title: Outcomes in necrotizing soft tissue infections treated with therapeutic plasma exchange.
abstract: Treatment of necrotizing soft tissue infections (NSTIs) includes prompt surgical debridement and antibiotics, but despite standard care, the morbidity and mortality remain high. Since therapeutic plasma exchange (TPE) has been considered for treatment of severe sepsis, this study evaluates the efficacy of TPE for patients with NSTI.
  
  
  
  This is a retrospective study of patients with diagnosis of NSTI who received treatment with and without TPE over an 11-year period. The primary outcome was in-hospital mortality.
  
  
  
  Fifty-two patients with NSTI treated with TPE (TPE group) and 125 patients with NSTI not treated with TPE (non-TPE group) were assessed. Nineteen (36.5%) patients died in the TPE group, and 35 (28%) patients died in the non-TPE group. Within the TPE group, there was significant improvement in white blood cell (WBC) count and sodium levels 7 days after TPE treatment, but no improvement in creatinine. Inverse probability weighting based on propensity scores was used to compare survival in the TPE and non-TPE groups and demonstrated that TPE was associated with an increased odds of death (odds ratio, 2.8). A second analysis matched for six variables yielded 31 pairs and demonstrated no significant difference in mortality or length of stay.
  
  
  
  This study describes the largest series of patients with NSTIs treated with TPE and showed no evidence of clinical benefit. Further carefully designed studies with meaningful clinical endpoints would prove useful in assessing reproducibility and determining if there is a role for TPE in other forms of severe sepsis.
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.|Bloodworks Northwest, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Nabiha Huq
authors.identifier: 0000-0003-1646-9201
authors.initials: NH
authors.lastname: Saifee
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Evans
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.|Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: Amalia S
authors.initials: AS
authors.lastname: Magaret
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: John R
authors.identifier: 0000-0001-8596-4420
authors.initials: JR
authors.lastname: Hess
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.|Bloodworks Northwest, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Meghan
authors.initials: M
authors.lastname: Delaney
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Grant E
authors.initials: GE
authors.lastname: O'Keefe
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Tam N
authors.initials: TN
authors.lastname: Pham
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Hugh
authors.initials: H
authors.lastname: Foy
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Eileen
authors.initials: E
authors.lastname: Bulger
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Monica B
authors.initials: MB
authors.lastname: Pagano
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology*; D010951:Plasma Exchange / Q000379:methods*; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome