Title : Real-world effectiveness of therapeutic plasma exchange in patients with severe fever with thrombocytopenia syndrome
Abstract:
Severe Fever with Thrombocytopenia Syndrome (SFTS) is a life-threatening infectious disease for which no standardized treatment has been established. Observational studies have suggested that therapeutic plasma exchange (TPE) may enhance survival outcomes in patients with SFTS. However, these findings are limited by small sample sizes and potential selection bias, reducing their generalizability and robustness. This study aims to assess the efficacy of TPE in improving survival outcomes in SFTS patients using real-world data. This retrospective, multicenter study was conducted across nine national university hospitals in South Korea from January 2013 to December 2023. Eligible patients included hospitalized adults (≥18 years) who tested positive for SFTS via RT-PCR. The primary outcome was 30-day mortality, compared between TPE and non-TPE groups using Kaplan-Meier survival analysis before and after applying inverse probability of treatment weighting (IPTW). To control for baseline confounders, propensity scores were estimated using a multivariate logistic regression model incorporating predefined covariates most relevant to TPE administration. A total of 431 patients were included, with 272 in the TPE group and 159 in the non-TPE group. Kaplan-Meier analysis demonstrated significantly higher survival rates in the non-TPE group compared to the TPE group (p < 0.001). After IPTW adjustment, the survival difference between groups was no longer statistically significant (p = 0.834). Although the non-TPE group maintained a numerically higher survival rate after adjustment, the difference was not significant. This study represents the largest multicenter observational investigation of SFTS treatment to date. By employing IPTW, this analysis mitigated selection bias, thereby enhancing the validity of findings. Despite the lack of significant survival benefits associated with TPE after adjustment, the study provides valuable insights into the clinical management of SFTS.
