Affiliation:
1. Medical Research Group of Egypt, Negida Academy Arlington Massachusetts USA
2. Faculty of Medicine Al‐Azhar University Cairo Egypt
3. Faculty of Medicine Al‐Azhar University for Girls Cairo Egypt
4. Faculty of Medicine Mansoura University Mansoura Egypt
5. Faculty of Medicine The Hashemite University Zarqa Jordan
6. Faculty of Medicine Zagazig University Zagazig Egypt
7. School of Pharmacy and Biomedical Sciences University of Portsmouth Portsmouth UK
8. Department of Global Health and Social Medicine Harvard Medical School Boston Massachusetts USA
9. Internal Medicine Department Faculty of Medicine Al‐Azhar University Cairo Egypt
Abstract
AbstractWe conducted this systematic review and meta‐analysis to evaluate the existing evidence and to quantitatively synthesise evidence on the impact of therapeutic plasma exchange (TPE) on severe COVID‐19 patients. This systematic review and meta‐analysis protocol was prospectively registered on PROSPERO (CRD42022316331). We systemically searched six electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, clinicaltrial.gov, and Cochrane Central Register of Controlled Trials) from inception until 1 June 2022. We included studies comparing patients who received TPE versus those who received the standard treatment. For risk of bias assessment, we used the Cochrane risk of bias assessment tool, the ROBINS1 tool, and the Newcastle Ottawa scale for RCTs, non‐RCTs, and observational studies, respectively. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as risk ratio in the random effect model with the corresponding 95% confidence intervals (CI). Thirteen studies (one randomized controlled trials (RCT) and 12 non‐RCTs) were included in the meta‐analysis, with a total of 829 patients. There is a moderate‐quality evidence from one RCT that TPE reduces the lactic dehydrogenase (LDH) levels (SMD −1.09, 95% CI [−1.59 to −0.60]), D‐dimer (SMD −0.86, 95% CI [−1.34 to −0.37]), and ferritin (SMD −0.70, 95% CI [−1.18 to −0.23]), and increases the absolute lymphocyte count (SMD 0.54, 95% CI [0.07–1.01]), There is low‐quality evidence from mixed‐design studies that TPE was associated with lower mortality (relative risk 0.51, 95% CI [0.35–0.74]), lower IL‐6 (SMD −0.91, 95% CI [−1.19 to −0.63]), and lower ferritin (SMD −0.51, 95% CI [−0.80 to −0.22]) compared to the standard control. Among severely affected COVID‐19 patients, TPE might provide benefits such as decreasing the mortality rate, LDH, D‐dimer, IL‐6, and ferritin, in addition to increasing the higher absolute lymphocyte count. Further well‐designed RCTs are needed.
Subject
Infectious Diseases,Virology
Cited by
2 articles.
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1. SARS-CoV-2-Infektion und Autoimmunität;Zeitschrift für Rheumatologie;2023-12-18
2. Therapeutic plasma exchange in critical illness;Journal of Translational Critical Care Medicine;2023-12