures to rule out any threats to validity.MethodsWe therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with the diagnosis of COVID-19-associated pneumonia confirmed by real-time polymerase chain reaction (RT-qPCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir), and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 l of patients' plasma by a solution, 50% of normal plasma, and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint.ResultsDeaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of structural equation modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name "severity"). Disease severity was lower (Wilkinson rank-sum test p < 0.001) among patients with COVID-19 undergoing TPE (median: -2.82; range: -5.18; 7.96) as compared to those not receiving TPE (median: -1.35; range: -3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as the covariate in Cox regression models. The univariate hazard ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p = 0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p = 0.741) after adjusting for severity.ConclusionsIn this study sample, the lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than the TPE effects.

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Treatment with therapeutic plasma exchange in severe COVID-19 pneumonia: A case report and review of the literature.

Publications

Treatment with therapeutic plasma exchange in severe COVID-19 pneumonia: A case report and review of the literature.

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