Evidence map›Paper›PMID 41029710›Full record

ArticleCritical care (London, England)2025

Severe autoimmune hemolytic anemia in ICU: a place for emergency plasma exchange? A French multicenter retrospective study.

Jean-Baptiste Destival, Tomas Urbina, Wulfran Bougouin, Judith Leblanc, Sacha Seksik, Delphine Gobert, Vincent Bonny, Louai Missri, Jean-Luc Baudel, Juliette Bernier and 5 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Jean-Baptiste DestivalIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Tomas UrbinaIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Wulfran BougouinIntensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 91377, Massy, France.
Judith LeblancSorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health; Assistance Publique, Hôpitaux de Paris (AP-HP), Hôpital St Antoine, Clinical Research Platform Paris-East, Paris, France.
Sacha SeksikAssistance Publique, Hôpitaux de Paris (AP-HP), Hôpital St Antoine, Clinical Research Platform Paris-East, Paris, France.
Delphine GobertService de Médecine Interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université, 75012, Paris, France.
Vincent BonnyIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Louai MissriIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Jean-Luc BaudelIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Juliette BernierIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Hafid Ait-OufellaIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Eric MauryIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Olivier FainService de Médecine Interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université, 75012, Paris, France.
Jérémie JoffreIntensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France. jeremie.joffre@aphp.fr.
AIHA study group of the clinical data warehouse of Greater Paris University Hospitals

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAutoimmune hemolytic anemia (AIHA) is a rare but potentially life-threatening condition requiring intensive care unit (ICU) admission in severe cases. While corticosteroids and immunosuppressants are standard treatments, their delayed efficacy limits their utility in critical settings requiring rapid hemolysis control. Plasma exchange (PlEx) may offer a rapid intervention, but its effectiveness in severe AIHA remains uncertain. This study aims to assess the clinical characteristics, outcomes, and the potential benefit of PlEx in ICU cases with severe AIHA.

methodsWe conducted a multicenter retrospective cohort study including patients with severe AIHA admitted to 15 ICUs within the Assistance Publique-Hôpitaux de Paris (AP-HP) network between 2017 and 2024. Clinical, biological, and therapeutic data were collected. A multivariate logistic regression model, an analysis adjusted on a propensity score (PS) and on inverse probability of treatment weighting (IPTW) were used to identify predictors of in-ICU mortality and evaluate the association between PlEx and in-ICU mortality.

resultsOne hundred forty-eight ICU stays involving severe AIHA hemolytic crises were analyzed. The median age at ICU admission was 61 {48-71} years, with a balanced sex ratio (51% male). Admission median hemoglobin was 5.2 g/dL {4.2-7.2} and in-ICU mortality was 17.6%. Risk factors for in-ICU mortality included age > 60 years, renal replacement therapy, mechanical ventilation, and high-dose intravenous methylprednisolone (HDIM). Therefore, ICU mortality was mainly driven by organ dysfunction rather than anemia severity. Standard corticosteroid therapy (1-2 mg/kg) (OR:0.19 [0.03-0.94], P = 0.05) and PlEx (OR:0.04 [0.004-0.4], P = 0.008) were associated with improved survival. The association between PlEx and outcome persisted after PS (OR: 0.04 [0.001-0.39]; P = 0.012) and IPTW (OR: 0.13 [0.02-0.55]; P = 0.011) adjustment.

conclusionIn this large ICU cohort, severe AIHA was associated with high mortality, driven by organ failure rather than anemia severity. PlEx are associated with survival, suggesting its potential role as a bridge to immunosuppressive therapy in selected cases. Prospective studies are needed to confirm these findings.

Indexed as

Anemia, Hemolytic, AutoimmunePlasma ExchangeAgedCohort StudiesFemaleFranceHumansIntensive Care UnitsLogistic ModelsMaleMiddle AgedPropensity ScoreRetrospective StudiesAutoimmune hemolytic anemiaCorticosteroidsIntensive careMortalityPlasma exchange

Identifiers

PMID41029710
PMCPMC12487022

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.