The effect of plasmapheresis on clinical outcome, interleukin-6 and D-dimer in COVID-19 patients

Acute respiratory distress syndrome (ARDS) is characterized by severe hypoxemia with severe lung inflammation. Inflammatory mediators such as colony stimulating factors, tumour necrosis factors, IL-1, IL-6, and IFNs pass through the alveolar membrane and cause a process known as cytokine storm (hypercytokinemia). It occurs commonly in viral infections such as COVID-19. Recent attention has been focused on extracorporeal adjustment of intravascular cytokine levels in COVID-19 patients experiencing severe inflammatory response. Therefore, plasmapheresis has been suggested to reduce the load of plasma cytokines and coagulation factors. The effects of plasmapheresis and its frequency on clinical manifestations, inflammatory markers, specific laboratory values, and their correlation were the main subjects of this study. The length of hospital stays and fatality rates were also evaluated. The participants were COVID-19 cases receiving either invasive mechanical ventilation (IMV) or non-invasive positive pressure ventilation (NIPPV), who were admitted to Shahid Sadoughi Hospital, Yazd, Iran. from March 2020 to May 2021. We evaluated 108 COVID-19 patients with positive PCR test results. A higher admission to plasmapheresis time significantly increased the mortality rate, while presence of chronic illnesses had no effect on survival. The dead cases had a longer admission to plasmapheresis period and hypoxemia upon arrival, whereas d-dimer and length of stay did not show any significant elevation in this group. In conclusion, our study showed that the therapeutic plasmapheresis blood purification technology is safe, effective, and enhances tissue oxygenation by removing inflammatory cytokines and acute phase proteins.