Nusshag Christian, Morath Christian, Speer Claudius, Kaelble Florian, Zeier Martin, Boxberger Monica, Schulze-Schleithoff Elisa, Fiedler Mascha O, Weigand Markus A, Merle Uta
Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany.
Department of Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany.
Crit Care Explor. 2021 Aug 20;3(8):e0517. doi: 10.1097/CCE.0000000000000517. eCollection 2021 Aug.
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%; = 0.044). In a multivariable analysis, the hazard ratio for death was 0.27 (95% CI, 0.11-0.68; = 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.
最近的证据表明，一种多层次炎症综合征是一些病情最严重的2019冠状病毒病患者的驱动因素，这些患者具有与其他过度炎症或自身免疫性疾病重叠的特征。因此，血浆置换被认为是这些患者的潜在治疗方法。
我们描述了血浆置换在具有2019冠状病毒病相关免疫病理学临床和实验室证据的重症患者中的纵向治疗效果和安全性。
设计、背景和参与者：一项对2020年3月至12月在海德堡大学医院接受血浆置换治疗的重症2019冠状病毒病患者的回顾性病例对照研究。将接受血浆置换治疗的患者与在年龄、性别、疾病严重程度和过度炎症综合征特征方面匹配的接受标准治疗的2019冠状病毒病患者进行比较。
评估2019冠状病毒病患者和接受标准治疗的患者中血浆置换后的死亡率以及临床和实验室参数的变化过程。置换的血浆量为每公斤体重50毫升或最多4升。
共有28例重症2019冠状病毒病患者接受了血浆置换治疗，每位患者平均进行了3次血浆置换。血浆置换治疗期间未发生相关并发症。血浆置换后，终末器官损伤和内皮激活的炎症及生化标志物显著降低，同时体温恢复正常、肺功能改善且血管升压药需求减少。最重要的是，这些改善在最后一次血浆置换后得以维持。相比之下，尽管对照组的基线临床和实验室参数相当，但未观察到此类效果。Kaplan-Meier分析显示，血浆置换组的30天生存率高于对照组（67.9%对42.9%；P = 0.044）。在多变量分析中，与标准治疗相比，血浆置换的死亡风险比为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在一部分重症2019冠状病毒病患者中提供了进一步证据，因为它可能逆转复杂的2019冠状病毒病免疫病理学。正在进行随机对照试验以证实这些阳性结果。
