Severe autoimmune hemolytic anemia in ICU: a place for emergency plasma exchange? A French multicenter retrospective study

IF 9.3 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2025-09-30 DOI:10.1186/s13054-025-05601-6

Jean-Baptiste Destival, Tomas Urbina, Wulfran Bougouin, Judith Leblanc, Sacha Seksik, Delphine Gobert, Vincent Bonny, Louai Missri, Jean-Luc Baudel, Juliette Bernier, Hafid Ait-Oufella, Eric Maury, Olivier Fain, Jérémie Joffre

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引用次数: 0

Abstract

Autoimmune hemolytic anemia (AIHA) is a rare but potentially life-threatening condition requiring intensive care unit (ICU) admission in severe cases. While corticosteroids and immunosuppressants are standard treatments, their delayed efficacy limits their utility in critical settings requiring rapid hemolysis control. Plasma exchange (PlEx) may offer a rapid intervention, but its effectiveness in severe AIHA remains uncertain. This study aims to assess the clinical characteristics, outcomes, and the potential benefit of PlEx in ICU cases with severe AIHA. We conducted a multicenter retrospective cohort study including patients with severe AIHA admitted to 15 ICUs within the Assistance Publique–Hôpitaux de Paris (AP-HP) network between 2017 and 2024. Clinical, biological, and therapeutic data were collected. A multivariate logistic regression model, an analysis adjusted on a propensity score (PS) and on inverse probability of treatment weighting (IPTW) were used to identify predictors of in-ICU mortality and evaluate the association between PlEx and in-ICU mortality. One hundred forty-eight ICU stays involving severe AIHA hemolytic crises were analyzed. The median age at ICU admission was 61 {48–71} years, with a balanced sex ratio (51% male). Admission median hemoglobin was 5.2 g/dL {4.2–7.2} and in-ICU mortality was 17.6%. Risk factors for in-ICU mortality included age > 60 years, renal replacement therapy, mechanical ventilation, and high-dose intravenous methylprednisolone (HDIM). Therefore, ICU mortality was mainly driven by organ dysfunction rather than anemia severity. Standard corticosteroid therapy (1–2 mg/kg) (OR:0.19 [0.03–0.94], P = 0.05) and PlEx (OR:0.04 [0.004–0.4], P = 0.008) were associated with improved survival. The association between PlEx and outcome persisted after PS (OR: 0.04 [0.001–0.39]; P = 0.012) and IPTW (OR: 0.13 [0.02–0.55]; P = 0.011) adjustment. In this large ICU cohort, severe AIHA was associated with high mortality, driven by organ failure rather than anemia severity. PlEx are associated with survival, suggesting its potential role as a bridge to immunosuppressive therapy in selected cases. Prospective studies are needed to confirm these findings.

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重症监护病房重症自身免疫性溶血性贫血：紧急血浆置换的场所？一项法国多中心回顾性研究

自身免疫性溶血性贫血（AIHA）是一种罕见但可能危及生命的疾病，严重者需要入住重症监护病房（ICU）。虽然皮质类固醇和免疫抑制剂是标准的治疗方法，但它们的延迟疗效限制了它们在需要快速溶血控制的关键情况下的应用。血浆置换（PlEx）可能提供快速干预，但其在严重AIHA中的有效性仍不确定。本研究旨在评估PlEx在重症AIHA ICU患者中的临床特点、结局和潜在获益。我们进行了一项多中心回顾性队列研究，包括2017年至2024年间在巴黎援助Publique-Hôpitaux （AP-HP）网络中入住15个icu的严重AIHA患者。收集临床、生物学和治疗数据。采用多变量logistic回归模型、倾向评分（PS）和治疗加权逆概率（IPTW）进行校正分析，确定icu内死亡率的预测因素，并评估PlEx与icu内死亡率之间的关系。对148例重症AIHA溶血危象ICU住院病例进行分析。ICU入院时的中位年龄为61 48-71岁，性别比例平衡（51%为男性）。入院时中位血红蛋白为5.2 g/dL {4.2-7.2}， icu死亡率为17.6%。icu内死亡的危险因素包括年龄60岁、肾脏替代治疗、机械通气和大剂量静脉注射甲基强的松龙（HDIM）。因此，ICU死亡率主要由器官功能障碍而非贫血严重程度驱动。标准皮质类固醇治疗（1-2 mg/kg）（OR:0.19 [0.03-0.94], P = 0.05）和PlEx （OR:0.04 [0.004-0.4], P = 0.008）与生存率提高相关。在PS （OR: 0.04 [0.001-0.39]; P = 0.012）和IPTW （OR: 0.13 [0.02-0.55]; P = 0.011）调整后，PlEx与预后的相关性仍然存在。在这个大型ICU队列中，严重的AIHA与高死亡率相关，由器官衰竭而不是贫血严重程度驱动。PlEx与生存有关，提示其在某些病例中作为免疫抑制治疗的桥梁的潜在作用。需要前瞻性研究来证实这些发现。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.