Plasma Exchange in Patients With Severe Coronavirus Disease 2019: A Single-Center Experience.
Plasma Exchange in Patients With Severe Coronavirus Disease 2019: A Single-Center Experience.
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DOI：
10.1097/cce.0000000000000517
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发表时间：
2021-08
影响因子：
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通讯作者：
Merle U
中科院分区：
文献类型：
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作者：
Nusshag C;Morath C;Speer C;Kaelble F;Zeier M;Boxberger M;Schulze-Schleithoff E;Fiedler MO;Weigand MA;Merle U
补充数字内容可在文本中找到。最近的证据表明，在一些最严重的2019冠状病毒病患者中，多级炎症综合征是一个驱动因素，这些患者与其他高炎症或自身免疫性疾病有重叠的特征。因此，血浆置换被认为是这些患者的潜在治疗方法。我们对具有2019冠状病毒病相关免疫病理临床和实验室证据的危重患者进行血浆置换的纵向疗效和安全性分析。2020年3月至12月在海德堡大学医院接受血浆置换治疗的2019冠状病毒病危重患者的回顾性病例对照研究将血浆交换治疗的患者与接受年龄、性别、疾病严重程度和高炎症综合征特征匹配的标准治疗的2019冠状病毒病患者进行比较。评估2019冠状病毒病患者和标准治疗患者血浆置换后的死亡率、临床过程和实验室参数。血浆量为每公斤体重50毫升或最多4升。总共有28名2019冠状病毒病危重患者接受了平均每名患者3次血浆置换手术。血浆交换治疗无相关并发症发生。血浆交换后，终末器官损伤和内皮活化的炎症和生化指标显著降低，体温正常化，肺功能改善，血管加压素需求降低。最重要的是，这些改善在最后一次等离子体交换后保持不变。相比之下，在对照组中没有观察到这种影响，尽管基线临床和实验室参数是可比的。Kaplan-Meier分析显示血浆置换组30天生存率较对照组提高（67.9% vs 42.9%; p = 0.044）。在多变量分析中，血浆置换与标准治疗的死亡风险比为0.27 （95% CI, 0.11-0.68; p = 0.005）。我们的数据为血浆置换作为一种新的治疗策略提供了进一步的证据，它有可能逆转2019年冠状病毒病的复杂免疫病理。正在进行随机对照试验以证实这些积极结果。
Supplemental Digital Content is available in the text. Recent evidence suggests a multilevel inflammatory syndrome as a driving factor in some of the most severely ill coronavirus disease 2019 patients with overlapping features to other hyperinflammatory or autoimmune diseases. Therefore, plasma exchange is considered as potential therapy in these patients. We characterize the longitudinal therapeutic efficacy and safety profile of plasma exchange in critically ill patients with clinical and laboratory evidences of coronavirus disease 2019–related immunopathology. A retropsective case-control study of critically ill coronavirus disease 2019 patients treated with plasma exchange at Heidelberg University Hospital between March and December 2020. Plasma exchange–treated patients were compared with coronavirus disease 2019 patients on standard therapy matched for age, gender, disease severity, and features of hyperinflammatory syndrome. Mortality rate and course of clinical and laboratory parameters in response to plasma exchange were assessed in coronavirus disease 2019 patients and in patients on standard care. A plasma volume of 50 mL per kg body weight or a maximum of 4 L was exchanged. In total, 28 critically ill coronavirus disease 2019 patients were treated with a median of three plasma exchange procedures per patient. No relevant complications occurred during plasma exchange therapy. Inflammatory and biochemical markers of end-organ damage and endothelial activation were significantly reduced following plasma exchange together with normalization of body temperature, improved pulmonary function, and reduced vasopressor demand. Most importantly, these improvements were maintained after the last plasma exchange. In contrast, no such effects were observed in the control group, although baseline clinical and laboratory parameters were comparable. Kaplan-Meier analysis showed improved 30-day survival in the plasma exchange group compared with the control group (67.9% vs 42.9%; p = 0.044). In a multivariable analysis, the hazard ratio for death was 0.27 (95% CI, 0.11–0.68; p = 0.005) with plasma exchange versus standard care. Our data provide further evidence for plasma exchange as a novel therapeutic strategy in a subset of critically ill coronavirus disease 2019 patients by potentially reversing the complex coronavirus disease 2019 immunopathology. Randomized controlled trials are underway to confirm these positive results.