Intensive Therapeutic Plasma Exchange—New Approach to Treat and Rescue Patients with Severe Form of Yellow Fever

Intensive Therapeutic Plasma Exchange—New Approach to Treat and Rescue Patients with Severe Form of Yellow Fever

Background: Severe yellow fever (YF) can result in acute liver failure (ALF) and high mortality. The role of therapeutic plasma exchange (TPE) in managing YF-ALF remains unclear. This study evaluated the impact of TPE strategies in severe YF. Methods: This observational case-series study evaluated t...

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Main Authors: Yeh-Li Ho, Youko Nukui, Paula Ribeiro Villaça, Erica Okazaki, Nelson Hidekazu Tatsui, Lucas Chaves Netto, Daniel Joelsons, Tania Rubia Flores da Rocha, Fernanda de Mello Malta, João Renato Rebello Pinho, Aluisio Augusto Cotrim Segurado, Vanderson Rocha
Format: Article
Language:English
Published: MDPI AG 2025-01-01
Series:Tropical Medicine and Infectious Disease
Subjects:
yellow fever
flaviviruses
arboviruses
plasma exchange
critical care
acute liver failure
Online Access:https://www.mdpi.com/2414-6366/10/2/39
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Summary:Background: Severe yellow fever (YF) can result in acute liver failure (ALF) and high mortality. The role of therapeutic plasma exchange (TPE) in managing YF-ALF remains unclear. This study evaluated the impact of TPE strategies in severe YF. Methods: This observational case-series study evaluated three groups of patients classified according to treatment: G1 (standard intensive care support [ICS]), G2 (ICS + high-volume-TPE [HV-TPE]), and G3 (ICS + intensive TPE). HV-TPE was performed during 3 consecutive days with extra sessions of one plasma-volume, if necessary, whereas intensive TPE consisted of one plasma volume/session performed twice daily, with additional fresh frozen plasma infusion. Hemostatic agents, including tranexamic acid, platelets, and cryoprecipitate, were administered as needed. TPE was de-escalated based on clinical and laboratory parameters. The primary outcome was mortality. Results: Sixty-six patients were included (G1: 41, G2: 11, G3: 14). Groups had similar baseline characteristics. Mortality was significantly lower in G3 (14%) compared to G2 (82%) and G1 (85%) (<i>p</i> < 0.001). Additionally, G3 patients showed a higher frequency of undetectable YF viral load. Conclusions: Intensive TPE is a feasible and effective intervention for severe YF, achieving an 84% reduction in mortality. The limitations of our results are the small sample size, observational and single-center study. Further studies are warranted to elucidate intensive TPE’s role in YF management.
ISSN:2414-6366

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