Bilal AYGUN, Funda PEPEDİL TANRİKULU, Mahmut Bakır KOYUNCU

Ağır Pnömonili Erişkin COVID-19 Hastalarında Terapötik Plazma Değişimi: Seksen Hastada Tek Merkez Deneyimi

Amaç: Terapötik plazma değişimi (TPD), ağır düzey koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) hastalarında sıklıkla tartışılmakta olan bir tedavi şeklidir. Uygulanması için deneyimli personele ve aferez cihazına gereksinim vardır. Bu çalışmada, TPD uygulanmış olan erişkin COVID-19 hastalarının özellikleri ve klinik sonlanımlarının ortaya konulması amaçlanmıştır. Gereç ve Yöntemler: Aferez ünitemizde TPD uygulanmış olan erişkin hastalar geriye dönük olarak incelenmiş ve COVID-19 pozitif olan vakalar bu çalışmaya dahil edilmiştir. Olgulara ait olan tüm tıbbi bilgiler elektronik veri tabanından alınmış ve aferez işlemlerine ait teknik detaylar ise aferez ünitesi kayıtlarından elde edilmiştir. Bulgular: Bu çalışmaya, ortanca yaşı 60 (19-85) yıl olan toplam 80 hasta dahil edildi. Olguların %98,8 (n=79)’inde ağır pnömoni varlığı söz konusu idi. Tüm olguların dörtte üçünden daha fazlasında lenfopeni, kritik düzeyde C-reaktif protein (CRP) ve D-dimer yüksekliği ile %41,0 (n=32)’inde ise ferritin yüksekliği mevcuttu. Yoğun bakım ünitesinde ortanca kalış süresi 26 (5-124) gündü. TPD işlemini takip eden 14. ve 28. günlerde gözlenen mortalite oranları sırasıyla %51,3 (n=41) ve %75,0 (n=60) idi. Çok değişkenli analizlerde ferritin yüksekliği, çoklu organ yetmezliği (multiple organ failure, MOF) varlığı ve entübasyon ihtiyacı mortalite ile ilişkili olarak bulundu. Sonuç: Araştırmamızda TPD uygulanan COVID-19’lu hastalar için gözlenen mortalite oranı literatürdeki işlem yapılmayan olgularla benzer bulunurken, bu hastalarda ferritin yüksekliği, entübasyon ve MOF varlığının mortalite riskini artırdığı gösterilmiştir.

Anahtar Kelimeler:

terapötik plazma değişimi, pnömoni, COVID-19

Therapeutic Plasma Exchange in Adult Patients with COVID-19 and Severe Pneumonia: Single Center Experience of Eighty Patients

Aim: Therapeutic plasma exchange (TPE) is a frequently discussed treatment modality in severe coronavirus disease 2019 (COVID-19) patients. It requires an apheresis device and experienced personnel for the application. In this study, we aimed to reveal the characteristics and clinical outcomes of adult patients with COVID-19 who experienced TPE. Material and Methods: Adult patients who had undergone TPE in our apheresis unit were retrospectively analyzed and COVID-19-positive cases were included in the study. All the medical information about the cases was obtained from the electronic database and technical details of the procedures were gathered from apheresis unit records. Results: A total of 80 patients with a median age of 60 (19-85) years were included in the study. Severe pneumonia was present in 98.8% (n=79) of the cases. More than three-quarters of the patients had lymphopenia, critically elevated C-reactive protein (CRP), and D-dimer, and 41.0% (n=32) had high ferritin. The median length of stay in the intensive care unit was 26 (5-124) days. The mortality rate observed on the 14th and 28th days following the TPE procedure was 51.3% (n=41) and 75.0% (n=60), respectively. High ferritin level, multiple organ failure (MOF), and intubation were parameters found to be associated with mortality in the multivariate analysis. Conclusion: The mortality rate observed in patients with COVID-19 who underwent TPE in our study was similar to the cases in the literature without the procedure, while it has been shown that high ferritin levels, intubation, and the presence of MOF increase the risk of mortality.

Keywords:

theurapeutic plasma exchange, pneumonia, COVID-19,

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