{ "abstract": "Background: Real-world evidence on therapeutic plasma exchange (TPE) from low- and middle-income countries remains limited. Egyptian data across multiple organ systems are scarce. This study aimed to evaluate the indications, safety, efficacy, and predictors of outcomes in patients undergoing TPE at a tertiary center in Egypt over 7 years. Methods and Findings: This retrospective cohort study included 221 consecutive patients who underwent TPE (2016–2022) at Zagazig University Hospitals, Egypt. Patients were stratified into renal, neurologic, hematologic, and metabolic groups. Primary outcomes were clinical response and all-cause mortality. Multivariate logistic regression, Cox proportional hazards models, and Kaplan–Meier survival analysis were performed. Among 221 patients (57.9% male; mean age 36.0 years), the most frequent indications were Guillain–Barré syndrome, thrombotic thrombocytopenic purpura, and myasthenia gravis crisis. ASFA category I indications constituted 77.8% of procedures, with response rates decreasing significantly across categories (p = 0.03). Overall response rate was 77.9% (complete remission in 93.0% of responders), with mortality 14.5%. Response rates exceeded 85% in autoimmune hemolytic anemia, hyperviscosity syndrome, and TTP. Neurologic indications achieved 81.6% response; renal indications showed lower response (73.2%) and highest mortality (21.3%). Adverse events occurred in 37.2% of patients, all mild-to-moderate with no session terminations. Independent mortality predictors included mechanical ventilation, creatinine >2.5 mg/dL, renal indication, hemoglobin <8 g/dL, while ASFA category I was protective (all aORs 2.67–5.22). In exploratory analyses, PLASMIC score ≥6 and time to TPE ≤ 2 days were associated with complete remission in TTP, while Hughes score ≥4 and time to TPE > 7 days were associated with poor functional outcome in GBS. These findings require external validation before clinical application. Diffuse alveolar hemorrhage (n = 9) demonstrated 100% mortality despite intervention, whereas SLE patients (n = 23) had 52.2% mortality, with 47.8% achieving complete remission or clinical improvement. A three-tier risk model stratified patients into high, intermediate, and low mortality risk groups. Independent predictors of clinical response included neurologic, hematologic, and metabolic indications compared to renal, ASFA category I, and ≥5 TPE sessions, while hemoglobin <8 g/dL and creatinine >2.5 mg/dL predicted poorer response. Conclusions: This single-center Egyptian TPE cohort demonstrates high efficacy and safety when aligned with ASFA guidelines. Neurologic and hematologic indications achieve optimal outcomes; renal indications and critical illness markers predict poorer prognosis. The PLASMIC score, treatment urgency in TTP and GBS, and the proposed three-tier model represent exploratory findings that, if prospectively validated, could become actionable prognostic tools. These findings suggest that evidence-based TPE expansion in resource-limited settings may be feasible, though multicenter validation is required.", "abstract_shown": true, "affiliations": [ "Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt", "Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt", "Internal Medicine Department, Faculty of Medicine, Suez University, Suez, Egypt", "Neurology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt", "Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt" ], "article_type": "Research Article", "arxiv": null, "author_total": 7, "authors": [ { "affs": [ 0 ], "name": "Mohamed Ahmed El Maghawry" }, { "affs": [ 1 ], "name": "Reham Abd Elkhalek" }, { "affs": [ 2 ], "name": "Fatima Altaher Taha" }, { "affs": [ 3 ], "name": "Amira A. A. Othman" }, { "affs": [ 4 ], "name": "Aliaa Mohamed Abd El Khalik Ahmed" }, { "name": "Dina A. Abdelhady" }, { "name": "Fatma M. Attia Elsayed" } ], "bibtex": "https://research.draconitic.com/paper/axd6fatq9sq7v.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0358069", "fulltext_url": null, "id": "axd6fatq9sq7v", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0358069", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2704|Blood transfusion and management" ], [ "plos", "/Biology and life sciences/Anatomy/Body fluids/Blood/Platelets" ], [ "plos", "/Biology and life sciences/Biochemistry/Biomarkers/Creatinine" ], [ "plos", "/Biology and life sciences/Cell biology/Cellular types/Animal cells/Blood cells/Platelets" ], [ "plos", "/Biology and life sciences/Immunology/Clinical immunology/Autoimmune diseases/Lupus erythematosus/Systemic lupus erythematosus" ], [ "plos", "/Biology and life sciences/Immunology/Clinical immunology/Autoimmune diseases/Myasthenia gravis" ], [ "plos", "/Biology and life sciences/Physiology/Body fluids/Blood/Platelets" ], [ "plos", "/Medicine and health sciences/Anatomy/Body fluids/Blood/Platelets" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Clinical immunology/Autoimmune diseases/Lupus erythematosus/Systemic lupus erythematosus" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Clinical immunology/Autoimmune diseases/Myasthenia gravis" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Hemorrhage" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Hematology" ], [ "plos", "/Medicine and health sciences/Hematology/Thrombocytopenia/Thrombotic thrombocytopenic purpura" ], [ "plos", "/Medicine and health sciences/Immunology/Clinical immunology/Autoimmune diseases/Lupus erythematosus/Systemic lupus erythematosus" ], [ "plos", "/Medicine and health sciences/Immunology/Clinical immunology/Autoimmune diseases/Myasthenia gravis" ], [ "plos", "/Medicine and health sciences/Rheumatology/Systemic lupus erythematosus" ], [ "plos", "/Medicine and health sciences/Vascular medicine/Hemorrhage" ] ], "openalex": "W7212257034", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0358069&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-11", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/axd6fatq9sq7v.ris", "sources": [ { "first_seen": "2026-10-30T12:17:50Z", "native_id": "10.1371/journal.pone.0358069", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0358069" } ], "subjects": [ { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "medicine", "origin": "plos:anatomy", "subfield": "physiology" } ], "title": "Therapeutic plasma exchange across multiple organ systems in an Egyptian tertiary center: A seven-year real-world cohort study", "title_text": "Therapeutic plasma exchange across multiple organ systems in an Egyptian tertiary center: A seven-year real-world cohort study", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:56Z", "url": "https://research.draconitic.com/paper/axd6fatq9sq7v", "venue": "PLOS One", "versions": [] }