Therapeutic plasma exchange in adults with severe COVID-19 infection

Faryal Khamis, Ibrahim Al-Zakwani, Sabria Al Hashmi, Samata Al Dowaiki, Maher Al Bahrani, Nenad Pandak, Huda Al Khalili, Ziad Memish, Faryal Khamis, Ibrahim Al-Zakwani, Sabria Al Hashmi, Samata Al Dowaiki, Maher Al Bahrani, Nenad Pandak, Huda Al Khalili, Ziad Memish

Abstract

Objective: To evaluate the therapeutic use of plasma exchange in COVID-19 patients compared to controls.

Methods: A case series of critically ill adult men and non-pregnant women, ≥18 years of age, with laboratory-confirmed COVID-19, was studied at the Royal Hospital, Oman, from April 17 to May 11, 2020. Therapeutic plasma exchange (TPE) was performed on patients admitted to the intensive care unit (ICU) with confirmed or imminent acute respiratory distress syndrome (ARDS) or severe pneumonia. The analysis was performed using univariate statistics.

Results: A total of 31 COVID-19 patients were included with an overall mean age of 51±15 years (range: 27-76 years); 90% (n=28) were males, and 35% (n=11) of the patients had TPE as a mode of treatment. The TPE group was associated with higher extubation rates than the non-TPE cohort (73% versus 20%; p=0.018). Additionally, patients on TPE had a lower 14 days (0 versus 35%; p=0.033) and 28 days (0 versus 35%; p=0.033) post plasma exchange mortality compared to patients not on TPE. However, all-cause mortality was only marginally lower in the TPE group compared to the non-TPE group (9.1% versus 45%; p=0.055; power=66%). Laboratory and ventilatory parameters also improved post TPE (n = 11).

Conclusions: The use of TPE in severe COVID-19 patients has been associated with improved outcomes, however, randomized controlled clinical trials are warranted to draw final, conclusive findings.

Keywords: COVID-19 infection; Cytokine release syndrome; Plasma exchange; Pneumonia; SARS-CoV-2; Severe acute respiratory distress syndrome.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

References

    1. ARDS Definition Task Force, Ranieri V.M., Rubenfeld G.D. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–2533.
    1. Busund R., Koukline V., Utrobin U., Nedashkovsky E. Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial. Intensive Care Med. 2002;28:1434–1439.
    1. Chang J.C. Sepsis and septic shock: endothelial molecular pathogenesis associated with vascular microthrombotic disease. Thromb J. 2019;17:10.
    1. Chen G., Wu D., Guo W. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2019;130:2620–2629.
    1. Chen N., Zhou M., Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513.
    1. Felsenstein S., Herbert J.A., McNamara P.S., Hedrich C.M. COVID-19: Immunology and treatment options. Clin Immunol. 2020;215:108448.
    1. Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506.
    1. Joyner M., Scott Wright R., Fairweather D. Early safety indicators of COVID-19 convalescent plasma in 5,000 patients. medRxiv. 2020 doi: 10.1101/2020.05.12.20099879. 05.12.20099879.
    1. 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;24:128.
    1. Keith P., Wells A., Hodges J. 2020. The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock With Multiple Organ Failure: a Single Center Retrospective Review. Available at: [Accessed 1 June 2020]
    1. Khamis F., Al-Zakwani I., Al Naamani H. Clinical characteristics and outcomes of the first 63 adult patients hospitalized with COVID-19: an experience from Oman. J Infect Public Health. 2020 doi: 10.1016/j.jiph.2020.06.002.
    1. Knaup H., Stahl K., Schmidt B.M.W. Early therapeutic plasma exchange in septic shock: a prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers. Crit Care. 2018;22:285.
    1. Ma J., Xia P., Zhou Y. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clin Immunol. 2020;214:108408.
    1. Ministry of Health, Oman . 2020. Human Infection with Novel Coronavirus (COVID-19)-7. Interim Guideline for Hospitals, Primary Care and Private Healthcare. Available at: [Accessed 15 June 2020]
    1. Patel P., Nandwani V., Vanchiere J., Conrad S.A., Scott L.K. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A–an associated respiratory failure and hemodynamic shock. Pediatr Crit Care Med. 2011;12:e87–e89.
    1. Qin C., Zhou L., Hu Z. dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020 ciaa248.
    1. Rimmer E., Houston B.L., Kumar A. The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis. Crit Care. 2014;18:699.
    1. Seguin A., Galicier L., Boutboul D., Lemiale V., Azoulay E. Pulmonary involvement in patients with Hemophagocytic Lymphohistiocytosis. Chest. 2016;149:1294–1301.
    1. Shi H., Zhou C., He P. Successful treatment of plasma exchange followed by intravenous immunoglobin in a critically ill patient with 2019 novel coronavirus infection. Int J Antimicrob Agents. 2020:105974. doi: 10.1016/j.ijantimicag.2020.105974.
    1. Wan S., Xiang Y., Fang W. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol. 2020;92:797–806.
    1. WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 2020. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Available at: [Accessed 1 June 2020]
    1. Wikipedia COVID-19 pandemic by country and territory. Available at: [Accessed 1 June 2020].
    1. Winters J.L. Plasma exchange: concepts, mechanisms, and an overview of the American Society for Apheresis guidelines. Hematol Am Soc Hematol Educ Program. 2012;2012:7–12.
    1. Xu X., Han M., Li T. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117:10970–10975.
    1. Yang X.H., Sun R.H., Zhao M.Y. Expert recommendations on blood purification treatment protocol for patients with severe COVID-19: recommendation and consensus. Chronic Dis Transl Med. 2020 10.1016/j.cdtm.2020.04.002.
    1. Zhang L., Zhai H., Ma S., Chen J., Gao Y. Efficacy of therapeutic plasma exchange in severe COVID-19 patients. Br J Haematol. 2020 doi: 10.1111/bjh.16890.

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