English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

In patients with COVID-19 pneumonia, high risk of thrombosis became a current issue, and D-dimer levels indicating fibrin degradation products (FDPs) in the plasma were found as a predictor for mortality [1, 2]. Although unfractionated heparin (UFH) and lowmolecular-weight heparin (LMWH) decrease the production of FDPs by inhibiting factors Xa and II, they cannot contribute metabolization of existing FDPs. Furthermore, FDPs cannot be filtered by known cytokine filters because of their molecular weight (minimum 240 kDa) [3, 4]. Yet, FDPs can be removed by therapeutic plasma exchange (TPE) [5]. Therefore, recently, three consecutive TPE sessions were performed in selected patients with COVID-19 pneumonia in intensive care units (ICUs) after the assessment of their clinical and coagulation status. In the study, the effect of TPE on outcomes was retrospectively investigated in patients with COVID19 pneumonia. All COVID-19 patients admitted to 5 different tertiary ICUs between 10 March and 10 May 2020 were evaluated, and 73 of 91 patients were included in the study. The patients who died within the first 4 days and who were still in the ICUs on 10 May were excluded. According to the Turkish Health Minister Algorithm for COVID-19, all included patients received the same antiviral (favipiravir, hydroxychloroquine, azithromycin) therapy and anticoagulant prophylaxis (UFH infusion 100 mcg/kg or LMWH 0.01 mL/kg). Since two different protocols were used in 5 ICUs, patients with D-dimer ≥ 2 in 3 ICUs had only received therapeutic anticoagulation whereas patients with D-dimer ≥ 2 in the other 2 ICUs had received TPE plus therapeutic anticoagulation. In all ICUs, for all patients in GII, echocardiography, lower extremity venous Doppler, and, if pulmonary thrombosis suspected, thorax computerized tomography angiography were performed. After collecting data, 73 patients were divided into 2 groups as group I (GI) (D-dimer < 2 mg/L) and group II (GII) (D-dimer ≥ 2mg/L), and then GII was also divided into 2 groups as GIIa (TPE+) and GIIb (TPE−). Patients’ characteristics, respiratory and laboratory parameters, and outcomes were recorded. Propensity score matching (PSM) analysis was conducted on R v4.0.1 (0.2 caliper without replacement and nearest neighbor model, 1:1 ratio) by using 14 covariates (age, gender, CCI, APACHE II, SOFA score, lactate, leucocyte, lymphocyte, D-dimer and creatinine at the ICU admission, maximum respiratory support, the usage of steroid, IL-6 blocker, and cytokine filter). The total mortality rate was 27.4%. Mortality rates of GI and GII were 5% and 35.9%, respectively. In GII, major thromboembolic events were not detected in any patients. The median (min-max) day for the starting TPE was 3 (2–4). In GIIa, APACHE II, SOFA scores, Ddimer and interleukin-6 (IL-6) levels at the ICU admission, and length of ICU stay were significantly higher than those of GI whereas mortality rates were similar in those groups (Table 1). The median values of the LOSICU in survivors and non-survivors in GII were 14 (6.5– 21.5) and 15.5 (8–23), respectively (p = 0.630). In GIIa, lactate dehydrogenase (LDH), D-dimer, ferritin, IL-6, Creactive protein (CRP), and procalcitonin levels were

Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study