Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts, USA.
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Rev Med Virol. 2023 May;33(3):e2435. doi: 10.1002/rmv.2435. Epub 2023 Mar 11.
We conducted this systematic review and meta-analysis to evaluate the existing evidence and to quantitatively synthesise evidence on the impact of therapeutic plasma exchange (TPE) on severe COVID-19 patients. This systematic review and meta-analysis protocol was prospectively registered on PROSPERO (CRD42022316331). We systemically searched six electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, clinicaltrial.gov, and Cochrane Central Register of Controlled Trials) from inception until 1 June 2022. We included studies comparing patients who received TPE versus those who received the standard treatment. For risk of bias assessment, we used the Cochrane risk of bias assessment tool, the ROBINS1 tool, and the Newcastle Ottawa scale for RCTs, non-RCTs, and observational studies, respectively. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as risk ratio in the random effect model with the corresponding 95% confidence intervals (CI). Thirteen studies (one randomized controlled trials (RCT) and 12 non-RCTs) were included in the meta-analysis, with a total of 829 patients. There is a moderate-quality evidence from one RCT that TPE reduces the lactic dehydrogenase (LDH) levels (SMD -1.09, 95% CI [-1.59 to -0.60]), D-dimer (SMD -0.86, 95% CI [-1.34 to -0.37]), and ferritin (SMD -0.70, 95% CI [-1.18 to -0.23]), and increases the absolute lymphocyte count (SMD 0.54, 95% CI [0.07-1.01]), There is low-quality evidence from mixed-design studies that TPE was associated with lower mortality (relative risk 0.51, 95% CI [0.35-0.74]), lower IL-6 (SMD -0.91, 95% CI [-1.19 to -0.63]), and lower ferritin (SMD -0.51, 95% CI [-0.80 to -0.22]) compared to the standard control. Among severely affected COVID-19 patients, TPE might provide benefits such as decreasing the mortality rate, LDH, D-dimer, IL-6, and ferritin, in addition to increasing the higher absolute lymphocyte count. Further well-designed RCTs are needed.
我们进行了这项系统评价和荟萃分析，以评估现有证据，并定量综合治疗性血浆置换（TPE）对严重 COVID-19 患者的影响。本系统评价和荟萃分析方案已在 PROSPERO（CRD42022316331）上进行了前瞻性注册。我们系统地检索了六个电子数据库（PubMed、Scopus、Web of Science、ScienceDirect、clinicaltrial.gov 和 Cochrane 对照试验中心注册库），从开始到 2022 年 6 月 1 日。我们纳入了比较接受 TPE 与接受标准治疗的患者的研究。对于风险偏倚评估，我们分别使用 Cochrane 风险偏倚评估工具、ROBINS1 工具和纽卡斯尔-渥太华量表对 RCT、非 RCT 和观察性研究进行评估。连续数据采用标准化均数差（SMD）进行汇总，二分类数据采用随机效应模型汇总风险比，并用相应的 95%置信区间（CI）表示。荟萃分析纳入了 13 项研究（1 项随机对照试验（RCT）和 12 项非 RCT），共 829 名患者。一项 RCT 提供了中等质量证据，表明 TPE 可降低乳酸脱氢酶（LDH）水平（SMD -1.09，95%CI [-1.59 至 -0.60]）、D-二聚体（SMD -0.86，95%CI [-1.34 至 -0.37]）和铁蛋白（SMD -0.70，95%CI [-1.18 至 -0.23]），并增加绝对淋巴细胞计数（SMD 0.54，95%CI [0.07-1.01]）。混合设计研究提供了低质量证据，表明与标准对照组相比，TPE 与较低的死亡率（相对风险 0.51，95%CI [0.35-0.74]）、较低的白细胞介素 6（SMD -0.91，95%CI [-1.19 至 -0.63]）和较低的铁蛋白（SMD -0.51，95%CI [-0.80 至 -0.22]）相关。在严重 COVID-19 患者中，TPE 可能会带来益处，如降低死亡率、LDH、D-二聚体、白细胞介素 6 和铁蛋白，同时增加更高的绝对淋巴细胞计数。需要进一步设计良好的 RCT 来验证。
