Adjunctive therapeutic plasma exchange as rescue therapy in septic shock due to streptococcal infection: a multicentric retrospective cohort study.
10 affiliations
- 1Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany.
- 2Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover Medical School (MHH), German Center for Lung Research (DZL), Hannover, Germany.
- 3PRACTIS Clinician Scientist Program, Dean's Office for Academic Career Development, Hannover Medical School, Hannover, Germany.
- 4Institute of Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland.
- 5Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
- 6Division of Cardiothoracic Anaesthesia and Intensive Care Medicine, Department of General Anaesthesia, Intensive Care and Pain Medicine, Medical University Vienna, Vienna, Austria.
- 7Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
- 8Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
- 9Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany. [email protected].
- 10Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover Medical School (MHH), German Center for Lung Research (DZL), Hannover, Germany. [email protected].
Abstract
Background
Septic 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
Patients 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
Of 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
In SRSS, adjunctive TPE was associated with rapid hemodynamic stabilization and improved lactate kinetics. Exploratory adjusted survival analyses support prospective evaluation of TPE in SRSS.
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BibTeX
@article{ruwisch2026adjunctive,
title = {{Adjunctive therapeutic plasma exchange as rescue therapy in septic shock due to streptococcal infection: a multicentric retrospective cohort study.}},
author = {Jannik Ruwisch and Alix Buhlmann and Lennart Wild and Pedro David Wendel-Garcia and Thorben Pape and Daniel A Hofmaenner and Christian Putensen and Philippe Kruse and Greta-Henrike Holtgrave and Heiko Schenk and Christian Bode and Sascha David and Klaus Stahl and Benjamin Seeliger and Bonn-Hannover-Zurich ARDS (BonHanZA) Study Group},
journal = {Intensive care medicine experimental},
year = {2026},
month = oct,
doi = {10.1186/s40635-026-00984-4},
url = {https://europepmc.org/article/MED/42955503},
note = {CC BY},
}
RIS
TY - JOUR
TI - Adjunctive therapeutic plasma exchange as rescue therapy in septic shock due to streptococcal infection: a multicentric retrospective cohort study.
AU - Jannik Ruwisch
AU - Alix Buhlmann
AU - Lennart Wild
AU - Pedro David Wendel-Garcia
AU - Thorben Pape
AU - Daniel A Hofmaenner
AU - Christian Putensen
AU - Philippe Kruse
AU - Greta-Henrike Holtgrave
AU - Heiko Schenk
AU - Christian Bode
AU - Sascha David
AU - Klaus Stahl
AU - Benjamin Seeliger
AU - Bonn-Hannover-Zurich ARDS (BonHanZA) Study Group
PY - 2026
DA - 2026/10/28
JO - Intensive care medicine experimental
DO - 10.1186/s40635-026-00984-4
UR - https://europepmc.org/article/MED/42955503
AB - Background Septic 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 Patients 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 Of 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 In SRSS, adjunctive TPE was associated with rapid hemodynamic stabilization and improved lactate kinetics. Exploratory adjusted survival analyses support prospective evaluation of TPE in SRSS.
SN - 2197-425X
ER -