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Outcomes in necrotizing soft tissue infections treated with therapeutic plasma exchange
Author(s) -
Saifee Nabiha Huq,
Evans Heather L.,
Magaret Amalia S.,
Hess John R.,
Delaney Meghan,
O'Keefe Grant E.,
Pham Tam N.,
Foy Hugh,
Bulger Eileen,
Pagano Monica B.
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14067
Subject(s) - medicine , sepsis , odds ratio , creatinine , surgery , retrospective cohort study , sofa score
BACKGROUND Treatment of necrotizing soft tissue infections (NSTIs) includes prompt surgical debridement and antibiotics, but despite standard care, the morbidity and mortality remain high. Since therapeutic plasma exchange (TPE) has been considered for treatment of severe sepsis, this study evaluates the efficacy of TPE for patients with NSTI. STUDY DESIGN AND METHODS This is a retrospective study of patients with diagnosis of NSTI who received treatment with and without TPE over an 11‐year period. The primary outcome was in‐hospital mortality. RESULTS Fifty‐two patients with NSTI treated with TPE (TPE group) and 125 patients with NSTI not treated with TPE (non‐TPE group) were assessed. Nineteen (36.5%) patients died in the TPE group, and 35 (28%) patients died in the non‐TPE group. Within the TPE group, there was significant improvement in white blood cell (WBC) count and sodium levels 7 days after TPE treatment, but no improvement in creatinine. Inverse probability weighting based on propensity scores was used to compare survival in the TPE and non‐TPE groups and demonstrated that TPE was associated with an increased odds of death (odds ratio, 2.8). A second analysis matched for six variables yielded 31 pairs and demonstrated no significant difference in mortality or length of stay. CONCLUSIONS This study describes the largest series of patients with NSTIs treated with TPE and showed no evidence of clinical benefit. Further carefully designed studies with meaningful clinical endpoints would prove useful in assessing reproducibility and determining if there is a role for TPE in other forms of severe sepsis.