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Keith P, Bohn RIC, Nguyen T, Scott LK, Richmond M, Day M, Choe C, Perkins L, Burnside R, Pyke R, Rikard B, Guffey A, Saini A, Park HJ, Carcillo J. Improved survival in COVID-19 related sepsis and ARDS treated with a unique "triple therapy" including therapeutic plasma exchange: A single center retrospective analysis. J Clin Apher 2024; 39:e22107. [PMID: 38404046 DOI: 10.1002/jca.22107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Abstract
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.
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Affiliation(s)
- Philip Keith
- Lexington Medical Center, West Columbia, South Carolina, USA
| | | | - Trung Nguyen
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - L Keith Scott
- Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Monty Richmond
- Medical Center Downtown, MUSC Health Columbia, Columbia, South Carolina, USA
| | - Matthew Day
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Carol Choe
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Linda Perkins
- Lexington Medical Center, West Columbia, South Carolina, USA
| | | | - Richard Pyke
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Ben Rikard
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Amanda Guffey
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Arun Saini
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - H J Park
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph Carcillo
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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