Adjunctive therapeutic plasma exchange as rescue therapy in septic shock due to streptococcal infection: a multicentric retrospective cohort study
In brief
Plasma exchange linked to about one-third lower adjusted mortality in streptococcal shock
In this retrospective study of 149 adults, 31 received plasma exchange and were more severely ill at baseline. Overall 90-day hospital mortality was similar, at 29% with exchange versus 27% with standard care, but adjusted analyses linked exchange to lower mortality and faster improvement in blood pressure support and lactate. A prospective study is needed to determine whether exchange improves survival.
- Journal
- Intensive care medicine experimental (Q1)
- Published
- 28 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Jannik Ruwisch, Alix Buhlmann, Lennart Wild, Pedro David Wendel-Garcia, Thorben Pape, Daniel A Hofmaenner, et al.
- PMID
- 42955503
- DOI
- 10.1186/s40635-026-00984-4
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 2 November 2026): Evaluates rescue therapy, hemodynamics, and mortality in septic shock
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.