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The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis
INTRODUCTION: Sepsis 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 removin...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318234/ https://www.ncbi.nlm.nih.gov/pubmed/25527094 http://dx.doi.org/10.1186/s13054-014-0699-2 |
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author | Rimmer, Emily Houston, Brett L Kumar, Anand Abou-Setta, Ahmed M Friesen, Carol Marshall, John C Rock, Gail Turgeon, Alexis F Cook, Deborah J Houston, Donald S Zarychanski, Ryan |
author_facet | Rimmer, Emily Houston, Brett L Kumar, Anand Abou-Setta, Ahmed M Friesen, Carol Marshall, John C Rock, Gail Turgeon, Alexis F Cook, Deborah J Houston, Donald S Zarychanski, Ryan |
author_sort | Rimmer, Emily |
collection | PubMed |
description | INTRODUCTION: Sepsis 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. METHODS: We 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. RESULTS: Of 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(2) 60%). In adults, plasma exchange was associated with reduced mortality (RR 0.63, 95% CI 0.42 to 0.96; I(2) 0%), but was not in children (RR 0.96, 95% CI 0.28 to 3.38; I(2) 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. CONCLUSIONS: Insufficient 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-014-0699-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4318234 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43182342015-02-06 The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis Rimmer, Emily Houston, Brett L Kumar, Anand Abou-Setta, Ahmed M Friesen, Carol Marshall, John C Rock, Gail Turgeon, Alexis F Cook, Deborah J Houston, Donald S Zarychanski, Ryan Crit Care Research INTRODUCTION: Sepsis 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. METHODS: We 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. RESULTS: Of 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(2) 60%). In adults, plasma exchange was associated with reduced mortality (RR 0.63, 95% CI 0.42 to 0.96; I(2) 0%), but was not in children (RR 0.96, 95% CI 0.28 to 3.38; I(2) 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. CONCLUSIONS: Insufficient 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-014-0699-2) contains supplementary material, which is available to authorized users. BioMed Central 2014-12-20 2014 /pmc/articles/PMC4318234/ /pubmed/25527094 http://dx.doi.org/10.1186/s13054-014-0699-2 Text en © Rimmer et al.; licensee BioMed Central. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Rimmer, Emily Houston, Brett L Kumar, Anand Abou-Setta, Ahmed M Friesen, Carol Marshall, John C Rock, Gail Turgeon, Alexis F Cook, Deborah J Houston, Donald S Zarychanski, Ryan The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis |
title | The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis |
title_full | The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis |
title_fullStr | The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis |
title_full_unstemmed | The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis |
title_short | The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis |
title_sort | efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318234/ https://www.ncbi.nlm.nih.gov/pubmed/25527094 http://dx.doi.org/10.1186/s13054-014-0699-2 |
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