The therapeutic efficacy of plasmapheresis for sepsis with multiple organ failure: a propensity score-matched analysis based on the MIMIC-IV database.

BACKGROUND: Despite advancements in sepsis treatment, mortality remains high. Plasmapheresis (PE) targeting multiple pathways simultaneously appears to be a potential treatment option, but evidence is insufficient. We aimed to investigate the efficacy of PE for sepsis with multiple organ failure (MOF).

METHOD: Septic patients with MOF were identified from the Medical Information Mart for Intensive Care IV database. Patients who received PE were matched with those receiving conventional therapy via propensity score matching (PSM). Regression analyses evaluated the association between PE and outcomes. The Kaplan-Meier (KM) method was utilized to analyze the survival probability. The generalized additive mixed model investigated early indexes changes' association with treatment modalities and 28-day mortality.

RESULTS: 906 septic patients with MOF were enrolled. After PSM, PE and conventional groups consisted of 60 cases each. PE was associated with a reduced risk of 28-day mortality (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.27-0.94), 1-year mortality (HR: 0.44, 95%CI: 0.26-0.74), and in-hospital mortality (HR: 0.38, 95%CI: 0.20-0.71). KM curves demonstrated significant differences in survival probability between groups. Compared with the conventional group, the sequential organ failure assessment, norepinephrine dosage, prothrombin time, actate dehydrogenase, total bilirubin, white blood cells, and immature granulocytes in the PE group significantly decreased over time, while platelets, red blood cells, and hemoglobin significantly increased over time.

CONCLUSIONS: Plasmapheresis demonstrated an association with reduced risks of 28-day, in-hospital and 1-year mortality in septic patients with MOF. Moreover, plasmapheresis might exhibit the potential to improve outcomes by improving organ function, hemodynamics and restoring several indicators such as coagulation, anemia, and inflammation.