Improved survival in COVID‐19 related sepsis and ARDS treated with a unique “triple therapy” including therapeutic plasma exchange: A single center retrospective analysis

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...

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Published in:	Journal of clinical apheresis Vol. 39; no. 1; pp. e22107 - n/a
Main Authors:	Keith, Philip, Bohn, Rebecca Inez Caldino, Nguyen, Trung, Scott, L. Keith, Richmond, Monty, Day, Matthew, Choe, Carol, Perkins, Linda, Burnside, Rebecca, Pyke, Richard, Rikard, Ben, Guffey, Amanda, Saini, Arun, Park, H. J., Carcillo, Joseph
Format:	Journal Article
Language:	English
Published:	Hoboken, USA John Wiley & Sons, Inc 01-02-2024 Wiley Subscription Services, Inc
Subjects:	Adult Apheresis ARDS corticosteroids COVID-19 COVID-19 - complications COVID-19 - therapy Critical Illness - therapy Humans Intubation mechanical ventilation Pandemics plasma exchange Plasma Exchange - adverse effects Respiratory Distress Syndrome - etiology Respiratory Distress Syndrome - therapy Retrospective Studies SARS-CoV-2 Sepsis Sepsis - complications Sepsis - therapy Ventilators COVID-19 corticosteroids mechanical ventilation plasma exchange ARDS
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0733-2459 1098-1101
DOI:	10.1002/jca.22107