Over 6 million people have died due to COVID-19 worldwide since the start of the pandemic. Several comorbidities are associated with COVID-19 disease severity, such as older age, obesity, cardiovascular disease, cancer, and other conditions that weaken the immune system. Furthermore, severity and mortality of COVID-19 have been linked to excessive cytokine release; specifically, elevated interleukin (IL)-6 levels have been shown to positively correlate with mortality. Plasma exchange therapy enables the removal of ~65% of cytokines, such as IL-6, in a one-volume exchange, and up to 85% of cytokines with two plasma exchange procedures. In order to determine if plasma exchange may improve the 60-day survival of patients with severe COVID-19, researchers at one medical center in Mexico City conducted a non-randomized trial comparing all-cause, 60-day mortality in 20 patients with severe COVID-19 (mean age 48 years; 72.5% male) who received two plasma exchange procedures in addition to standard care to 40 patients (mean age 47 years; 47.7% male) who received only standard care. Plasma exchange therapy was associated with reduced mortality compared to the standard care arm (20% vs. 50%; OR 0.25; 95% C.I., 0.071 to 0.880, p=0.029) without significant adverse events. Results from the multivariable model also showed a similar association with reduced mortality. However, the length of hospital stay was greater in patients who received plasma exchange and the risk of mechanical ventilation was similar between arms. Further studies are needed to confirm these results and pinpoint the patients who may benefit the most from plasma exchange to treat severe COVID-19.
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