The association between therapeutic plasma exchange and the risk of mortality among patients critically ill with COVID-19: a meta-analysis

Shinta Oktya Wardhani; Jonny Karunia Fajar; Gatot Soegiarto; Laksmi Wulandari; Helnida Anggun Maliga; Muhammad Ilmawan; Risna Merysa; Arlentina Bentivolia Simamora; Qurrata Aini; Komang Noviantari; Ayu Widya Lestari; Maria Yoheni Harnila; Imam Syafi'i; Jane Andrea Christiano Djianzonie; Nenci Siagian; Sri Nining; Risyda Zakiyah Hanim; Wahyuni Wahyuni; Fitri Aulia; Juliansyah Juliansyah; Reflin Mahmud; Fredo Tamara; Aditya Indra Mahendra; Amanda Cininta Wowor; Fikri Baladraf; Ponda Hernest Hadinata; Adhityari Ikkeputri; Hana Nadya; Dessy Aprilia Kartini; Milda Husnah; Firzan Nainu; Harapan Harapan

doi:10.12688/f1000research.74972.1

Home Browse The association between therapeutic plasma exchange and the risk of...

ALL Metrics

-

Views

-

Downloads

Get PDF

Get XML

Export

▬

✚

Systematic Review

The association between therapeutic plasma exchange and the risk of mortality among patients critically ill with COVID-19: a meta-analysis

[version 1; peer review: 2 approved, 2 approved with reservations]

Shinta Oktya Wardhani ¹, Jonny Karunia Fajar ², Gatot Soegiarto ³, [...] Laksmi Wulandari⁴, Helnida Anggun Maliga⁵, Muhammad Ilmawan⁵, Risna Merysa⁶, Arlentina Bentivolia Simamora², Qurrata Aini⁶, Komang Noviantari⁶, Ayu Widya Lestari⁷, Maria Yoheni Harnila⁶, Imam Syafi'i⁸, Jane Andrea Christiano Djianzonie⁹, Nenci Siagian¹⁰, Sri Nining⁶, Risyda Zakiyah Hanim⁶, Wahyuni Wahyuni¹¹, Fitri Aulia¹¹, Juliansyah Juliansyah⁶, Reflin Mahmud⁶, Fredo Tamara², Aditya Indra Mahendra², Amanda Cininta Wowor², Fikri Baladraf², Ponda Hernest Hadinata², Adhityari Ikkeputri², Hana Nadya², Dessy Aprilia Kartini⁵, Milda Husnah^12,13, Firzan Nainu¹⁴, Harapan Harapan^12,15,16

Shinta Oktya Wardhani ¹, Jonny Karunia Fajar ², [...] Gatot Soegiarto ³, Laksmi Wulandari⁴, Helnida Anggun Maliga⁵, Muhammad Ilmawan⁵, Risna Merysa⁶, Arlentina Bentivolia Simamora², Qurrata Aini⁶, Komang Noviantari⁶, Ayu Widya Lestari⁷, Maria Yoheni Harnila⁶, Imam Syafi'i⁸, Jane Andrea Christiano Djianzonie⁹, Nenci Siagian¹⁰, Sri Nining⁶, Risyda Zakiyah Hanim⁶, Wahyuni Wahyuni¹¹, Fitri Aulia¹¹, Juliansyah Juliansyah⁶, Reflin Mahmud⁶, Fredo Tamara², Aditya Indra Mahendra², Amanda Cininta Wowor², Fikri Baladraf², Ponda Hernest Hadinata², Adhityari Ikkeputri², Hana Nadya², Dessy Aprilia Kartini⁵, Milda Husnah^12,13, Firzan Nainu¹⁴, Harapan Harapan^12,15,16

PUBLISHED 14 Dec 2021

Author details Author details

¹ Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
² Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
³ Division of Allergy & Immunology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
⁴ Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
⁵ Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
⁶ Faculty of Nursing, Universitas Indonesia, Jakarta, 10430, Indonesia
⁷ Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
⁸ Faculty of Pharmacy, Universitas Indonesia, Jakarta, 10430, Indonesia
⁹ Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
¹⁰ Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
¹¹ Faculty of Public Health, Universitas Indonesia, Jakarta, 10430, Indonesia
¹² Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
¹³ Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
¹⁴ Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
¹⁵ Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
¹⁶ Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia

Shinta Oktya Wardhani
Roles: Conceptualization, Investigation, Methodology, Supervision, Validation

Jonny Karunia Fajar
Roles: Conceptualization, Investigation, Methodology, Supervision, Validation

Gatot Soegiarto
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Validation

Laksmi Wulandari
Roles: Supervision, Validation

Helnida Anggun Maliga
Roles: Conceptualization, Methodology, Validation

Muhammad Ilmawan
Roles: Formal Analysis, Investigation, Methodology, Software, Writing – Original Draft Preparation

Risna Merysa
Roles: Data Curation, Project Administration, Resources, Visualization

Arlentina Bentivolia Simamora
Roles: Data Curation, Investigation, Project Administration, Resources, Visualization

Qurrata Aini
Roles: Data Curation, Investigation, Project Administration, Resources, Validation

Komang Noviantari
Roles: Data Curation, Investigation, Project Administration, Software, Visualization

Ayu Widya Lestari
Roles: Data Curation, Investigation, Project Administration, Resources, Visualization

Maria Yoheni Harnila
Roles: Data Curation, Investigation, Project Administration, Resources, Visualization

Imam Syafi'i
Roles: Data Curation, Investigation, Project Administration, Resources, Visualization

Jane Andrea Christiano Djianzonie
Roles: Data Curation, Project Administration, Resources, Visualization

Nenci Siagian
Roles: Data Curation, Project Administration, Resources, Visualization

Sri Nining
Roles: Data Curation, Project Administration, Resources, Visualization

Risyda Zakiyah Hanim
Roles: Data Curation, Project Administration, Resources, Visualization

Wahyuni Wahyuni
Roles: Data Curation, Project Administration, Resources, Visualization

Fitri Aulia
Roles: Data Curation, Project Administration, Resources, Visualization

Juliansyah Juliansyah
Roles: Data Curation, Project Administration, Resources, Visualization

Reflin Mahmud
Roles: Data Curation, Project Administration, Resources, Visualization

Fredo Tamara
Roles: Data Curation, Project Administration, Resources, Visualization

Aditya Indra Mahendra
Roles: Data Curation, Project Administration, Resources, Visualization

Amanda Cininta Wowor
Roles: Data Curation, Project Administration, Resources, Visualization

Fikri Baladraf
Roles: Data Curation, Project Administration, Resources, Visualization

Ponda Hernest Hadinata
Roles: Data Curation, Project Administration, Resources, Visualization

Adhityari Ikkeputri
Roles: Data Curation, Project Administration, Resources, Visualization

Hana Nadya
Roles: Data Curation, Project Administration, Resources, Visualization

Dessy Aprilia Kartini
Roles: Data Curation, Project Administration, Resources, Visualization

Milda Husnah
Roles: Data Curation, Project Administration, Resources, Visualization

Firzan Nainu
Roles: Data Curation, Project Administration, Resources, Visualization

Harapan Harapan
Roles: Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Emerging Diseases and Outbreaks gateway.

This article is included in the Coronavirus (COVID-19) collection.

Abstract

Background: Cytokine storm has been widely known to contribute to the development of the critical condition in patients with coronavirus disease 2019 (COVID-19), and studies had been conducted to assess the potential aspect of cytokine storm elimination by performing therapeutic plasma exchange (TPE). However, contradictory findings were observed. The objective of this study was to assess the association between TPE and the reduction of mortality of critically ill COVID-19 patients.
Methods: A meta-analysis was conducted by collecting data from PubMed, Scopus, and Web of Science. Data on the mortality rate of critically ill COVID-19 patients treated with TPE plus standard of care and that of patients treated with standard of care alone were analyzed using a Z test.
Results: We included a total of four papers assessing the association between TPE and the risk of mortality among critically ill COVID-19 patients. Our findings suggested that critically ill COVID-19 patients treated with TPE had lower risk of mortality compared to those without TPE treatment.
Conclusion: Our study has identified the potential benefits of TPE in reducing the risk of mortality among critically ill COVID-19 patients.

Keywords

COVID-19; therapeutic plasma exchange; cytokine storm; treatment

Corresponding authors: Shinta Oktya Wardhani, Jonny Karunia Fajar, Gatot Soegiarto

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2021 Wardhani SO et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Wardhani SO, Fajar JK, Soegiarto G et al. The association between therapeutic plasma exchange and the risk of mortality among patients critically ill with COVID-19: a meta-analysis [version 1; peer review: 2 approved, 2 approved with reservations]. F1000Research 2021, 10:1280 (https://doi.org/10.12688/f1000research.74972.1) First published: 14 Dec 2021, 10:1280 (https://doi.org/10.12688/f1000research.74972.1) Latest published: 14 Dec 2021, 10:1280 (https://doi.org/10.12688/f1000research.74972.1)

Introduction

Since first reported in December 2019,¹ coronavirus disease 2019 (COVID-19) has become an unresolved global pandemic. The challenge of the pandemic management at the present time might be due to the fact that a number of mutations have occurred making the virus more transmissible and causing critical illness.² The World Health Organization (WHO) has established a living guideline on drugs for the management of COVID-19³ and updated it periodically. However, the treatment of critically ill COVID-19 patients remains a serious issue.⁴ Patients critically ill with COVID-19 have been widely reported to have a poor prognosis, and theory reveals that cytokine storm might underlie this mechanism. In a cytokine storm excessive accumulation of pro-inflammatory cytokines might be responsible for the poor prognosis of COVID-19 patients. No study has found an effective treatment for the management of a cytokine storm in patients critically ill with COVID-19. Therefore, an investigation into the treatment that acts to remove these pro-inflammatory cytokines, for example, using therapeutic plasma exchange (TPE) may be required.

Since first introduced in 1952, TPE has been shown to provide an excellent outcome in patients with multiple myeloma to control hyperviscosity.⁵ Moreover, the implementation of this therapeutic treatment has also been reported in an Escherichia coli outbreak,⁶ a Shigella infection,⁷ infectious toxicosis,⁸ and septic shock with multiple organ failure⁹; and reduced risk of mortality was revealed. In the case of COVID-19, the US Food and Drug Administration (FDA) has posited that TPE may have a role as a rescue therapy in critically ill patients with COVID-19.¹⁰ However, insufficient evidence has resulted in indecision in applying TPE for the management of critically ill COVID-19 patients. To date, TPE has been studied in Oman,¹¹ Turkey,¹² Pakistan,¹³ and Saudi Arabia.¹⁴ However, contradictory findings exist. Therefore, our study aimed to assess the potential of TPE in reducing mortality of critically ill COVID-19 patients using a meta-analysis approach. The findings might add new insight and clarify the true potency of TPE for treating patients critically ill with COVID-19.

Methods

Study design

From March to August 2021, a meta-analysis following the protocols of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)¹⁵ was conducted to evaluate the effectiveness of TPE in reducing the mortality rate of critical COVID-19 patients. The PRISMA checklist in our present study is presented as extended data in Figshare.¹⁶ The major databases including PubMed, Scopus, and Web of Science were used to search for potential articles.

Eligibility criteria

Inclusion and exclusion criteria were defined to assess relevant articles. The inclusion criteria of the study were (1) observational or randomized controlled trial studies, (2) having adequate information to calculate the potential association and effect estimates, and (3) applying a well-defined methodological approach to establish a COVID-19 diagnosis. All case reports, case series, letters to the editor, reviews, and commentaries, as well as studies with pre-post test comparison, and poor-quality methodology assessed with the Newcastle-Ottawa scale (NOS) were excluded.

Search strategy and data extraction

The source databases used in our study were PubMed, Scopus, and Web of Science. We restricted the searching period up to 28 July 2021, and the language was English only. The Medical Subject Headings were: (“COVID-19” or “SARS-CoV-2”) and (“plasma exchange” or “therapeutic plasma exchange” or “TPE”). The reference lists of all potential related articles were also assessed to retrieve additional relevant articles. Data extraction was performed for all included papers, including: (1) name of the first author; (2) year of publication; (3) country of origin; (4) sample size of cases and controls, (5) TPE, and (6) mortality rate between groups.

Assessment of the methodology quality

All included articles were assessed for their quality using NOS for observational studies¹⁷ and the Jada-modified scale for RCTs.¹⁸ The article quality was interpreted as low, moderate, and high. Low quality articles were excluded from our study. The assessment was performed by two independent authors (MI, HAM), and when a discrepancy was observed an assessment by a senior researcher (JKF) was conducted.

Outcome measure

The main outcome of the study was all causes of mortality among critical COVID-19 patients treated with and without TPE. The diagnosis of COVID-19 was established by using RT-PCR of SARS-CoV-2 RNA from nasal or oropharyngeal swab samples, and critical COVID-19 patients were defined by following the guideline (requires life sustaining treatment, acute respiratory distress syndrome, sepsis, or septic shock).³^,¹⁹

Statistical analysis

The calculation of potential publication bias, heterogeneity among studies, and the association between the use of TPE and the risk of mortality among patients with COVID-19 were assessed using an Egger test, a Q test, and a Z test; respectively. The Egger test with a p-value more than 0.05 indicated the presence of potential publication bias. Moreover, the heterogeneity among studies was considered when the p-value of a Q test indicated less than 0.10. The pooled association was calculated using a Z test, where the p-value of less than 0.05 indicates a significant association. The estimated effect was presented as an odds ratio with 95% confidence interval (OR 95% CI). The cumulative calculation was presented as a forest plot. An R package software (R Studio version 4.1.1, MA, USA, (RRID:SCR_000432) was used to perform the analyses.

Results

Studies selection

We identified a total of 255 papers. Among them, four papers were excluded due to duplication and additional 227 papers due to irrelevant context. There were 24 papers in total included for full-text assessment. Then, 20 of the 24 papers were further excluded since 18 were reviews and case reports and two papers had insufficient data. Four papers were included in the final analysis.¹¹^–¹⁴ The article selection PRISMA flowchart is presented in Figure 1 and the baseline characteristics are described in Table 1.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of article selection in our meta-analysis.

Table 1. Baseline characteristics of articles included in our study.

Study and year	Country	Study design	Quality	TPE		Control
Study and year	Country	Study design	Quality	Total	Mortality	Total	Mortality
Khamis et al., 2020¹¹	Oman	Cohort Retrospective	High	11	1	20	9
Gucyetmez et al., 2020¹²	Turkey	Cohort Retrospective	Moderate	12	1	12	7
Kamran et al., 2020¹³	Pakistan	Cohort Retrospective	High	45	4	45	18
Faqihi et al., 2020¹⁴	Saudi Arabia	RCT	High	43	9	44	15

TPE treatment and COVID-19 mortality rate

A total of 111 COVID-19 patients treated with TPE and 121 COVID-19 patients without TPE, retrieved from three retrospective cohort studies and one RCT, were included in our analysis. Our results found that COVID-19 patients treated with TPE had reduced mortality rate compared to COVID-19 patients without TPE treatment (OR: 0.21; 95% CI: 0.05, 0.85) (Figure 2).

Figure 2. Forest plot of mortality rate between therapeutic plasma exchange vs control (OR: 0.2097; 95% CI: 0.0516, 0.852; p-value: 0.0382; pHet: 0.2065; pE: 02153).

Heterogeneity and potency of bias across the studies

Our analysis revealed the absence of the evidence of heterogeneity. Therefore, we applied a fixed-effect model to assess the correlation. For the potency of bias assessment across the studies, our analysis using an Egger test found no publication bias.

Discussion

Our study identified that TPE treatment in critically ill COVID-19 patients reduced the mortality rate. To date, our study is the first meta-analysis to report on the use of TPE for the management of COVID-19. In our analyses, we included four studies from Oman,¹¹ Turkey,¹² Pakistan,¹³ and Saudi Arabia¹⁴; and all reports revealed similar findings in which TPE treatment reduced mortality among patients with COVID-19. TPE has been applied and proved to reduce the risk of mortality in the management of several infectious diseases, such as Escherichia coli O157:H7-associated hemolytic uremic syndrome,⁶^,²⁰ Shigella infection,⁷ infectious toxicosis,⁸ HIV infection,²¹ peripheral HIV neuropathy,²² Kaposi's sarcoma,²¹ disseminated cryptococcosis,²³ and septic shock with multiple organ failure.⁹ Moreover, in the case of the Escherichia coli O157 outbreak in 1996, TPE proved beneficial in the reduction of mortality.⁶ Therefore, as suggested in our study, TPE might possess potential benefits in COVID-19 treatment.

The precise mechanism of how TPE benefits COVID-19 patients remains debatable. In critical COVID-19 patients, the excessive accumulation of cytokines may occur, and this can lead to a fatal outcome. Previous studies have revealed that the levels of pro-inflammatory cytokines/chemokines including interleukin-2 (IL-2), interleukin-6 (IL-6), granulocyte colony stimulating factor (GCSF), IFN-γ inducible protein 10, monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1A, tumor necrosis factor-α (TNF-α) were observed to be higher in patients critically ill with COVID-19 compared to those with mild-moderate disease.²⁴^,²⁵ TPE is a therapeutic procedure principally acting to remove (through double filtration) molecules of 60–140 nm in size.⁵ The molecule size of pro-inflammatory cytokines/chemokines is 80–220 nm.²⁶ Therefore, the elimination of pro-inflammatory cytokines/chemokines, proven to affect those critically ill with COVID-19 might provide benefits to improve the prognosis of COVID-19 patients. Moreover, a previous study also reported that TPE played an important role in eliminating toxic substances by suppressing the cytokine release syndrome.²⁷ It was also suggested that TPE plays a crucial role in restoring normal substances that may be deficient in the plasma,⁵ leading to stabilization and restoration of endothelial membranes.²⁸ Another possibility is when fresh frozen plasma was used in fluid replacement; TPE was associated with the improvement of coagulopathy in COVID-19 patients.²⁹ Previous evidence suggests that TPE might play an important role in maintaining the balance between anti and pro-inflammatory cytokines in the plasma, and might rectify the prognosis in patients with COVID-19, as reported in our study.

To the best of our knowledge, our study is the first meta-analysis reporting the benefit of TPE in reducing the mortality rate of critically ill COVID-19 patients. We found that COVID-19 patients treated with TPE had a lower risk of mortality compared to those without TPE treatment. Since COVID-19 guidelines suggest that the use of TPE for patients with COVID-19 should be carefully implemented as the evidence of TPE efficacy was only limited to a case report,³ our current findings might strengthen the evidence that the use of TPE is effective in reducing the risk of mortality among patients with COVID-19. However, in real-world implementation, special settings such as appropriate condition, target of treatment, potential complications, and particular case or comorbidity should be investigated.

Since this is the initial evidence on the potential efficacy of TPE for the management of COVID-19, several limitations should be highlighted. First, we did not include any potential confounding factors such as comorbidity, the levels of proinflammatory cytokines, and onset of disease course to describe the association between TPE and the risk of mortality rate. Second, a limited number of investigations on the use of TPE in COVID-19 management resulted in our study including only a limited number of articles. Therefore, further investigation involving a larger sample size is required. Third, the clinical setting on the use of TPE might differ among studies, and therefore, this variation might also govern the potency of bias. Fourth, among the included studies, we obtained only one randomized control trial (RCT) and three observational studies. Further meta-analyses involving only RCT studies might provide better levels of evidence.

Conclusion

The data suggests that the use of TPE for the management of critically ill COVID-19 patients could reduce the mortality rate. The application of TPE for the management of COVID-19 should be considered in well-equipped hospitals.

Data availability

Underlying data

All data underlying the results are available as part of the article and no additional source data are required.

Reporting guidelines

Figshare: PRISMA checklist for ‘the association between therapeutic plasma exchange and the risk of mortality among patients with critically ill COVID-19: a meta-analysis. https://doi.org/10.6084/m9.figshare.16622572.v1¹⁶

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

We thank Lembaga Pengelola Dana Pendidikan (LPDP) Republic of Indonesia for supporting this project.

References

1. Wang C, Horby PW, Hayden FG, et al.: A novel coronavirus outbreak of global health concern. Lancet. 2020; 395: 470–473. PubMed Abstract | Publisher Full Text
2. Coccia M: The impact of first and second wave of the COVID-19 pandemic in society: comparative analysis to support control measures to cope with negative effects of future infectious diseases. Environ Res. 2021; 197: 111099. PubMed Abstract | Publisher Full Text
3. Rochwerg B, Agarwal A, Siemieniuk RA, et al.: A living WHO guideline on drugs for covid-19. BMJ. 2020; 370: m3379.
4. Salluh JIF, Arabi YM, Binnie A: COVID-19 research in critical care: the good, the bad, and the ugly. Intensive Care Med. 2021; 47: 470–472. PubMed Abstract | Publisher Full Text
5. Simon TL, Snyder EL, Stowell CP, et al.: Rossi's principles of transfusion medicine. John Wiley & Sons; 2009. Publisher Full Text
6. Dundas S, Murphy J, Soutar RL, et al.: Effectiveness of therapeutic plasma exchange in the 1996 Lanarkshire Escherichia coli O157:H7 outbreak. Lancet. 1999; 354: 1327–1330. PubMed Abstract | Publisher Full Text
7. Brocklebank V, Wong EK, Fielding R, et al.: Atypical haemolytic uraemic syndrome associated with a CD46 mutation triggered by Shigella flexneri. Clin Kidney J. 2014; 7: 286–288. PubMed Abstract | Publisher Full Text
8. Burakovskii NI, Sviridchuk VM: A case using plasmapheresis in treating infectious toxicosis in young infants. Pediatriia. 1988; 98–99. PubMed Abstract
9. Keith PD, Wells AH, Hodges J, et al.: The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience. Crit Care. 2020; 24: 518. PubMed Abstract | Publisher Full Text
10. Tabibi S, Tabibi T, Conic RRZ, et al.: Therapeutic Plasma Exchange: A potential Management Strategy for Critically Ill COVID-19 Patients. J Intensive Care Med. 2020; 35: 827–835. PubMed Abstract | Publisher Full Text
11. Khamis F, Al-Zakwani I, Al Hashmi S, et al.: Therapeutic plasma exchange in adults with severe COVID-19 infection. Int J Infect Dis. 2020; 99: 214–218. PubMed Abstract | Publisher Full Text
12. Gucyetmez B, Atalan HK, Sertdemir I, et al.: Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study. Crit Care. 2020; 24: 492. PubMed Abstract | Publisher Full Text
13. Kamran SM, Mirza ZE, Naseem A, et al.: Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study. PLoS One. 2021; 16: e0244853. PubMed Abstract | Publisher Full Text
14. Faqihi F, Alharthy A, Abdulaziz S, et al.: Therapeutic plasma exchange in patients with life-threatening COVID-19: a randomised controlled clinical trial. Int J Antimicrob Agents. 2021; 57: 106334. PubMed Abstract | Publisher Full Text
15. Liberati A, Altman DG, Tetzlaff J, et al.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339: b2700. PubMed Abstract | Publisher Full Text
16. Fajar J, et al.: The association between therapeutic plasma exchange and the risk of mortality among patients with critically ill COVID-19: a meta-analysis. Figshare. Dataset. 2021. Publisher Full Text
17. Stang A: Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25: 603–605. PubMed Abstract | Publisher Full Text
18. Olivo SA, Macedo LG, Gadotti IC, et al.: Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther. 2008; 88: 156–175. Publisher Full Text
19. Liu J, Liu S: The management of coronavirus disease 2019 (COVID-19). J Med Virol. 2020; 92: 1484–1490. PubMed Abstract | Publisher Full Text
20. Downes KA, Allen K, Sarode R, et al.: Consanguineous hemolytic uremic syndrome secondary to Escherichia coli O157:H7 infection treated with aggressive therapeutic plasma exchange. J Clin Apher. 2001; 16: 155–156. PubMed Abstract | Publisher Full Text
21. Reiss RF, Rubinstein P, Friedman-Kien A, et al.: Partial plasma exchange in patients with AIDS and Kaposi's sarcoma. Plasmapheresis in AIDS. AIDS Res. 1986; 2: 183–190. PubMed Abstract | Publisher Full Text
22. Salim YS, Faber V, Skinhoj P, et al.: Plasmapheresis in the treatment of peripheral HIV neuropathy. Ugeskr Laeger. 1989; 151: 1754–1756. PubMed Abstract
23. Bollee G, Touzot M, Mechai F, et al.: Plasma exchange for disseminated cryptococcosis. Am J Kidney Dis. 2009; 53: 673–676. PubMed Abstract | Publisher Full Text
24. Huang C, Wang Y, Li X, et al.: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497–506. PubMed Abstract | Publisher Full Text
25. Channappanavar R, Perlman S: Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017; 39: 529–539. PubMed Abstract | Publisher Full Text
26. Strauss RG, Ciavarella D, Gilcher RO, et al.: An overview of current management. J Clin Apher. 1993; 8: 189–194. Publisher Full Text
27. Padmanabhan A, Connelly-Smith L, Aqui N, et al.: Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019; 34: 171–354. PubMed Abstract | Publisher Full Text
28. Bar-On YM, Flamholz A, Phillips R, et al.: SARS-CoV-2 (COVID-19) by the numbers. Elife. 2020; 9. PubMed Abstract | Publisher Full Text
29. Zachariah U, Nair SC, Goel A, et al.: Targeting raised von Willebrand factor levels and macrophage activation in severe COVID-19: Consider low volume plasma exchange and low dose steroid. Thromb Res. 2020; 192: 2. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 14 Dec 2021