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Efficacy of therapeutic plasma exchange in severe COVID-19 disease: A meta-analysis

Vox Sang. 2023 Jan;118(1):49-58 doi: 10.1111/vox.13367.
PICO Summary
POPULATION:

Patients with severe COVID-19 disease (6 studies, n= 382).

INTERVENTION:

Therapeutic plasma exchange (TPE).

COMPARISON:

Standard treatment.

OUTCOME:

The random model analysis for mortality evaluated a risk ratio of 0.38 (95% CI: 0.28-0.52) with a significant reduction in the TPE group. The certainty of the evidence was moderate, with a risk ratio of 0.34 (95% CI: 0.24-0.49). Length of intensive care unit stays between TPE versus standard care showed a standardized mean difference of 0.08 (95% CI: -0.38-0.55) and was not significant.

Abstract
BACKGROUND AND OBJECTIVES:

Therapeutic plasma exchange (TPE) has been used in severe COVID-19 disease to eliminate the cytokine storm. This meta-analysis aims to assess the effectiveness of TPE in reducing mortality in severe COVID-19 disease compared to standard treatment.

MATERIALS AND METHODS:

A comprehensive literature search was performed in PubMed, the Cochrane database and the International Clinical Trial Registry Platform (ICTRP). The random-effect model was used to calculate the risk ratio and standardized mean difference (SMD) as pooled effect size for the difference in mortality and length of the intensive care unit (ICU) stay. The risk of bias and publication bias were assessed in R version 4.1.0. The certainty of the evidence was calculated using the GradePro tool.

RESULTS:

The database identified 382 participants from six studies, including one randomized control trial. Egger's test did not detect any publication bias (p = 0.178). The random model analysis for mortality evaluated a risk ratio of 0.38 (95% CI: 0.28-0.52) with a significant reduction in the TPE group. The certainty of the evidence was moderate, with a risk ratio of 0.34 (95% CI: 0.24-0.49). Length of ICU stays between TPE versus standard care showed an SMD of 0.08 (95% CI: -0.38, 0.55) and was not significant.

CONCLUSION:

The length of ICU stay in the TPE group was not different from standard care. However, this meta-analysis revealed a significant benefit of TPE in reducing mortality in severe COVID-19 disease compared to standard treatment.

Metadata
KEYWORDS: COVID-19 treatment; SARS-CoV-2; hypercytokinaemia; mortality; plasma exchange
MESH HEADINGS: Humans; COVID-19; Plasma Exchange
Study Details
Study Design: Systematic Review
Language: eng
Credits: Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine