Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study

• Published in: PloS one 2021-01, Vol.16 (1), p.e0244853
• Main Authors: Kamran, Sultan Mehmood, Mirza, Zill-E-Humayun, Naseem, Arshad, Liaqat, Jahanzeb, Fazal, Imran, Alamgir, Wasim, Saeed, Farrukh, Saleem, Salman, Nisar, Shazia, Yousaf, Muhammad Ali, Khan, Asad Zaman, Hussain, Mehmood, Azam, Rizwan, Hussain, Maryam, Khan, Kumail Abbas, Jamal, Yousaf, Iftikhar, Raheel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Apheresis; Armed forces; Biology and Life Sciences; Care and treatment; Case-Control Studies; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - physiopathology; Critical care; Cytokine Release Syndrome - therapy; Cytokine storm; Cytokines; Dehydrogenases; Exchanging; Female; Genes; Health aspects; Hospital patients; Hospitals; Humans; Infectious diseases; Inflammation; Male; Matching; Medicine; Medicine and Health Sciences; Middle Aged; Neurology; Pakistan; Pathophysiology; Patient outcomes; Patients; Physical Sciences; Plasma; Plasma Exchange; Plasma exchange (Therapeutics); Pneumonia; Polymerase chain reaction; Propensity Score; Proteins; Research and Analysis Methods; Retrospective Studies; Sepsis; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Signs and symptoms; Software; Stem cells; Survival; Survival analysis; Viral diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0244853

Cytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by removing the pathogenic cytokines is hypothesized to dampen CRS. To evaluate the outcomes of the patients with COVID-19 having CRS being treated with TPE compared to controls on the standard of care. Retrospective propensity score-matched analysis in a single centre from 1st April to 31st July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS initially. PSM was used to minimize bias from non-randomized treatment assignment. Using PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was done for disease severity, routine standard care and advanced supportive care. Many other Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on Polymerase chain reaction testing. After PS-matching, the selected cohort had a median age of 60 years (range 32-73 in TPE, 37-75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days (range 3-22 days' TPE and 3-20 days controls), p = 0.266. Disease severity in both groups was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival was significantly superior in the TPE group (91.1%), 95% CI 78.33-97.76; as compared to PS-matched controls (61.5%), 95% CI 51.29-78.76 (log rank 0.002), p