Efficacy of therapeutic plasma exchange in severe COVID-19 disease: A meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis primarily comprising non-randomized studies (5 observational studies, 1 randomized controlled trial)
PubMed 36254849 · doi:10.1111/vox.13367
What was done
Authors conducted a systematic review and meta-analysis searching PubMed, Cochrane, and the International Clinical Trial Registry Platform (ICTRP) to assess the efficacy of therapeutic plasma exchange (TPE) compared to standard care in severe COVID-19. Pooled risk ratios (RR) for mortality and standardized mean differences (SMD) for ICU length of stay were calculated using random-effects models. Publication bias was evaluated with Egger's test, and certainty of evidence was graded using GRADEpro.
What was found
Six studies totaling 382 participants were included (one randomized controlled trial and five observational studies): - Mortality: TPE was associated with a significant reduction in mortality compared to standard treatment (random-effects RR 0.38, 95% CI: 0.28 to 0.52; reported moderate certainty evidence RR 0.34, 95% CI: 0.24 to 0.49). - ICU length of stay: No significant difference was observed between TPE and standard care (SMD 0.08, 95% CI: -0.38 to 0.55). - Publication bias: Egger's test showed no significant publication bias (p = 0.178).
Why it matters
This review suggests therapeutic plasma exchange may offer a mortality benefit in severe COVID-19 cases experiencing cytokine storm, although it does not appear to alter the duration of ICU hospitalization.
Limits
The total sample size is small (382 participants across six studies). Five of the six included studies were non-randomized, presenting high risks of confounding and selection bias. The abstract does not detail specific TPE protocols, timing, baseline patient severity, or adverse event rates.
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