The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock with Multiple Organ Failure: A Single Center Retrospective Review

Abstract

Background: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence behind therapeutic plasma exchange in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure compared to standard therapy alone. Methods: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine resistant septic shock and multiple organ failure in Intensive care units at a tertiary care hospital in Winston Salem, North Carolina from August 2015- March 2019. Adult patients with catecholamine resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure (lactic acid >2, platelets < 200, and pH < 7.3) were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using APACHE II score, SOFA score, and age was used to match patients, resulting in 40 patients in each arm. Results: Mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients. The 28-day mortality rate was 40% in the TPE group versus 62.5% in the standard care group (p=0.07). The subgroup of patients with pneumonia as the primary diagnosis had a 28-day mortality rate of 47.8% with adjunct TPE compared 81.3% with standard care alone (p = 0.05). Improvements in baseline SOFA scores at 48 hours were greater in the TPE group compared to standard care alone (p= 0.001). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay. Conclusions: Our retrospective, observational study in adult patients with septic shock and multiple organ failure did not show improvement with adjunct TPE except in patients with pneumonia as the primary source of sepsis. Hemodynamics and organ dysfunction did improve with TPE regardless of source. A prospective, randomized clinical trial is needed to investigate TPE in adult sepsis and to identify subgroups that are most likely to benefit.