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Review
. 2022 Aug;61(4):103433.
doi: 10.1016/j.transci.2022.103433. Epub 2022 Mar 23.

Role of therapeutic plasma exchange in the management of COVID-19-induced cytokine storm syndrome

Mickael Beraud  1 , Sabria Al Hashami  2 , Miquel Lozano  3 , Aicha Bah  4 , Philip Keith  5
Affiliations
Review

Role of therapeutic plasma exchange in the management of COVID-19-induced cytokine storm syndrome

Mickael Beraud et al. Transfus Apher Sci. 2022 Aug.

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.

Keywords: COVID-19; Cytokine storm syndrome; Efficacy; Penn grading; SARS-CoV-2; Safety; Therapeutic plasma exchange.

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Conflict of interest statement

Declaration of Competing Interest M. Beraud and A. Bah are employees of Terumo Blood and Cell Technologies Europe N.V. (Belgium). M. Lozano on behalf of his institution, Clinic Research Foundation, has received research support from Terumo Blood and Cell Technologies and Sanofi-Genzyme, and speaker honoraria from Grífols. S. Al Hashami and Philip Keith have nothing to declare.

Figures

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Graphical abstract
Fig. 1
Fig. 1
PRISMA flowchart. COVID-19, coronavirus disease 2019; CSS, cytokine storm syndrome; n, number of records; TPE, therapeutic plasma exchange.
See this image and copyright information in PMC

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