Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil.
Duke University School of Medicine, Durham, North Carolina, USA.
Transfusion. 2022 Feb;62(2):386-395. doi: 10.1111/trf.16769. Epub 2021 Dec 18.
Although therapeutic plasma exchange (TPE) is associated with hemostatic abnormalities, its impact on bleeding outcomes is unknown. Therefore, the main study objective was to determine bleeding outcomes of inpatients treated with TPE.
In a cross-sectional analysis of the National Inpatient Sample (NIS), discharges were identified with 10 common TPE-treated conditions. A 1:3 propensity-matched analysis of TPE- to non-TPE-treated discharges was performed. The primary outcome was major bleeding and secondary outcomes were packed red blood cell (PRBC) transfusion, mortality, disposition, hospital length of stay (LOS), and charges. Multivariable regression analyses were used to examine the association between TPE and study outcomes.
The study population was 15,964 discharges, of which 3991 were TPE- treated. The prevalence of major bleeding was low (5.4%). When compared to non-TPE discharges, TPE had a significant and positive association with major bleeding (OR = 1.37, 95% CI: 1.16-1.63, p = .0003). TPE was also associated with PRBC transfusion (OR = 1.66, 95% CI: 1.42-1.94, p < .0001), in-hospital mortality (OR = 1.45, 95% CI: 1.10-1.90, p = .0008), hospital length of stay (12.45 [95% CI: 11.95-12.97] vs. 7.38 [95% CI: 7.12-7.65] days, p < .0001) and total charges, ($125,123 [95% CI: $119,220-$131,317] vs. $61,953 [95% CI: $59,391-$64,625], p < .0001), and disposition to non-self-care (OR = 1.29, 95% CI: 1.19-1.39, p < .0001).
The use of TPE in the inpatient setting is positively associated with bleeding; however, with low prevalence. Future studies should address risk factors that predispose patients to TPE-associated bleeding.
尽管治疗性血浆置换（TPE）与止血异常有关，但它对出血结局的影响尚不清楚。因此，主要研究目的是确定接受 TPE 治疗的住院患者的出血结局。
在国家住院患者样本（NIS）的横断面分析中，确定了 10 种常见 TPE 治疗情况的出院患者。对 TPE 治疗和非 TPE 治疗出院患者进行了 1:3 倾向匹配分析。主要结局是大出血，次要结局是输红细胞悬液（PRBC）、死亡率、处置、住院时间（LOS）和费用。多变量回归分析用于检查 TPE 与研究结局之间的关联。
研究人群为 15964 例出院患者，其中 3991 例接受 TPE 治疗。大出血的发生率较低（5.4%）。与非 TPE 出院患者相比，TPE 与大出血有显著正相关（OR=1.37，95%CI：1.16-1.63，p=0.0003）。TPE 还与 PRBC 输血（OR=1.66，95%CI：1.42-1.94，p<0.0001）、住院内死亡率（OR=1.45，95%CI：1.10-1.90，p=0.0008）、住院时间（12.45[95%CI：11.95-12.97]vs.7.38[95%CI：7.12-7.65]天，p<0.0001）和总费用（$125123[95%CI：$119220-$131317]vs.$61953[95%CI：$59391-$64625]，p<0.0001）以及非自我护理处置（OR=1.29，95%CI：1.19-1.39，p<0.0001）有关。
TPE 在住院环境中的使用与出血呈正相关，但出血发生率较低。未来的研究应解决使患者易发生 TPE 相关出血的风险因素。
