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The following is a summary of “Effect of therapeutic plasma exchange on tissue factor and tissue factor pathway inhibitor in septic shock,” published in the October 2024 issue of Critical Care by Stahl et al.
Coagulopathy, a pathological response to sepsis, characterized by increased plasma tissue factor (TF) and tissue factor pathway inhibitor (TFPI), leading to disseminated intravascular coagulation (DIC), multi-organ dysfunction, and higher mortality, with no targeted treatments available.
Researchers conducted a retrospective study investigating the therapeutic plasma exchange (TPE) mitigating sepsis-induced coagulopathy by rebalancing plasma proteins.
They examined 51 individuals with early (shock onset <24 hours) and severe septic shock (norepinephrine dose >0.4 μg/kg/min) who received either standard of care (SOC, n=14) or SOC with a single therapeutic plasma exchange (TPE, n=37). Plasma levels of TF and TFPI were measured at baseline and again 6 hours after inclusion. The impact of TPE on TF and TFPI levels was assessed and compared with those receiving only SOC. Baseline TF and TFPI levels were used to model and predict clinical outcomes following TPE based on the reduction in lactate levels over the first 24 hours post-inclusion.
The results showed a significant reduction in TF and TFPI levels post-TPE, while SOC had no effect, while TF decreased by 18.3% in the TPE group and increased by 14% in the SOC group (P <0.001). Similarly, TFPI decreased by 20% in the TPE group and increased by 14.4% in the SOC group (P =0.022). The TF: TFPI ratio remained unchanged in both groups. Higher baseline TF and TFPI levels correlated with increased lactate reduction in the TPE group.
They concluded adjunctive TPE in septic shock significantly reduced TF and TFPI levels, potentially contributing to early hemodynamic improvement, and higher baseline TF and TFPI levels predicted better treatment response.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05142-4
