Does therapeutic plasma exchange have a role in resistant cytokine storm state of COVID-19 infection?

ABSTRACT

Introduction

Among the main causes of mortality in COVID-19 patients is cytokine storm (CS) state. Few treatment options with variable efficacy results are available for its management. We aimed to illustrate the efficacy of Therapeutic Plasma Exchange (TPE) treatment in COVID-19 patients with resistant CS.

Material and methods

This research is a prospective pilot study which included ten COVID-19 positive patients with CS state with no response after two doses of tocilizumab. Each patient received three to five TPE sessions according to his/her response. Respiratory status {oxygen (O₂) requirements and data of mechanical ventilation} and laboratory markers (IL-6, CRP, ferritin, D dimer, LDH) were assessed before and after TPE. We reported mortality at 28 day of illness.

Results

Six males and four females were enrolled in the study with a mean age of (52.9 years). Seven patients (70%) were on mechanical ventilation (MV). After TPE, oxygenation parameters and most laboratory markers improved significantly in all patients (p < 0.05). Four patients survived and were discharged (40%). One was on MV and three were not. The four patients had better hypoxic index (PaO2/FiO2 ratio) (˃100 vs <100), started TPE sooner after tocilizumab failure (2–3 vs 5–6 days), needed fewer TPE sessions (3 vs 4–5, p = 0.03), and less duration in ICU (6.5 vs 12.5 days) compared to those who did not benefit.

Conclusions

In patients with CS state who did not respond well to tocilizumab and steroids, TPE could be a good option. Larger randomized clinical trials are needed to support its use.

Clinical trials registration

ClinicalTrials.gov Identifier:NCT04457349

KEYWORDS:

• COVID-19
• cytokine storm
• therapeutic plasma exchange
• TPE

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Mohamed Mamdouh Elsayed

Mohamed Mamdouh Elsayed is a lecturer of nephrology & internal medicine.

Montasser Mohamed Zeid

Montasser Mohamed Zeid is a professor of nephrology & internal medicine.

Akram Mohamed Fayed

Akram Mohamed Fayed is a professor of critical care medicine.

Ehab Mahmoud Elreweny

Ehab Mahmoud Elreweny is a professor of critical care medicine.

Nermine Hossam Zakaria

Nermine Hossam Zakaria is a professor of clinical and chemical pathology.

Ayman Ibrahim Baess

Ayman Ibrahim Baess is an assistant professor of chest diseases.