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Crit Care Med. 2019 Mar;47(3):e173-e181. doi: 10.1097/CCM.0000000000003559.

Therapeutic Plasma Exchange in Children With Thrombocytopenia-Associated Multiple Organ Failure: The Thrombocytopenia-Associated Multiple Organ Failure Network Prospective Experience.

Author information

1
Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA.
2
Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
3
Department of Anesthesia and Critical Care Medicine, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
4
Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati Children's Medical Center, Cincinnati, OH.
5
Department of Pediatrics, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH.
6
Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr Children's Hospital, Nashville, TN.
7
Department of Pediatric Intensive Care, Children's Hospital and Clinics of Minnesota, Minneapolis, MN.
8
Department of Pediatric Critical Care, Phoenix Children's Hospital, Phoenix, AZ.
9
Department of Pediatric Critical Care Medicine, Children's National Medical Center, Washington, DC.
10
Department of Pediatrics, University of Michigan School of Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI.
11
Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, GA.

Abstract

OBJECTIVE:

The objective was to compare the resolution of organ dysfunction, 28-day mortality, and biochemical markers in children with thrombocytopenia-associated multiple organ failure who received therapeutic plasma exchange versus no therapeutic plasma exchange.

DESIGN:

Observational longitudinal cohort study.

SETTING:

Nine U.S. PICUs.

PATIENTS:

Eighty-one children with sepsis-induced thrombocytopenia-associated multiple organ failure.

INTERVENTIONS:

Therapeutic plasma exchange.

MEASUREMENTS AND MAIN RESULTS:

Adjusted relative risk for 28-day mortality was modeled using standard multivariate regression with propensity score weighting to reduce covariate confounding. Change from baseline Pediatric Logistic Organ Dysfunction scores between therapeutic plasma exchange and no therapeutic plasma exchange differed in temporal pattern during the first week (p = 0.009). By day 4, mean Pediatric Logistic Organ Dysfunction score declined by 7.9 points (95% CI, -10.8 to -5.1) in the therapeutic plasma exchange-treated group compared with no change with no therapeutic plasma exchange. Use of therapeutic plasma exchange was associated with reduced 28-day mortality by multivariate analysis (adjusted relative risk, 0.45; 95% CI, 0.23-0.90; p = 0.02) and by propensity score weighting (adjusted relative risk, 0.46; 95% CI, 0.22-0.97; p = 0.04).

CONCLUSIONS:

Therapeutic plasma exchange use in thrombocytopenia-associated multiple organ failure was associated with a decrease in organ dysfunction. After accounting for several risk factors, 28-day all-cause mortality was lower in children treated with therapeutic plasma exchange compared with those receiving no therapeutic plasma exchange. A multicenter randomized clinical trial is necessary to determine a causal relationship.

PMID:
30531184
DOI:
10.1097/CCM.0000000000003559
[Indexed for MEDLINE]

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