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Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients

Year 2023, Volume: 25 Issue: 1, 15 - 20, 30.04.2023

Bilal Aygun Funda Pepedil Tanrikulu Mahmut Bakır Koyuncu

https://doi.org/10.18678/dtfd.1179587

Abstract

Aim: Therapeutic plasma exchange (TPE) is a frequently discussed treatment modality in severe coronavirus disease 2019 (COVID-19) patients. It requires an apheresis device and experienced personnel for the application. In this study, we aimed to reveal the characteristics and clinical outcomes of adult patients with COVID-19 who experienced TPE.
Material and Methods: Adult patients who had undergone TPE in our apheresis unit were retrospectively analyzed and COVID-19-positive cases were included in the study. All the medical information about the cases was obtained from the electronic database and technical details of the procedures were gathered from apheresis unit records.
Results: A total of 80 patients with a median age of 60 (19-85) years were included in the study. Severe pneumonia was present in 98.8% (n=79) of the cases. More than three-quarters of the patients had lymphopenia, critically elevated C-reactive protein (CRP), and D-dimer, and 41.0% (n=32) had high ferritin. The median length of stay in the intensive care unit was 26 (5-124) days. The mortality rate observed on the 14th and 28th days following the TPE procedure was 51.3% (n=41) and 75.0% (n=60), respectively. High ferritin level, multiple organ failure (MOF), and intubation were parameters found to be associated with mortality in the multivariate analysis.
Conclusion: The mortality rate observed in patients with COVID-19 who underwent TPE in our study was similar to the cases in the literature without the procedure, while it has been shown that high ferritin levels, intubation, and the presence of MOF increase the risk of mortality.

Keywords

theurapeutic plasma exchange pneumonia COVID-19

References

  • Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536-44.
  • Gavriatopoulou M, Ntanasis-Stathopoulos I, Korompoki E, Fotiou D, Migkou M, Tzanninis IG, et al. Emerging treatment strategies for COVID-19 infection. Clin Exp Med. 2021;21(2):167-79.
  • Ullah S, Al-Sehemi AG, Klemeš JJ, Saqib S, Gondal SMA, Saqib S, et al. A review of the progress of COVID-19 vaccine development. Duzce Med J. 2021;23 (S1):1-23.
  • Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al; COVID-19 Lombardy ICU Network. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-55.
  • Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-70.
  • Fernández-Zarzoso M, Gómez-Seguí I, de la Rubia J. Therapeutic plasma exchange: Review of current indications. Transfus Apher Sci. 2019;58(3):247-53.
  • Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The eighth special issue. J Clin Apher. 2019;34(3):171-354.
  • Krzych ŁJ, Putowski Z, Czok M, Hofman M. What is the role of therapeutic plasma exchange as an adjunctive treatment in severe COVID-19: A systematic review. Viruses. 2021;13(8):1484.
  • Lu W, Kelley W, Fang DC, Joshi S, Kim Y, Paroder M, et al. The use of therapeutic plasma exchange as adjunctive therapy in the treatment of coronavirus disease 2019: A critical appraisal of the current evidence. J Clin Apher. 2021;36(3):483-91.
  • Gucyetmez B, Atalan HK, Sertdemir I, Cakir U, Telci L. Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study. Crit Care. 2020;24(1):492.
  • Zhang L, Zhai H, Ma S, Chen J, Gao Y. Efficacy of therapeutic plasma exchange in severe COVID-19 patients. Br J Haematol. 2020;190(4):e181-3.
  • Keith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A. A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19. Crit Care. 2020;24(1):128.
  • Stahl K, Bode C, David S. First do no harm-beware the risk of therapeutic plasma exchange in severe COVID-19. Crit Care. 2020;24(1):363.
  • Felsenstein S, Herbert JA, McNamara PS, Hedrich CM. COVID-19: Immunology and treatment options. Clin Immunol. 2020;215:108448.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  • Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-8.
  • Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620-9.
  • Topcu H, Arik YE. The importance of D-dimer, ferritin, CRP and lymphocyte values in determining mortality in COVID-19 disease in Turkey. Clin Lab. 2022;68(5).
  • Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1753466620937175.
  • Bivona G, Agnello L, Ciaccio M. Biomarkers for prognosis and treatment response in COVID-19 patients. Ann Lab Med. 2021;41(6):540-8.
  • Armstrong RA, Kane AD, Kursumovic E, Oglesby FC, Cook TM. Mortality in patients admitted to intensive care with COVID-19: an updated systematic review and meta-analysis of observational studies. Anaesthesia. 2021;76(4):537-48.
  • Ñamendys-Silva SA, Alvarado-Ávila PE, Domínguez-Cherit G, Rivero-Sigarroa E, Sánchez-Hurtado LA, Gutiérrez-Villaseñor A, et al; Mexico COVID-19 Critical Care Collaborative Group. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study. Heart Lung. 2021;50(1):28-32.
  • Teker AG, Emecen AN, Girgin S, Simsek Keskin H, Siyve N, Sezgin E, et al. Epidemiological characteristics of COVID-19 cases in a university hospital in Turkey. Klimik Derg. 2021;34(1):61-8.
  • Cegolon L, Einollahi B, Panahi Y, Imanizadeh S, Rezapour M, Javanbakht M, et al. On therapeutic plasma exchange against severe COVID-19-associated pneumonia: an observational clinical study. Front Nutr. 2022;9:809823.
  • Khamis F, Al-Zakwani I, Al Hashmi S, Al Dowaiki S, Al Bahrani M, Pandak N, et al. Therapeutic plasma exchange in adults with severe COVID-19 infection. Int J Infect Dis. 2020;99:214-8.
  • Keith PD, Scott LK, Weaver KE, Day M, Choe C, Perkins L, et al. Treatment of critically ill coronavirus disease 2019 patients with adjunct therapeutic plasma exchange: a single-center retrospective case series. Crit Care Explor. 2020;2(9):e0223.

Ağır Pnömonili Erişkin COVID-19 Hastalarında Terapötik Plazma Değişimi: Seksen Hastada Tek Merkez Deneyimi

Year 2023, Volume: 25 Issue: 1, 15 - 20, 30.04.2023

Bilal Aygun Funda Pepedil Tanrikulu Mahmut Bakır Koyuncu

https://doi.org/10.18678/dtfd.1179587

Abstract

Amaç: Terapötik plazma değişimi (TPD), ağır düzey koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) hastalarında sıklıkla tartışılmakta olan bir tedavi şeklidir. Uygulanması için deneyimli personele ve aferez cihazına gereksinim vardır. Bu çalışmada, TPD uygulanmış olan erişkin COVID-19 hastalarının özellikleri ve klinik sonlanımlarının ortaya konulması amaçlanmıştır.
Gereç ve Yöntemler: Aferez ünitemizde TPD uygulanmış olan erişkin hastalar geriye dönük olarak incelenmiş ve COVID-19 pozitif olan vakalar bu çalışmaya dahil edilmiştir. Olgulara ait olan tüm tıbbi bilgiler elektronik veri tabanından alınmış ve aferez işlemlerine ait teknik detaylar ise aferez ünitesi kayıtlarından elde edilmiştir.
Bulgular: Bu çalışmaya, ortanca yaşı 60 (19-85) yıl olan toplam 80 hasta dahil edildi. Olguların %98,8 (n=79)’inde ağır pnömoni varlığı söz konusu idi. Tüm olguların dörtte üçünden daha fazlasında lenfopeni, kritik düzeyde C-reaktif protein (CRP) ve D-dimer yüksekliği ile %41,0 (n=32)’inde ise ferritin yüksekliği mevcuttu. Yoğun bakım ünitesinde ortanca kalış süresi 26 (5-124) gündü. TPD işlemini takip eden 14. ve 28. günlerde gözlenen mortalite oranları sırasıyla %51,3 (n=41) ve %75,0 (n=60) idi. Çok değişkenli analizlerde ferritin yüksekliği, çoklu organ yetmezliği (multiple organ failure, MOF) varlığı ve entübasyon ihtiyacı mortalite ile ilişkili olarak bulundu.
Sonuç: Araştırmamızda TPD uygulanan COVID-19’lu hastalar için gözlenen mortalite oranı literatürdeki işlem yapılmayan olgularla benzer bulunurken, bu hastalarda ferritin yüksekliği, entübasyon ve MOF varlığının mortalite riskini artırdığı gösterilmiştir.

Keywords

terapötik plazma değişimi pnömoni COVID-19

References

  • Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536-44.
  • Gavriatopoulou M, Ntanasis-Stathopoulos I, Korompoki E, Fotiou D, Migkou M, Tzanninis IG, et al. Emerging treatment strategies for COVID-19 infection. Clin Exp Med. 2021;21(2):167-79.
  • Ullah S, Al-Sehemi AG, Klemeš JJ, Saqib S, Gondal SMA, Saqib S, et al. A review of the progress of COVID-19 vaccine development. Duzce Med J. 2021;23 (S1):1-23.
  • Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al; COVID-19 Lombardy ICU Network. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-55.
  • Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-70.
  • Fernández-Zarzoso M, Gómez-Seguí I, de la Rubia J. Therapeutic plasma exchange: Review of current indications. Transfus Apher Sci. 2019;58(3):247-53.
  • Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The eighth special issue. J Clin Apher. 2019;34(3):171-354.
  • Krzych ŁJ, Putowski Z, Czok M, Hofman M. What is the role of therapeutic plasma exchange as an adjunctive treatment in severe COVID-19: A systematic review. Viruses. 2021;13(8):1484.
  • Lu W, Kelley W, Fang DC, Joshi S, Kim Y, Paroder M, et al. The use of therapeutic plasma exchange as adjunctive therapy in the treatment of coronavirus disease 2019: A critical appraisal of the current evidence. J Clin Apher. 2021;36(3):483-91.
  • Gucyetmez B, Atalan HK, Sertdemir I, Cakir U, Telci L. Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study. Crit Care. 2020;24(1):492.
  • Zhang L, Zhai H, Ma S, Chen J, Gao Y. Efficacy of therapeutic plasma exchange in severe COVID-19 patients. Br J Haematol. 2020;190(4):e181-3.
  • Keith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A. A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19. Crit Care. 2020;24(1):128.
  • Stahl K, Bode C, David S. First do no harm-beware the risk of therapeutic plasma exchange in severe COVID-19. Crit Care. 2020;24(1):363.
  • Felsenstein S, Herbert JA, McNamara PS, Hedrich CM. COVID-19: Immunology and treatment options. Clin Immunol. 2020;215:108448.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  • Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-8.
  • Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620-9.
  • Topcu H, Arik YE. The importance of D-dimer, ferritin, CRP and lymphocyte values in determining mortality in COVID-19 disease in Turkey. Clin Lab. 2022;68(5).
  • Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1753466620937175.
  • Bivona G, Agnello L, Ciaccio M. Biomarkers for prognosis and treatment response in COVID-19 patients. Ann Lab Med. 2021;41(6):540-8.
  • Armstrong RA, Kane AD, Kursumovic E, Oglesby FC, Cook TM. Mortality in patients admitted to intensive care with COVID-19: an updated systematic review and meta-analysis of observational studies. Anaesthesia. 2021;76(4):537-48.
  • Ñamendys-Silva SA, Alvarado-Ávila PE, Domínguez-Cherit G, Rivero-Sigarroa E, Sánchez-Hurtado LA, Gutiérrez-Villaseñor A, et al; Mexico COVID-19 Critical Care Collaborative Group. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study. Heart Lung. 2021;50(1):28-32.
  • Teker AG, Emecen AN, Girgin S, Simsek Keskin H, Siyve N, Sezgin E, et al. Epidemiological characteristics of COVID-19 cases in a university hospital in Turkey. Klimik Derg. 2021;34(1):61-8.
  • Cegolon L, Einollahi B, Panahi Y, Imanizadeh S, Rezapour M, Javanbakht M, et al. On therapeutic plasma exchange against severe COVID-19-associated pneumonia: an observational clinical study. Front Nutr. 2022;9:809823.
  • Khamis F, Al-Zakwani I, Al Hashmi S, Al Dowaiki S, Al Bahrani M, Pandak N, et al. Therapeutic plasma exchange in adults with severe COVID-19 infection. Int J Infect Dis. 2020;99:214-8.
  • Keith PD, Scott LK, Weaver KE, Day M, Choe C, Perkins L, et al. Treatment of critically ill coronavirus disease 2019 patients with adjunct therapeutic plasma exchange: a single-center retrospective case series. Crit Care Explor. 2020;2(9):e0223.
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Bilal Aygun 0000-0001-7368-8123

Funda Pepedil Tanrikulu 0000-0003-1878-1872

Mahmut Bakır Koyuncu 0000-0002-0507-9294

Publication Date April 30, 2023
Submission Date September 25, 2022
Published in Issue Year 2023 Volume: 25 Issue: 1

Cite

APA Aygun, B., Pepedil Tanrikulu, F., & Koyuncu, M. B. (2023). Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients. Duzce Medical Journal, 25(1), 15-20. https://doi.org/10.18678/dtfd.1179587
AMA Aygun B, Pepedil Tanrikulu F, Koyuncu MB. Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients. Duzce Med J. April 2023;25(1):15-20. doi:10.18678/dtfd.1179587
Chicago Aygun, Bilal, Funda Pepedil Tanrikulu, and Mahmut Bakır Koyuncu. “Therapeutic Plasma Exchange in Adult Patients With COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients”. Duzce Medical Journal 25, no. 1 (April 2023): 15-20. https://doi.org/10.18678/dtfd.1179587.
EndNote Aygun B, Pepedil Tanrikulu F, Koyuncu MB (April 1, 2023) Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients. Duzce Medical Journal 25 1 15–20.
IEEE B. Aygun, F. Pepedil Tanrikulu, and M. B. Koyuncu, “Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients”, Duzce Med J, vol. 25, no. 1, pp. 15–20, 2023, doi: 10.18678/dtfd.1179587.
ISNAD Aygun, Bilal et al. “Therapeutic Plasma Exchange in Adult Patients With COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients”. Duzce Medical Journal 25/1 (April 2023), 15-20. https://doi.org/10.18678/dtfd.1179587.
JAMA Aygun B, Pepedil Tanrikulu F, Koyuncu MB. Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients. Duzce Med J. 2023;25:15–20.
MLA Aygun, Bilal et al. “Therapeutic Plasma Exchange in Adult Patients With COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients”. Duzce Medical Journal, vol. 25, no. 1, 2023, pp. 15-20, doi:10.18678/dtfd.1179587.
Vancouver Aygun B, Pepedil Tanrikulu F, Koyuncu MB. Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients. Duzce Med J. 2023;25(1):15-20.
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