Comparison of Sepsis in Covid 19 Infected Patients on Therapeutic Plasma Exchange Vs Tocilizumab
DOI:
https://doi.org/10.51253/pafmj.v75iSUPPL-4.6921Keywords:
COVID 19; Plasma exchange; Sepsis; TocilizumabAbstract
Objective: To compare the presence of sepsis in COVID 19 infected patients on therapeutic plasma exchange vs Tocilizumab managed at Pak Emirates Military Hospital Rawalpindi
Study Design: Comparative Prospective study
Place and Duration of Study: Pak Emirates Military hospital Rawalpindi, from Feb 2021 to May 2021
Methodology: Patients who were diagnosed with COVID-19 on polymerase chain reaction and were oxygen dependent but not mechanical ventilation dependent were included in the study. They were randomly divided into two groups. Group I received 3-5 sessions of plasma exchange while group II received 1-2 doses of Tocilizumab. They were followed up for 10 days to look for presence of sepsis on basis of pro-calcitonin. Type of treatment used and other factors were correlated with presence of sepsis among the target population.
Results: Out of 350 patients included in the study 201 (57.4%) were male while 149 (42.6%) were female. Mean age of the study participants was 49.69 ±9.456 years. 287 (82%) had procalcitonin within range and no evidence of bacterial sepsis while 63 (18%) were diagnosed as having sepsis on the basis of raised pro-calcitonin levels. Advanced age, presence of comorbidities and use of Tocilizumab had statistically significant relationship (p-value<0.05) with presence of sepsis among the patients managed for severe COVID 19.
Conclusion: Bacterial sepsis was found in significant number of patients with severe COVID 19 illness undergoing therapeutic plasma exchange or receiving Tocilizumab. Patients more than 40 years of age or having comorbid medical illnesses or receiving Tocilizumab instead of plasma...
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References
Huremović D. Brief History of Pandemics (Pandemics Throughout History). Psych Pandem. 2019; 7(1): 35. Published 2019 May 16. https://doi:10.1007/978-3-030-15346-5_2
Ge H, Wang X, Yuan X, Xiao G, Wang C, Deng T et al. The epidemiology and clinical information about COVID-19. Eur J Clin Microbiol Infect Dis. 2020; 39(6): 1011‐1019.
https://doi:10.1007/s10096-020-03874-z
Stevens MP, Doll M, Pryor R, Godbout E, Cooper K, Bearman G. Impact of COVID-19 on traditional healthcare-associated infection prevention efforts. Infect Control Hosp Epidemiol. 2020;1‐2. https://doi:10.1017/ice.2020.141
Bose S, Adapa S, Aeddula NR, Roy S, Nandikanti D, Vupadhyayula PM, et al. Medical Management of COVID-19: Evidence and Experience. J Clin Med Res. 2020 Jun;12(6):329-343.https://doi: 10.14740/jocmr4201.
Wunsch H. Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology. Am J Respir Crit Care Med. 2020; 202(1): 1-4. https://doi:10.1164/rccm.2020041385ED
Schulze-Koops H, Specker C, Iking-Konert C, Holle J, Moosig F, Krueger K. Preliminary recommendations of the German Society of Rheumatology (DGRh eV) for the management of patients with inflammatory rheumatic diseases during the SARS-CoV-2/COVID-19 pandemic. Ann Rheum Dis. 2020; 79(6): 840‐842.
https://doi:10.1136/annrheumdis-2020-217628
Guaraldi G, Meschiari M, Cozzi-Lepri A, Milic J, Tonelli R, Menozzi M, et al. Tocilizumab in patients with severe COVID-19: a retrospective cohort study. Lancet Rheumatol. 2020 Aug; 2(8): e474-e484.
https://doi: 10.1016/S2665-9913(20)30173-9.
ElSeirafi MM, Hasan HM, Sridharan K, Zamoori A, Alkhawaja S, Pasha SAA. Efficacy and safety of tocilizumab in critically ill adults with COVID-19 infection in Bahrain: A report of 5 cases. Respir Med Case Rep. 2020 Jun 23; 30(3): 101139.
https://doi: 10.1016/j.rmcr.2020.101139.
Valk SJ, Piechotta V, Chai KL, Doree C, Monsef I, Wood EM, et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a rapid review. Cochrane Database Syst Rev. 2020 May 14; 5(5): CD013600.
Kamran SM, Mirza ZE, Naseem A, Liaqat J, Fazal I, Alamgir W et al. Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study. PLoS One. 2021; 16(1): e0244853. Published 2021 Jan 7.
https://doi:10.1371/journal.pone.0244853
He S, Liu W, Jiang M, Huang P, Xiang Z, Deng D, et al. Clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection: A multi-center study. PLoS ONE. 2021;16(4): e0249668.
https://doi.org/10.1371/journal.pone.0249668
Sergent SR, Ashurst JV. Plasmapheresis. StatPearls Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK560566/
Samaee H, Mohsenzadegan M, Ala S, Maroufi SS, Moradimajd P. Tocilizumab for treatment patients with COVID-19: Recommended medication for novel disease. Int Immunopharmacol. 2020; 89(Pt A): 107018.
https://doi:10.1016/j.intimp.2020.107018
Cleland DA, Eranki AP. Procalcitonin. StatPearls Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK539794/
Mushtaq Z , Mahmood SBZ, Jamil B, Aziz A, Ali SA. Outcome of COVID-19 patients with use of Tocilizumab: A single center experience. Int Immunopharmacol. 2020 Nov; 88(1):106926. https://doi: 10.1016/j.intimp.2020.106926.
Vu CA, DeRonde KJ, Vega AD, Maxam M, Holt G, Natori Y, et al. Effects of Tocilizumab in COVID-19 patients: a cohort study. BMC Infect Dis. 2020 Dec 22; 20(1): 964.
https://doi: 10.1186/s12879-020-05701-4.
Balagholi S, Dabbaghi R, Eshghi P, Mousavi SA, Heshmati F, Mohammadi S. Potential of therapeutic plasmapheresis in treatment of COVID-19 patients: Immunopathogenesis and coagulopathy. Transfus Apher Sci. 2020; 59(6): 102993. https://doi:10.1016/j.transci.2020.102993
Lu J, Zhang L, Xia C, Tao Y. Complications of therapeutic plasma exchange: A retrospective study of 1201 procedures in 435 children. Medicine (Baltimore). 2019; 98(50): e18308. https://doi:10.1097/MD.0000000000018308
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Copyright (c) 2025 Amina Hussain, Imran Fazal, Sana Uruj, Asim Saleem, Natasha Sarwar
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