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.
【저자키워드】 Randomized controlled trial, severe acute respiratory syndrome coronavirus 2, Coronavirus disease 2019, intensive care unit, interferon, C-reactive protein, Cytokine storm syndrome, interleukin, tumor necrosis factor, macrophage activation syndrome, secondary hemophagocytic lymphohistiocytosis, COVID-19 convalescent plasma, Length of stay, Therapeutic plasma exchange, fresh frozen plasma, COVID-19coronavirus disease 2019, SARS-CoV-2severe acute respiratory syndrome coronavirus 2, ICUIntensive Care Unit, ILInterleukin, TNFTumor Necrosis Factor, CRPC-reactive protein, IFNinterferon, RCTrandomized controlled trial, MASmacrophage activation syndrome, SOFASequential Organ Failure Assessment, Sequential Organ Failure Assessment, ADAMTS-13a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, ARDSacute respiratory syndrome, acute respiratory syndrome, ASFAAmerican Society for Apheresis, American Society for Apheresis, CCPCOVID-19 convalescent plasma, CSScytokine storm syndrome, FFPfresh frozen plasma, LOSlength of stay, MODSmultiple organ dysfunction syndrome, multiple organ dysfunction syndrome, PaO2:FiO2pressure of arterial oxygen to fractional inspired oxygen concentration, pressure of arterial oxygen to fractional inspired oxygen concentration, sHLHsecondary hemophagocytic lymphohistiocytosis, TAMOFthrombocytopenia-associated multiple organ failure, thrombocytopenia-associated multiple organ failure, TPEtherapeutic plasma exchange, 【초록키워드】 COVID-19, Treatment, coronavirus disease, Cytokines, Mortality, feasibility, interleukin-6, risk, D-dimer, ferritin, Intervention, Coagulopathy, Clinical outcome, improvement, Lymphocyte count, Randomized, Case series, Patient, Case-control, patients, Evidence, Safe, criteria, hypercoagulable, Critically ill patient, available data, Controlled clinical trial, treat, article, excessive immune response, while, offer, immunomodulatory effect, Inflammatory factor, Hyperinflammatory, Effects, approach, benefit, reduce mortality, selected, resulting, identify, pathologic, conducted, reduce, peer-reviewed, CSS, fibrinogen level, offset, patients with COVID-19, potential clinical benefits, prevent disease progression, TPE, with COVID-19, 【제목키워드】 management, role,