The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysisReport as inadecuate




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Critical Care

, 18:699

First Online: 20 December 2014Received: 08 September 2014Accepted: 27 November 2014

Abstract

IntroductionSepsis and septic shock are leading causes of intensive care unit ICU mortality. They are characterized by excessive inflammation, upregulation of procoagulant proteins and depletion of natural anticoagulants. Plasma exchange has the potential to improve survival in sepsis by removing inflammatory cytokines and restoring deficient plasma proteins. The objective of this study is to evaluate the efficacy and safety of plasma exchange in patients with sepsis.

MethodsWe searched MEDLINE, EMBASE, CENTRAL, Scopus, reference lists of relevant articles, and grey literature for relevant citations. We included randomized controlled trials comparing plasma exchange or plasma filtration with usual care in critically ill patients with sepsis or septic shock. Two reviewers independently identified trials, extracted trial-level data and performed risk of bias assessments using the Cochrane Risk of Bias tool. The primary outcome was all-cause mortality reported at longest follow-up. Meta-analysis was performed using a random-effects model.

ResultsOf 1,957 records identified, we included four unique trials enrolling a total of 194 patients one enrolling adults only, two enrolling children only, one enrolling adults and children. The mean age of adult patients ranged from 38 to 53 years n = 128 and the mean age of children ranged from 0.9 to 18 years n = 66. All trials were at unclear to high risk of bias. The use of plasma exchange was not associated with a significant reduction in all-cause mortality risk ratio RR 0.83, 95% confidence interval CI 0.45 to 1.52, I 60%. In adults, plasma exchange was associated with reduced mortality RR 0.63, 95% CI 0.42 to 0.96; I 0%, but was not in children RR 0.96, 95% CI 0.28 to 3.38; I 60%. None of the trials reported ICU or hospital lengths of stay. Only one trial reported adverse events associated with plasma exchange including six episodes of hypotension and one allergic reaction to fresh frozen plasma.

ConclusionsInsufficient evidence exists to recommend plasma exchange as an adjunctive therapy for patients with sepsis or septic shock. Rigorous randomized controlled trials evaluating clinically relevant patient-centered outcomes are required to evaluate the impact of plasma exchange in this condition.

AbbreviationsADAMTS-13A Disintegrin-like and Metalloproteinase with Thrombospondin type-1 Motifs 13

CIconfidence interval

RRrisk ratio

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0699-2 contains supplementary material, which is available to authorized users.

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Author: Emily Rimmer - Brett L Houston - Anand Kumar - Ahmed M Abou-Setta - Carol Friesen - John C Marshall - Gail Rock - Alexis

Source: https://link.springer.com/



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