{ "abstract": "Background\n\nSeptic shock due to streptococcal infection (SRSS) carries a high mortality and is in part driven by toxin-mediated inflammation. Therapeutic plasma exchange (TPE) may modulate the septic host responses by removing injurious mediators while replenishing protective plasma factors, but data specific to SRSS is lacking. We performed a retrospective, multicenter, cohort study of adults with SRSS between 2012-2024.Methods\n\nPatients from three tertiary care ECMO centers in Germany and Switzerland were included requiring (i) streptococcal spp. detected in blood or primary focus and (ii) septic shock according to sepsis-3 definition. Adjunctive TPE with fresh frozen plasma at the intensivists` discretion was compared with standard of care (SOC). The primary outcome was 90-day-hospital mortality. Key exploratory outcomes included 24-h kinetics of vasoactive-inotropic score(VIS) and lactate, as well as SRSS-related complications. Results were validated in a 1:1 propensity score-matched (PSM) cohort.Results\n\nOf 149 patients, 31 (20.8%) received TPE and 118 (79.2%) SOC. TPE patients were more severely ill at baseline: SOFA 14 (IQR 13.5-15) vs 11 (IQR 8-14) (p<0.001); lactate 6.4 vs 2.8 mmol/L (p<0.001); Vasoactive-Inotropic-Score (VIS) 70.7 vs 23.3 (p<0.001); more frequent invasive ventilation (87% vs 65%), VV-ECMO (36% vs 19%), and renal replacement therapy (96.8% vs 52.5%). Overall, 90-day hospital mortality was 27.5% (TPE 29.0%, SOC 27.1%). Following SOFA-score adjustment, TPE was associated with lower mortality risk (aHR 0.67 [95% CI 0.5-0.9]; p=0.009). This was validated in the PSM cohort, with an aHR for TPE of 0.44 (95% CI 0.3-0.8); p=0.002. Mixed-effects modeling demonstrated a significant VIS reduction only with TPE (fixed effect 24-h change, p=0.027) and improved lactate decrease versus SOC.Conclusion\n\nIn SRSS, adjunctive TPE was associated with rapid hemodynamic stabilization and improved lactate kinetics. Exploratory adjusted survival analyses support prospective evaluation of TPE in SRSS.", "abstract_shown": true, "affiliations": [ "Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany.", "Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover Medical School (MHH), German Center for Lung Research (DZL), Hannover, Germany.", "PRACTIS Clinician Scientist Program, Dean's Office for Academic Career Development, Hannover Medical School, Hannover, Germany.", "Institute of Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland.", "Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.", "Division of Cardiothoracic Anaesthesia and Intensive Care Medicine, Department of General Anaesthesia, Intensive Care and Pain Medicine, Medical University Vienna, Vienna, Austria.", "Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.", "Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.", "Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany. seeliger.benjamin@mh-hannover.de.", "Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover Medical School (MHH), German Center for Lung Research (DZL), Hannover, Germany. seeliger.benjamin@mh-hannover.de." ], "article_type": "research article", "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0, 1, 2 ], "name": "Jannik Ruwisch", "orcid": "0000-0003-1654-6668" }, { "affs": [ 3 ], "name": "Alix Buhlmann" }, { "affs": [ 4 ], "name": "Lennart Wild" }, { "affs": [ 3, 5 ], "name": "Pedro David Wendel-Garcia" }, { "affs": [ 0, 1, 2 ], "name": "Thorben Pape" }, { "affs": [ 3 ], "name": "Daniel A Hofmaenner" }, { "affs": [ 4 ], "name": "Christian Putensen" }, { "affs": [ 4 ], "name": "Philippe Kruse" }, { "affs": [ 0 ], "name": "Greta-Henrike Holtgrave" }, { "affs": [ 6 ], "name": "Heiko Schenk" }, { "affs": [ 4 ], "name": "Christian Bode" }, { "affs": [ 3 ], "name": "Sascha David" }, { "affs": [ 7 ], "name": "Klaus Stahl" }, { "affs": [ 8, 9 ], "name": "Benjamin Seeliger", "orcid": "0000-0001-7373-752X" }, { "name": "Bonn-Hannover-Zurich ARDS (BonHanZA) Study Group" } ], "bibtex": "https://research.draconitic.com/paper/7h8hbs3ezzfxg.bib", "cited_by": 0, "doi": "10.1186/s40635-026-00984-4", "fulltext_url": "https://europepmc.org/articles/PMC13719982", "id": "7h8hbs3ezzfxg", "issns": [ "2197-425X" ], "landing_url": "https://europepmc.org/article/MED/42955503", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Research Articles" ], [ "openalex", "2713|Sepsis Diagnosis and Treatment" ] ], "openalex": "W7224475848", "pdf_url": "https://europepmc.org/articles/PMC13719982?pdf=render", "pmcid": "PMC13719982", "pmid": "42955503", "published": "2026-10-28", "publisher": "Springer", "ris": "https://research.draconitic.com/paper/7h8hbs3ezzfxg.ris", "sources": [ { "first_seen": "2026-11-01T00:20:36Z", "native_id": "MED:42955503", "source": "europepmc", "url": "https://europepmc.org/article/MED/42955503" }, { "first_seen": "2026-11-02T12:23:51Z", "native_id": "PMC13719982", "source": "pmc", "url": "https://doi.org/10.1186/s40635-026-00984-4" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2713|Sepsis Diagnosis and Treatment", "subfield": "epidemiology-public-health" } ], "title": "Adjunctive therapeutic plasma exchange as rescue therapy in septic shock due to streptococcal infection: a multicentric retrospective cohort study.", "title_text": "Adjunctive therapeutic plasma exchange as rescue therapy in septic shock due to streptococcal infection: a multicentric retrospective cohort study.", "type": "peer-reviewed", "updated_at": "2026-11-03T12:20:57Z", "url": "https://research.draconitic.com/paper/7h8hbs3ezzfxg", "venue": "Intensive care medicine experimental", "versions": [] }