Abstract:
Background
Cytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by
removing the pathogenic cytokines is hypothesized to dampen CRS.
Objective
To evaluate the outcomes of the patients with COVID-19 having CRS being treated with
TPE compared to controls on the standard of care.
Methodology
Retrospective propensity score-matched analysis in a single centre from 1st April to 31st
July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS
initially. PSM was used to minimize bias from non-randomized treatment assignment. Using
PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was
done for disease severity, routine standard care and advanced supportive care. Many other
Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on
Polymerase chain reaction testing
Results
After PS-matching, the selected cohort had a median age of 60 years (range 32–73 in TPE,
37–75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days
(range 3–22 days’ TPE and 3–20 days controls), p = 0.266. Disease severity in both groups
was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival
was significantly superior in the TPE group (91.1%), 95% CI 78.33–97.76; as compared to
PS-matched controls (61.5%), 95% CI 51.29–78.76 (log rank 0.002), p<0.001. Median duration of hospitalization was significantly reduced in the TPE treated group (10 days vs 15
days) (p< 0.01). CRS resolution time was also significantly reduced in the TPE group (6
days vs. 12 days) (p< 0.001). In 71 patients who underwent TPE, the mortality was 0 (n =
43) if TPE was done within the first 12 days of illness while it was 17.9% (deaths 5, n = 28
who received it after 12th day (p = 0.0045).
Conclusion
An earlier use of TPE was associated with improved overall survival, early CRS resolution
and time to discharge compared to SOC for COVID-19 triggered CRS in this selected cohort
of PS-matched male patients from one major hospital in Pakistan.
