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Therapeutic plasma exchange and mortality in critically ill patients with sepsis-associated acute kidney injury: A retrospective cohort study using propensity score matching.
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Abstract
ObjectiveTo assess the link between therapeutic plasma exchange (TPE) and mortality outcomes in intensive care unite (ICU) patients with sepsis-associated acute kidney injury (AKI).MethodsThis retrospective cohort study was conducted using data from the MIMIC-IV database. Adult ICU patients with sepsis-associated AKI were identified using Sepsis-3 criteria and the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI during ICU admission. Standard TPE was defined as a volume of approximately 1.0-1.5 times the total plasma volume. Kaplan-Meier analysis was used to estimate 30- and 90-day ICU mortality. Cox proportional hazards models were applied to evaluate the associations between TPE and mortality outcomes. Propensity score matching (PSM) was further performed to assess the robustness of the findings.ResultsA total of 17,533 patients with sepsis-associated AKI were included; 204 (1.2%) received adequate TPE. During the 90-day follow-up period, 5,458 patients (31.8%) in the non-TPE group and 119 patients (58.3%) in the TPE group died. In Cox proportional hazards models, TPE was associated with increased 30-day (hazard ratio [HR] = 2.36, 95% confidence interval [CI] 1.94-2.87) and 90-day mortality (HR = 2.30, 95% CI 1.92-2.76). After PSM with good covariate balance (all standardized mean differences <0.1), TPE remained associated with higher 30-day (HR = 1.68, 95% CI 1.22-2.31) and 90-day mortality (HR = 1.59, 95% CI 1.19-2.12).ConclusionsIn ICU patients with sepsis-associated AKI, TPE was associated with higher 30-day and 90-day ICU mortality, underscoring the need for careful patient selection and prospective studies to clarify its clinical role.
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