Role of therapeutic plasma exchange in the management of COVID-19-induced cytokine storm syndrome. (August 2022)

• Record Type: Journal Article
• Authors: Beraud, Mickael; Hashami, Sabria Al; Lozano, Miquel; Bah, Aicha; Keith, Philip
• Is Part Of: Transfusion and apheresis science. Volume 61:Number 4(2022)
• Publication Date: 2022-08
• Subjects: ADAMTS-13 a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 -- ARDS acute respiratory syndrome -- ASFA American Society for Apheresis -- CCP COVID-19 convalescent plasma -- COVID-19 coronavirus disease 2019 -- CRP C-reactive protein -- CSS cytokine storm syndrome -- FFP fresh frozen plasma -- ICU intensive care unit -- IFN interferon -- IL interleukin -- LOS length of stay -- MAS macrophage activation syndrome -- MODS multiple organ dysfunction syndrome -- PaO2:FiO2 pressure of arterial oxygen to fractional inspired oxygen concentration -- RCT randomized controlled trial -- SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 -- sHLH secondary hemophagocytic lymphohistiocytosis -- SOFA Sequential Organ Failure Assessment -- TAMOF thrombocytopenia-associated multiple organ failure -- TNF tumor necrosis factor -- TPE therapeutic plasma exchange; Therapeutic plasma exchange -- Cytokine storm syndrome -- COVID-19 -- Efficacy -- Safety -- SARS-CoV-2 -- Penn grading; Blood -- Transfusion -- Periodicals; Hemapheresis -- Periodicals; 615.39
• DOI: 10.1016/j.transci.2022.103433
• Languages: English
• ISSNs: 1473-0502

Abstract

Abstract: The risk of mortality in patients with coronavirus disease 2019 (COVID-19) is largely related to an excessive immune response, resulting in a hyperinflammatory and hypercoagulable condition collectively referred to as cytokine storm syndrome (CSS). Management of critically ill patients with COVID-19 has included attempts to abate this process, prevent disease progression, and reduce mortality. In this context, therapeutic plasma exchange (TPE) offers an approach to eliminate inflammatory factors and cytokines, offset the pathologic coagulopathy, and reduce the CSS effects. The aim of this review is to analyze available data on the use of TPE for the treatment of CSS in patients with COVID-19. Systematic searches of PubMed, Scopus and COVID-19 Research were conducted to identify articles published between March 1, 2020 and May 26, 2021 reporting the use of TPE for the treatment of COVID-19-induced CSS. A total of 34 peer-reviewed articles (1 randomized controlled trial, 4 matched case-control series, 15 single-group case series, and 14 case reports), including 267 patients, were selected. Despite the low evidence level of the available data, TPE appeared to be a safe intervention for critically ill patients with COVID-19-induced CSS. Although inconsistencies exist between studies, they showed a general trend for decreased interleukin-6, C-reactive protein, ferritin, D -dimer, and fibrinogen levels and increased lymphocyte counts following TPE, supporting the immunomodulatory effect of this treatment. Moreover, TPE was associated with improvements in clinical outcomes in critically ill patients with COVID-19. While TPE may offer a valuable option to treat patients with COVID-19-induced CSS, high-quality randomized controlled clinical trials are needed to confirm its potential clinical benefits, feasibility, and safety. Moreover, clear criteria should be established to identify patients with CSS who might benefit from TPE. Graphical Abstract: ga1