Improved survival in COVID-19 related sepsis and ARDS treated with a unique "triple therapy" including therapeutic plasma exchange: A single center retrospective analysis.

Autor: Keith P; Lexington Medical Center, West Columbia, South Carolina, USA., Bohn RIC; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Nguyen T; Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA., Scott LK; Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA., Richmond M; Medical Center Downtown, MUSC Health Columbia, Columbia, South Carolina, USA., Day M; Lexington Medical Center, West Columbia, South Carolina, USA., Choe C; Lexington Medical Center, West Columbia, South Carolina, USA., Perkins L; Lexington Medical Center, West Columbia, South Carolina, USA., Burnside R; Lexington Medical Center, West Columbia, South Carolina, USA., Pyke R; Lexington Medical Center, West Columbia, South Carolina, USA., Rikard B; Lexington Medical Center, West Columbia, South Carolina, USA., Guffey A; Lexington Medical Center, West Columbia, South Carolina, USA., Saini A; Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA., Park HJ; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Carcillo J; University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Journal of clinical apheresis [J Clin Apher] 2024 Feb; Vol. 39 (1), pp. e22107.
DOI: 10.1002/jca.22107
Abstrakt: Background: Throughout the COVID-19 pandemic, the mortality of critically ill patients remained high. Our group developed a treatment regimen targeting sepsis and ARDS which we labeled "triple therapy" consisting of (1) corticosteroids, (2) therapeutic plasma exchange (TPE), and (3) timely intubation with lung protective ventilation. Our propensity analysis assesses the impact of triple therapy on survival in COVID-19 patients with sepsis and ARDS.
Methods: Retrospective propensity analysis comparing triple therapy to no triple therapy in adult critically ill COVID-19 patients admitted to the Intensive Care Unit at Lexington Medical Center from 1 March 2020 through 31 October 2021.
Results: Eight hundred and fifty-one patients were admitted with COVID-19 and 53 clinical and laboratory variables were analyzed. Multivariable analysis revealed that triple therapy was associated with increased survival (OR: 1.91; P = .008). Two propensity score-adjusted models demonstrated an increased likelihood of survival in patients receiving triple therapy. Patients with thrombocytopenia were among those most likely to experience increased survival if they received early triple therapy. Decreased survival was observed with endotracheal intubation ≥7 days from hospital admission (P < .001) and there was a trend toward decreased survival if TPE was initiated ≥6 days from hospital admission (P = .091).
Conclusion: Our analysis shows that early triple therapy, defined as high-dose methylprednisolone, TPE, and timely invasive mechanical ventilation within the first 96 hours of admission, may improve survival in critically ill septic patients with ARDS secondary to COVID-19 infection. Further studies are needed to define specific phenotypes and characteristics that will identify those patients most likely to benefit.
(© 2024 The Authors. Journal of Clinical Apheresis published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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