Indications and outcomes of patients receiving therapeutic plasma exchange under critical care conditions: a retrospective eleven-year single-center study at a tertiary care center

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While per se is not among the daily routine of the intensivist TPE is frequently be performed under critical care conditions. However, data regarding TPE indications, patient characteristics and technical details on the intensive care unit (ICU) are sparse. Methods : We performed a retrospective, single-center study using data from January 2010 until August 2021 for patients treated with TPE in an ICU setting at the University Hospital Zurich. Data was collected from de-identified electronic patient medical records using specific search terms. Patient characteristics (including demographics, BMI, comorbidities, lab values and ICU-specific parameters, outcome), apheresis-specific technical parameters and complications were recorded and analyzed. Results : We identified n=105 patients meeting our inclusion criteria, with an even sex distribution (50.5% women) and median age of 56 (17-85) years. These 105 patients received a total of n=408 TPE treatments for 25 different indications. The most common indication were thrombotic microangiopathies (TMA) (38%), with thrombotic thrombocytopenic purpura (TTP) being the most prevalent sub-indication (27.6%). Level of evidence according to ASFA (American Society for Apheresis) guidelines varied and was well established in 63.8% of cases. Ten patients presented with TPE-related complications, with anaphylaxis being the most common. Bleeding complications were rare (1%). Median duration of ICU treatment was 8 ± 14 days. A total of 59 (56.2%), 26 (24.8%), and 35 (33.3%) patients needed ventilator, renal replacement or vasopressor support, respectively, with 6 (5.7%) needing extracorporeal membrane oxygenation. The overall survival in our critically ill patients treated with TPE was 88.6%. Conclusion : Our study provides a comprehensive overview of TPE indications in ICU patients at a major tertiary academic medical center and could serve as a point of reference for other comparable hospitals. Similar studies should be encouraged to establish reliable standards and ultimately improved treatment outcomes. plasmapheresis indications ASFA category intensive care unit (ICU) academic medical center thrombotic microangiopathy Figures Figure 1 Figure 2 Figure 3 Background Intensive care units (ICUs) are specialized treatment departments for patients requiring close monitoring and often life-saving critical care, including pharmacological or mechanical organ support due to hemodynamic instability or organ failure. Despite developments in diagnosis and treatment, mortality rates in ICUs remain high ( 1 ). Therapeutic plasma exchange (TPE or PEX) is a life-saving therapeutic intervention for otherwise untreatable and severe conditions ( 2 , 3 ) commonly used as primary or adjunct therapy for a variety of indications with relevance to intensivists ( 4 ). TPE is an automated, extracorporeal process that allows the replacement of large volumes of plasma with a substitute solution (e.g., human albumin, healthy donor plasma, mixtures). The procedure can benefit patients in two broad disease categories: 1) Removal of pathologic elements from the blood circulation (e.g., autoantibodies, toxins, cytokines, adhesion molecules) via apheresis to reverse a pathologic process. Examples are (auto-) immune mediated conditions including neurological disorders, graft rejections following solid organ transplantation, or infectious diseases ( 2 ). 2) Substitution of missing or inactivated protective plasma factors through healthy donor plasma. The classic example for this application is thrombotic microangiopathy (TMA) caused by thrombotic thrombocytopenic purpura (TTP), a potentially fatal condition resulting from an acquired or inherited reduced activity of the von Willebrand cleaving protease ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) ( 5 ). Two principal methods are used to separate plasma and cellular components: centrifugal forces or membrane filtration ( 6 ). While cellular components are usually returned to the patient they can also be deliberately removed (e.g., in patients at risk for leukostasis) or harvested (i.e., cytapheresis) to perform hematopoietic stem cell transplantation ( 7 , 8 ). The American Society for Apheresis (ASFA), supported by the European Society for Hemapheresis (ESFH), publishes regularly updated evidence-based treatment guidelines for TPE ( 2 ). Yet, these guidelines are not tailored towards ICU patients and only a limited number of studies have specifically addressed TPE in an ICU setting ( 9 – 12 ). In the current study we performed a comprehensive, single-center 11-year retrospective analysis of TPE indications in critically ill patients at a University Hospital. Methods Study population and research design We performed a retrospective, single-center study using data from January 2010 through September 2021 for patients treated with TPE at the Institute of Intensive Care Medicine (6 units, 72 beds total capacity) at the University Hospital Zurich (USZ). The key aim of our study was to analyze indications, technical details as well as patient- and ICU-specific parameters. Patients were identified from our electronic health record systems using specific search terms: “plasmapheresis”, “plasma exchange” and/or “PEX”. We included all patients age ≥ 18 years treated for any indication with TPE in the ICU setting. Recorded and analyzed variables included patient socio-demographic data (age and gender), BMI, underlying disease (according to ASFA classification), major comorbidities, laboratory parameters, ICU-specific data (sequential organ failure assessment (SOFA) score, mechanical support (renal, ventilatory, circulatory), vasoactive-inotropic treatment, duration of ICU stay, ICU survival), TPE-specific procedural parameters (number of TPE sessions, type and amount of replacement fluids, vascular access and complications). Apheresis was performed in collaboration with the Department of Hematology using the COBE Specta or Spectra Optia Apheresis System (Terumo, Tokio, Japan), which apply continuous-flow centrifugation for separation of cellular components from plasma. Plasma volumes were calculated using each patient’s weight and hematocrit value. Regional citrate anticoagulation was used in all cases. The study was approved by the cantonal ethics committee Zurich (BASEC reference number 2021 − 01130) and performed in accordance with the Declaration of Helsinki. Data presentation Raw data was processed using Excel (Microsoft, Redmond, Washington) or GraphPad Prism (GraphPad Software, San Diego, California). No power calculation was performed. Categorical variables are presented as median and range, continuous variables are presented as mean ± standard deviation (± SD) or percentage of the whole. Results Study population We identified a total of 105 patients that met the inclusion criteria for our study. The median number of patients treated per year in our ICU setting was 8 (range 3–18). The socio-demographic and other patient specific data (including BMI, comorbidities, and ICU specific) are presented in Table 1 . The median age of our cohort was 56 (range 17–85) years, with similar distribution of female and male patients (50.5% vs. 49.5%, respectively). The most common comorbidities were hypertension (36.2%), obesity (defined as a BMI ≥ 30 kg/m2) (19%), and chronic kidney disease (CKD) (11.4%). Table 1 Patient characteristics. Data are shown as patients per category and percentage of the total population. Abbreviations: COPD – chronic obstructive pulmonary disease, CAD – coronary artery disease, IMV – invasive mechanical ventilation, NIV – non-invasive ventilation, ECMO – extracorporeal membrane oxygenation. SOFA – Sequential Organ Failure Assessment. BMI – body mass index. ICU – intensive care unit. SD – standard deviation. TPE – therapeutic plasma exchange. *mean ± SD. # SOFA score was available for n = 64 (61%) and only recorded after 2013. Patient Characteristics n = 105 Gender n (%) Women 53 (50.5) Men 52 (49.5) Ages n (%) < 18 2 (1.9) 18–29 13 (12.4) 30–49 28 (26.7) 50–64 36 (34.3) 65–79 21 (20) 80+ 5 (4.8) median age (range) 56 (17–85) BMI (kg/m²) 25.8 ± 4.8* Comorbidities n (%) Obesity 20 (19) Hypertension 38 (36.2) Diabetes 7 (6.7) COPD 2 (1.9) Heart failure 9 (8.6) CAD 8 (7.6) CKD 12 (11.4) Length of ICU stay 14.5 ± 17.9 ICU specifics n (%) non-ventilated 46 (43.8) IMV 52 (49.5) NIV 3 (2.9) high flow 4 (3.8) renal replacement 26 (24.8) ECMO 6 (5.7) Vasoactive-inotropic treatment 35 (33.3) SOFA score # , 1st day of TPE 7.7 ± 3.7* TPE indications and laboratory findings Overall, these critically ill patients were treated for a total 25 indications with TPE (Table 2 ). Figure 1 illustrates the eight most common indications and their numerical distribution. TMA was the most common indication (n = 40, 46.5%), with TTP representing most TMA cases (n = 29, 33.7%). Table 2 Laboratory parameters before initiation of TPE per indication . Data are presented as mean ± SD. Abbreviations: TTP – Thrombotic thrombocytopenic purpura, TMA – Thrombotic microangiopathy, TPE – therapeutic plasma exchange, SD – standard deviation. # Transplantation-associated included: n = 3 desensitization, n = 9 antibody- mediated rejections, n = 1 cellular rejection, n = 1 rejection prophylaxis Indication (total n) Hematocrit Hemoglobin (g/l) Leukocytes (G/l) Thrombocytes G/l CRP (mg/l) Procalcitonin (µg/l) LDH (U/l) Bilirubin (µmol/l) Creatinine (µmol/l) eGFR (ml/min) All 0.27 ± 0.07 87 ± 25 13.2 ± 8.3 172 ± 160 76.7 ± 81.5 5.4 ± 18.29 1632 ± 3560 28.1 ± 36 210 ± 235 61 ± 40 TMA, all (n = 40) 0.25 ± 0.07 82 ± 26 12 ± 6.1 91 ± 135 80.6 ± 81 6.8 ± 20.36 1768 ± 1009 36.8 ± 45.4 309 ± 302 40 ± 36 TMA, TTP (n = 29) 0.26 ± 0.08 82 ± 30 11.1 ± 6.1 107 ± 155 78 ± 86.2 10.6 ± 24.21 1598 ± 1095 45.1 ± 52.1 236 ± 280 53 ± 37 TMA, complement-mediated (n = 6) 0.21 ± 0.03 74 ± 8 13.6 ± 4.3 59 ± 40 74.2 ± 80.1 0.78 ± 0.65 1877 ± 425 17.7 ± 6 625 ± 309 12 ± 12 TMA, infection associated (n = 5) 0.28 ± 0.05 94 ± 17 14.8 ± 8 42 ± 34 103.4 ± 58.2 1.15 ± 0.35 2086 ± 1107 16.8 ± 6.9 342 ± 172 15 ± 7 Transplantation-associated # (n = 14) 0.3 ± 0.09 97 ± 32 13.7 ± 7.7 182 ± 92 52.6 ± 65.6 25.09 ± 32.37 1057 ± 1362 18.5 ± 18.7 232 ± 254 57 ± 43 Vasculitis (n = 12) 0.26 ± 0.04 85 ± 12 20.8 ± 12.9 412 ± 168 148 ± 100.8 3.31 ± 5.52 643 ± 327 12.6 ± 15.6 283 ± 281 51 ± 44 Guillain-Barré Syndrome (n = 9) 0.31 ± 0.08 101 ± 29 9.7 ± 4.3 286 ± 92 38.8 ± 23.4 0.22 ± 0.16 374 ± 90 9.5 ± 8.8 63 ± 24 98 ± 14 Autoimmune encephalitis (n = 6) 0.28 ± 0.04 90 ± 14 13.1 ± 9.4 284 ± 193 60.8 ± 108.7 0.07 ± 0.04 326 ± 146 1.8 ± 0.5 79 ± 41 93 ± 36 Myasthenia gravis (n = 5) 0.34 ± 0.1 115 ± 39 10.3 ± 4.2 292 ± 39 34.2 ± 53.3 1.51 ± 1.39 337 ± 13 11 ± 5.4 66 ± 22 102 ± 26 Goodpasture's Syndrome (n = 3) 0.27 ± 0.09 86 ± 30 15.22 ± 6.2 287 ± 28 49.7 ± 14.2 3.2 381 ± 153 19.8 ± 4.2 154 ± 63 54 ± 33 Acute liver failure (n = 2) 0.29 ± 0.12 92 ± 35 22.8 ± 25.3 31 ± 30 81.5 ± 70 0.36 ± 0.17 4070 ± 3789 78.5 ± 48.8 90 ± 9 86 ± 15 Macrophage-activating Syndrome (n = 1) 0.254 85 15.81 55 133 4.43 32976 57 167 39 Progressive bulbar palsy (n = 1) 0.223 68 5.92 249 39 0.37 204 4 52 84 Hypertriglyceridemia, idiopathic (n = 1) 0.191 64 28.83 154 113 8.91 698 122 99 68 Coagulopathy after polytrauma (n = 1) 0.135 45 1.78 89 0.6 0.1 383 6 73 97 Anti-IgLON5-associated encephalopathy (n = 1) 0.356 107 11.13 178 91 0.09 - - 71 90 Systemic sclerosis (n = 1) 0.261 85 20.06 135 47 0.43 1674 36 266 16 Chronic inflammatory demyelinating neuropathy (n = 1) 0.3 96 5.67 214 1.8 0.5 221 - 58 111 Postpartum microangiopathy (n = 1) 0.21 77 17.96 55 81 - 1692 10 283 18 Miller-Fisher Syndrome (n = 1) 0.257 87 11.18 225 131 0.48 - 5 51 107 Polyradiculoneuritis (n = 1) 0.235 78 23.55 444 16 0.17 543 - 75 90 Paraneoplastic neurological syndrome (n = 1) 0.316 115 10.92 158 69 0.5 395 13 50 90 Catastrophic antiphospholipid syndrome (n = 1) 0.271 93 20.99 99 164 0.96 788 4 103 61 acute demyelinating neuropathy (n = 1) 0.249 86 18.59 299 98 0.07 - 11 39 90 Hyperviscosity in hypergammaglobulinemia (n = 1) 0.26 88 11.9 36 38 0.67 715 100 147 44 Eleven cases of TMA were treated with TPE, nine (82%) of which had normal ADAMTS13 activity or lack of inhibitor. One patient died and analysis was canceled. Transplantation associated (n = 14, 16.3%), vasculitis (n = 12, 14%) and Guillain-Barré Syndrome (n = 9, 10.5%) were the second, third and fourth most common indication in our cohort, respectively. In the group of transplantation associated TPE 9 patients received TPE due to antibody mediated rejection, 3 due to desensitization, 1 for rejection prophylaxis and 1 because of cellular rejection. Of all 105 patients, 62 (59%) could be classified into ASFA category I, five (4.8%) were ASFA category II and 27 (25.7%) were ASFA category III (supplementary table S1). Out of the 10 most common indications, five are ASFA category I (TTP, Guillain-Barré Syndrome (GBS), Autoimmune encephalitis, Myasthenia gravis, Goodpasture’s Syndrome) one was ASFA category III (TMA, infection associated) and four indications had variable ASFA categories depending on more detailed knowledge about the disease. Analysis of clinical routine laboratory parameters showed that most patients were anemic (mean hematocrit 0.27 ± 0.07 and hemoglobin levels 87 ± 25 g/l) (Table 2 ). Inflammation parameters were elevated in 94 patients: CRP 76.7 ± 81.5 mg/l, procalcitonin 5.4 ± 18.3 µg/l, leukocyte count 13.2 ± 8.3 G/L. Kidney function was decreased in 54 patients (estimated glomerular filtration rate (eGFR) 61 ± 40 ml/min, creatinine 210 ± 235 µmol/l) and mean bilirubin-levels were 28.1 ± 36 µmol/l (elevated in 38 patients). Considering abnormal findings categorized by disease showed that leukocyte count was highest in patients with acute liver failure (22.8 ± 25.3 G/l) and vasculitis (20.8 ± 12.9 G/l). Patients with acute liver failure (n = 2) additionally presented with the most severe thrombocytopenia (31 ± 30 G/l) and the highest LDH levels (4070 ± 3789 U/l). Procalcitonin levels were highest in patients with transplantation-associated indications for TPE (25.1 ± 32.4 µg/l). The most severe impairment of renal function was recorded for complement-mediated (12 ± 12 ml/min) and infection associated TMAs (n = 6) (15 ± 7 ml/min). ICU specific findings and outcome Median length of stay in the ICU across all patients and indications was 8 ± 14.4 days and SOFA score was 7.7 ± 3.7 (on day 1 of TPE initiation). A total of 59 (56.2%) patients required ventilator support (52 (49.5%) invasive mechanical ventilation (IMV), three (2.9%) non-invasive ventilation (NIV) and four (3.8%) high flow oxygen via nasal cannula). Renal replacement therapy or vasoactive-inotropic treatment during the ICU stay was needed in 27 (25.7%) and 35 (33.3%) patients, respectively. Six (5.7%) patients required extracorporeal membrane oxygenation (ECMO) (Table 1 and Table 3 ). Overall ICU survival rate was 88.6%. Looking at TMA as the most common indication for TPE in our ICU setting, one fifth (20%) of cases were ventilated, 25.7% had renal replacement therapy and 12.5% needed vasoactive inotropic treatment (Table 3 ). The mean SOFA score for these patients was 8.5 ± 3.2 and 90% survived the ICU. Complement-mediated TMA had a lower-than-average ICU survival rate with 83.3%. All patients presenting with Guillain-Barré Syndrome (n = 9) required invasive mechanical ventilation (IMV) and all survived their ICU stay. The highest mean SOFA score on the first day of TPE was recorded patients with liver failure (15 ± 4.2) and only survived the ICU. Patients with autoimmune encephalitis (n = 6) had the longest ICU stay with 36 ± 29.9 days. Notably, a high percentage of these patients required IMV (83.3%) and vasoactive-inotropic support (66.7%). The ICU survival for patients suffering from autoimmune encephalitis was 83.3%. Patients with Goodpasture’s syndrome (n = 3) had a poor outcome in our cohort (66.6% ICU mortality). TPE procedural details and level of evidence During the 11-year observation period, the total of 408 (mean of 3.9 ± 3.3 per patient) TPE sessions were performed, representing 10.2% of all TPE’s performed at the USZ during the study period (n = 4008. Patients with TMA required 3.5 ± 3.7 TPE sessions, and TTP being exchanged most often (3.8 ± 4.2 TPE session). Nine TMA patients (31%) underwent only one TPE session (Fig. 2 A). At our institution, TPE for TPA was performed daily and stopped after thrombocyte count reaches > 150G/l three times in a row. The overall highest number of sessions was documented for Goodpasture’s syndrome (7 ± 5.3). Autoimmune-related diseases were usually exchanged every 2–3 days to allow transfer into of IgG from tissues and subsequent removal from the bloodstream. Figure 3 summarizes all indications including number of patients, mean TPE session count and their respective ASFA category and grade of recommendation. We evaluated several TPE procedural aspects in more detail. The amount of replacement fluid averaged at 3.4 liters per session and the type of replacement fluid was fresh frozen plasma (FFP) in 84 Table 3 Indications with ICU specifics. Data are shown as patients per category and percentage of the total population. Abbreviations: TTP – Thrombotic thrombocytopenic purpura, TMA – Thrombotic microangiopathy, SOFA score – Sequential Organ Failure Assessment score, ICU – intensive care unit, ECMO –extracorporeal membrane oxygenation, TPE – plasma exchange, SD – standard deviation. * Data expressed as mean ± SD. # Transplantation-associated included: n = 3 desensitization, n = 9 antibody-mediated rejections, n = 1 cellular rejection, n = 1 rejection prophylaxis. Indications (total n) Non-ventilated IMV NIV high flow Renal replacement ECMO Vasopressors Length of ICU stay Length of hospital stay ICU survival SOFA score ICU submission* SOFA score 1st day TPE* All (n = 105) 46 (43.8) 52 (49.5) 3 (2.9) 4 (3.8) 27 (25.7) 6 (5.7) 35 (33.3) 14.5 ± 17.9 36.6 ± 30.1 93 (88.6) 7.7 ± 3.4 7.7 ± 3.7 TMA, all (n = 40) 32 (80) 7 (17.5) 0 1 (2.5) 10 (25) 1 (2.5) 5 (12.5) 5.8 ± 8 19.2 ± 16.5 36 (90) 8.4 ± 3.2 8.5 ± 3.2 TMA, TTP (n = 29) 24 (82.8) 5 (17.2) 0 0 5 (17.2) 1 (3.5) 2 (6.9) 6.2 ± 9.1 20.1 ± 18.2 26 (89.7) 8 ± 3.7 8 ± 3.7 TMA, complement-mediated (n = 6) 4 (66.7) 2 (3.3) 0 0 2 (3.3) 0 1 (16.7) 4 ± 2.8 15.3 ± 7.6 5 (83.3) 8.7 ± 2.3 8.7 ± 2.3 TMA, infection associated (n = 5) 4 (80) 0 0 1 (20) 3 (60) 0 2 (40) 5.6 ± 4.6 18.6 ± 14.6 5 (100) 9.2 ± 3.4 9.6 ± 2.9 Transplantation-associated # (n = 14) 6 (42.9) 7 (50) 1 (7.1) 0 8 (57.1) 4 (28.6) 7 (50) 21.1 ± 17.8 57.4 ± 34.3 12 (85.7) 7.1 ± 3.1 7.4 ± 3.1 Vasculitis (n = 12) 2 (16.7) 7 (58.3) 2 (16.7) 1 (8.3) 3 (25) 1 (8.3) 6 (50) 8.5 ± 6.8 27.6 ± 12.1 12 (100) 5.4 ± 2.3 5.4 ± 2.3 Guillain-Barré Syndrome (n = 9) 0 9 (100) 0 0 0 0 2 (22.2) 28.3 ± 33.9 40.6 ± 36.1 9 (100) 4.8 ± 2.9 4.2 ± 2.6 Autoimmune encephalitis (n = 6) 1 (16.7) 5 (83.3) 0 0 0 0 4 (66.7) 36 ± 29.9 78.8 ± 38.9 5 (83.3) 6.5 ± 2.6 7 ± 2.8 Myasthenia gravis (n = 5) 0 5 (100) 0 0 0 0 3 (60) 23.4 ± 8.7 61.6 ± 36.6 5 (100) 6 ± 3.9 6 ± 4.4 Goodpasture’s Syndrome (n = 3) 0 2 (66.7) 0 1 (33.3) 0 0 2 (66.7) 26 ± 25 46.7 ± 30.6 2 (66.7) 8 ± 2.7 8 ± 2.7 Acute liver failure (n = 2) 0 1 (50) 0 1 (50) 2 (100) 0 1 (50) 7.5 ± 2.1 15.5 ± 13.4 1 (50) 11.5 ± 0.7 15 ± 4.2 Macrophage-activating Syndrome (n = 1) 0 1 0 0 1 0 1 4 25 0 18 16 Progressive bulbar palsy (n = 1) 0 1 0 0 0 0 0 17 55 1 9 4 Hypertriglyceridemia, idiopathic (n = 1) 0 1 0 0 1 0 1 29 61 1 12 13 Coagulopathy after polytrauma (n = 1) 0 1 0 0 - - 1 2 2 0 12 12 Anti-IgLON5-associated encephalopathy (n = 1) 0 1 0 0 0 0 0 9 35 1 7 3 Systemic sclerosis (n = 1) 1 0 0 0 1 0 0 11 35 0 8 8 Chronic inflammatory demyelinating neuropathy (n = 1) 0 1 0 0 0 0 1 31 75 1 6 4 Postpartum microangiopathy (n = 1) 1 0 0 0 0 0 0 12 45 1 - - Miller-Fisher Syndrome (n = 1) 0 1 0 0 0 0 0 28 55 1 - - Polyradiculoneuritis (n = 1) 0 1 0 0 0 0 0 30 35 1 - - Paraneoplastic neurological syndrome (n = 1) 0 1 0 0 0 0 1 17 34 1 - - Catastrophic antiphospholipid syndrome (n = 1) 1 0 0 0 0 0 0 6 25 1 - - acute demyelinating neuropathy (n = 1) 1 0 0 0 0 0 0 6 90 1 - - Hyperviscosity in hypergammaglobulinemia (n = 1) 1 0 0 0 1 0 0 5 51 1 - - (80%) patients, human albumin in 13 (12.4%) patients and a mixture of both in five (4.8%) patients (Table 4 ). Three patient records (2.9%) did not have documentation of the replacement fluid used. Most patients (n = 97, 92.4%) received a central vascular catheter for the procedure, five (4.8%) had a peripheral access and three (2.8%) had incomplete records. Complications occurred in 10 (9.5%) of patients and were mostly mild to moderate transfusion-related anaphylactic reactions (grade 1 n = 4, 3.8%; grade 2 n = 3, 2.9%) that responded well to guideline confirm treatment (Table 4 ). More severe complication occurred in 3 patients (noted as others in Table 4 ): one patient with progressive bulbar palsy suffered repeat bleeding while receiving human albumin and required substitution of fibrinogen, cryoprecipitated factor concentrates and Factor XIII. After switching replacement fluid to FFP no further complications occurred. Another patient with TTP went into cardiac arrest and died during TPE, which was posthumously classified as disease related due to massive thrombi in both ventricles. A third patient developed atrial fibrillation, which was successfully treated with cardioversion. Table 4 TPE specific parameters . Data are shown as patients per category and percentage of the total population. * Data expressed as mean ± SD. Abbreviations: FFP – fresh frozen plasma, TPE – therapeutic plasma exchange. SD – standard deviation. TPE sessions total TPE sessions 408 average TPE sessions per patient 3.9 ± 3.3* Replacement fluid n (%) amount per session (L) 3.4 ± 0.85* FFP 84 (80) Human albumin 13 (12.4) Mix 5 (4.8) Vascular access n (%) central 97 (92.4) periphery 5 (4.8) Complications n (%) transfusion reaction, anaphylaxis grade 1 4 (3.8) transfusion reaction, anaphylaxis grade 2 3 (2.9) bleeding complications 1 (0.95) others 2 (1.9) Discussion Our retrospective study spanning 11 years and a sizeable number of patients (n = 105) treated with TPE in the ICU setting demonstrated that TPE is overall save and beneficial, with ICU survival reaching 88.6% across all indications, reaffirming the role of TPE in the treatment of ICU patients. Indication for TPE according to ASFA was grade I in 59% of cases, demonstrating the overall robustness of decision making but also encouraging further investigations towards rigorous standards. The spectrum of indications for TPE in the critically ill in our cohort was to a large degree comparable to common indications in non-ICU cohorts published previously ( 2 – 4 , 13 ), including TMA (TTP), catastrophic antiphospholipid syndrome, Guillain-Barré Syndrome or acute liver failure. Other explorative indications such as sepsis ( 14 ), PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) ( 15 ) or drug overdoses / poisoning ( 16 ) were not present in our cohort. While ASFA guidelines are comprehensive, currently listing 89 diseases or 179 indications supported by various levels of evidence (I-III), uncertainties remain. For example, TMAs were the most common indication for TPE in our study (n = 40, 38.1%), which represent a heterogeneous group of disorders characterized by similar clinical laboratory findings, but markedly different underlying pathophysiology ( 17 ). The striking success of TPE as upfront emergency therapy in TTP, reducing morbidity and mortality from 90% in untreated patients to below 20% led to application in other forms of TMA, often before confirmation of ADAMTS13 status ( 18 , 19 ). In our cohort 11 (10.5%) patients received TPE for TMAs other than TTP and subsequent analysis normal ADAMTS13 activity or lack of inhibitor in nine (82%). The underlying pathology for these entities may not be circulatory factors purgeable via TPE, and could be associated with endothelial cell related factors or enterotoxins, thus potentially limiting benefit or causing harm in these conditions ( 17 , 20 ). A retrospective evaluation of TPE used during the EHEC-HUS pandemic in 2011 revealed lack of efficiency of plasma exchange in enterotoxin-mediated HUS in adults ( 21 ). On the other hand, current tests do not detect all ADAMTS13 deficiencies in patients presenting with TTP ( 22 ) and lack of specific criteria complicate decision making. Further studies are warranted, also regarding management of refractory TMA cases (e.g., TPE regimens; combination with caplacizumab) ( 23 , 24 ), ideally in randomized trials. A growing number of explorative indications for TPE further underline the potential and at the same time the necessity for standardization. Some examples include infections for example utilized in a) pediatric patients with H1N1 influenza A related respiratory failure and hemodynamic compromise ( 25 ), b) COVID-19 coagulopathy ( 26 , 27 ), c) septic shock ( 28 ) or d) enhanced removal of inflammatory cytokines by combining conventional TPE with specific adsorbers, has been applied in enveloped viral disease (e.g., Ebola) ( 29 ). In terms of procedural aspects, strong evidence for recommendations regarding the ideal treatment initiation and duration time-points, amount of the exchange volume, anticoagulation, type and composition of the substitute solution or vascular access are lacking and often locally defined in standard operating procedures within individual institutions. For example, the choice of replacement fluid, though important, partially lacks solid standards. The predominant use of FFP in our study can be partially explained by the high percentage of TMAs (TTP) compared to other studies ( 30 ) where FFP is the obligatory replacement solution to increase ADAMTS13 activity. A contrary example is the use of FFP in patients with GBS, which showed no benefit but an association with greater risks of citrate and transfusion reactions ( 31 , 30 ). In our study one third (n = 3) of GBS patients received FFP and one patient experienced atrial fibrillation during TPE with FFP, which was resolved with cardioversion. Still, the adverse advent rate for TPE in GBS vs. comparable to the overall complication rate (was 11% vs. 9.5%). Previously reported TPE-associated complication rates vary significantly, ranging from 1–2% up to 39%) ( 9 , 30 , 32 ). Anaphylactic reactions were the primary complications as reported by others in conjunction with plasma use ( 9 , 32 ). Only a single bleeding event was found which compares favorably with previous reports of up to 8.7% ( 9 ). Hypotension as a complication of TPE was not recorded in any patient, despite being the most common complications according to literature and correlating with a low hematocrit as present in most of our patients ( 9 ). Patients in our study received on average 3.9 ± 3.3 TPE sessions, similar to other studies in the ICU setting ( 9 , 11 ). Unlike the report from Lemaire et al. we did not see a higher amount of TPE procedures required in patients with TMAs compared to other indications ( 9 ). On the contrary, several other indications (Guillain-Barré Syndrome (5.8 ± 3.5), autoimmune encephalitis (5.5 ± 2.6) and Goodpasture Syndrome (7.7 ± 6)) resulted in more TPE sessions than all TMAs (3.5 ± 3.7). The median length of ICU stay (8 ± 14.4 days) was similar to previously results, but has also been reported with a median of 20.2 ± 25 days ( 9 , 11 , 12 ). Since cost and patient outcome are correlated with length of ICU stay ( 33 ) this difference is of importance and warrants further investigation of underlying factors. A strength of our study is the substantial amount of critically ill patients from a large tertiary care center in Switzerland with a total of 408 analyzed TPE sessions. Another strength is the detailed analysis of patient characteristics and laboratory findings as well as procedural aspects of TPE. Limitations of our study include its retrospective character and non-uniform documentation over the study period. Bias might occur through inconsistent reporting of minor complications. SOFA scores have only been recorded systematically in Switzerland after 2013 and 41 patients had no SOFA score available, which hindered a thorough assessment of the severity of illness. Finally, our analysis did not allow us to reliably distinguish solid indications for ICU treatment vs. other factors leading to TPE in the ICU. In conclusion, we provide a comprehensive analysis of TPE indications in patients requiring ICU treatment according to our in-house clinical practice at the University Hospital of Zurich. Overall, specific disease remission and ICU survival with almost 90% was excellent. We believe that our study is representative and could serve as a point of reference for other similar hospitals and might encourage similar research to form a basis for comparative analysis. Such shared experiences may be translated into reliable treatment standards and ultimately improved patient outcomes. Abbreviations TPE – therapeutic plasma exchange ICU – intensive care unit TTP – Thrombotic thrombocytopenic purpura TMA – Thrombotic microangiopathy ASFA – American Society for Apheresis ESFH – European Society for Hemapheresis ECMO – extracorporeal membrane oxygenation SD – standard deviation COPD – chronic obstructive pulmonary disease CAD – coronary artery disease IMV – invasive mechanical ventilation NIV – non-invasive ventilation SOFA score – Sequential Organ Failure Assessment score FFP – fresh frozen plasma Declarations Ethics approval and consent to participate The study was approved by the cantonal ethics committee Zurich (reference number 2021-01130). Consent for publication Not applicable Availability of data and materials All data generated or analyzed during this study are included in this published article [and its supplementary information files]. Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors’ contributions AR and AWS analyzed and interpreted the patient data regarding TPE indications in ICU patients, designed figures and tables and wrote the manuscript. All authors read and approved the final manuscript. Acknowledgements We would like to thank Michael Fetzer (USZ IT department) for helping with data retrieval. Also, we are grateful to our apheresis nursing staff who have spent endless nights and weekends on the ICU to perform TPEs. References Vincent JL, Marshall JC, Namendys-Silva SA, François B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014 May;2(5):380–6. Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apheresis. 2019 Jun;34(3):171–354. Stegmayr B, Mörtzell Henriksson M, Newman E, Witt V, Derfler K, Leitner G, et al. Distribution of indications and procedures within the framework of centers participating in the WAA apheresis registry. Transfus Apher Sci Off J World Apher Assoc Off J Eur Soc Haemapheresis. 2017 Feb;56(1):71–4. Linenberger ML, Price TH. Use of cellular and plasma apheresis in the critically ill patient: Part II: Clinical indications and applications. J Intensive Care Med. 2005 Apr;20(2):88–103. Kremer Hovinga JA, Coppo P, Lämmle B, Moake JL, Miyata T, Vanhoorelbeke K. Thrombotic thrombocytopenic purpura. Nat Rev Dis Primer. 2017 Apr 6;3:17020. Linenberger ML, Price TH. Use of cellular and plasma apheresis in the critically ill patient: part 1: technical and physiological considerations. J Intensive Care Med. 2005 Feb;20(1):18–27. Blum W, Porcu P. Therapeutic apheresis in hyperleukocytosis and hyperviscosity syndrome. Semin Thromb Hemost. 2007 Jun;33(4):350–4. Statkute L, Verda L, Oyama Y, Traynor A, Villa M, Shook T, et al. Mobilization, harvesting and selection of peripheral blood stem cells in patients with autoimmune diseases undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant. 2007 Mar;39(6):317–29. Lemaire A, Parquet N, Galicier L, Boutboul D, Bertinchamp R, Malphettes M, et al. Plasma exchange in the intensive care unit: Technical aspects and complications. J Clin Apheresis. 2017 Dec;32(6):405–12. Faria R, Bucur A, Gordinho A, Falcão L, Carrão A, Fernandes S, et al. Therapeutic Plasmapheresis: Seven Year Experience of an Intensive Care Unit in Portugal. Acta Med Port. 2021 Aug 20; Paton E, Baldwin IC. Plasma exchange in the intensive care unit: a 10 year retrospective audit. Aust Crit Care Off J Confed Aust Crit Care Nurses. 2014 Aug;27(3):139–44. Yilmaz AA, Can OS, Oral M, Unal N, Ayyildiz E, Ilhan O, et al. Therapeutic plasma exchange in an intensive care unit (ICU): a 10-year, single-center experience. Transfus Apher Sci Off J World Apher Assoc Off J Eur Soc Haemapheresis. 2011 Oct;45(2):161–6. Sanchez AP, Balogun RA. Therapeutic Plasma Exchange in the Critically Ill Patient: Technology and Indications. Adv Chronic Kidney Dis. 2021 Jan;28(1):59–73. David S, Bode C, Putensen C, Welte T, Stahl K, EXCHANGE study group. Adjuvant therapeutic plasma exchange in septic shock. Intensive Care Med. 2021 Mar;47(3):352–4. Latimer ME, L’Etoile N, Seidlitz J, Swedo SE. Therapeutic plasma apheresis as a treatment for 35 severely ill children and adolescents with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Child Adolesc Psychopharmacol. 2015 Feb;25(1):70–5. Schutt RC, Ronco C, Rosner MH. The role of therapeutic plasma exchange in poisonings and intoxications. Semin Dial. 2012 Apr;25(2):201–6. Winters JL. Plasma exchange in thrombotic microangiopathies (TMAs) other than thrombotic thrombocytopenic purpura (TTP). Hematol Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):632–8. Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol. 2012 Aug;158(3):323–35. Bell WR, Braine HG, Ness PM, Kickler TS. Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. N Engl J Med. 1991 Aug 8;325(6):398–403. McMinn JR, Thomas IA, Terrell DR, Duvall D, Vesely SK, George JN. Complications of plasma exchange in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: a study of 78 additional patients. Transfusion (Paris). 2003 Mar;43(3):415–6. Menne J, Nitschke M, Stingele R, Abu-Tair M, Beneke J, Bramstedt J, et al. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study. BMJ. 2012 Jul 19;345:e4565. Vesely SK, George JN, Lämmle B, Studt JD, Alberio L, El-Harake MA, et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood. 2003 Jul 1;102(1):60–8. Nguyen L, Li X, Duvall D, Terrell DR, Vesely SK, George JN. Twice-daily plasma exchange for patients with refractory thrombotic thrombocytopenic purpura: the experience of the Oklahoma Registry, 1989 through 2006. Transfusion (Paris). 2008 Feb;48(2):349–57. Scully M, Cataland SR, Peyvandi F, Coppo P, Knöbl P, Kremer Hovinga JA, et al. Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura. N Engl J Med. 2019 Jan 24;380(4):335–46. Patel P, Nandwani V, Vanchiere J, Conrad SA, Scott LK. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A–an associated respiratory failure and hemodynamic shock. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2011 Mar;12(2):e87-89. Keith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A. A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19. Crit Care Lond Engl. 2020 Apr 2;24(1):128. Keith P, Day M, Choe C, Perkins L, Moyer L, Hays E, et al. The successful use of therapeutic plasma exchange for severe COVID-19 acute respiratory distress syndrome with multiple organ failure. SAGE Open Med Case Rep. 2020;8:2050313X20933473. Knaup H, Stahl K, Schmidt BMW, Idowu TO, Busch M, Wiesner O, et al. Early therapeutic plasma exchange in septic shock: a prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers. Crit Care Lond Engl. 2018 Oct 30;22(1):285. Büttner S, Koch B, Dolnik O, Eickmann M, Freiwald T, Rudolf S, et al. Extracorporeal virus elimination for the treatment of severe Ebola virus disease–first experience with lectin affinity plasmapheresis. Blood Purif. 2014;38(3–4):286–91. Bouget J, Chevret S, Chastang C, Raphael JC. Plasma exchange morbidity in Guillain-Barré syndrome: results from the French prospective, randomized, multicenter study. The French Cooperative Group. Crit Care Med. 1993 May;21(5):651–8. Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome. Ann Neurol. 1987 Dec;22(6):753–61. Mörtzell Henriksson M, Newman E, Witt V, Derfler K, Leitner G, Eloot S, et al. Adverse events in apheresis: An update of the WAA registry data. Transfus Apher Sci Off J World Apher Assoc Off J Eur Soc Haemapheresis. 2016 Feb;54(1):2–15. Rapoport J, Teres D, Lemeshow S, Gehlbach S. A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study. Crit Care Med. 1994 Sep;22(9):1385–91. Additional Declarations No competing interests reported. Supplementary Files GA.png Graphical abstractCaption: Retrospective, multiparametric (patient, PEX and ICU-specific parameters) single center study of n=105 patients encompassing n=405 PEX sessions. 1 – TTP, 2 – infection associated, 3 – complement mediated. 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David@usz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBAC+QYGBmYgXcfAwNgg8QEsxoNfi8EBiJZkkBbJGURpYYBoSQTaxiDNQ5QW9uMPPxfUMCT2z0huvG3bVmfPwH72AF4t8j05xtIzjjEkzriR2Gyd23aYmYEnLwG/NQdy2Jh52IAOO3OwTTq37QAbgwSPAX4t558/Y+b5x5A4H6TFsq2Oh7CWGwlmzLxtDIkbjje2STO2MUsQ1GJw442xNG+fRLLh8cZmy55zhw3YeHLwa5HvT3/4meebTZ3cYfaHN36U1dnzs58h4DAIkEAw2YhRPwpGwSgYBaMAPwAAYlBA5E0zFjIAAAAASUVORK5CYII=","orcid":"","institution":"University Hospital Zurich","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sascha.","middleName":"","lastName":"David@usz","suffix":""}],"badges":[],"createdAt":"2022-05-30 13:59:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1708237/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1708237/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":22224913,"identity":"6f739db6-056c-41e6-a670-61c72ab0c2ed","added_by":"auto","created_at":"2022-06-03 14:05:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19216,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of indications among all TPE treatments in the ICU setting.\u003c/strong\u003e The top eight indications including number of patients and percentage of all study patients (n=105) are shown. Abbreviations: TTP – Thrombotic thrombocytopenic purpura, TMA – Thrombotic microangiopathy.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-1708237/v1/601523867f19d003aff80fc3.png"},{"id":22224912,"identity":"ec7166a3-0313-48ad-a0db-3aa3cc82c45d","added_by":"auto","created_at":"2022-06-03 14:05:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20614,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNumber of TPE session per indication for the top 11 indications. 2A: \u003c/strong\u003eHeatmap showing the absolute number of TPE sessions per indication. Color coding represents mean session numbers (legend below graph). \u003cstrong\u003e2B: \u003c/strong\u003eMean TPE sessions with SD. Abbreviations: TTP – Thrombotic thrombocytopenic purpura, TMA – Thrombotic microangiopathy, SD – standard deviation.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-1708237/v1/17c4196b3cc4ed5aab7615a5.png"},{"id":22224914,"identity":"fddec276-67a4-41f0-b73b-9fc62d60c5de","added_by":"auto","created_at":"2022-06-03 14:05:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":41609,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCombined analysis using indication for number of patients, mean number of TPE sessions and ASFA category per TPE indication performed in an ICU setting. \u003c/strong\u003eCircle color – ASFA category, circle size – mean number of TPE session per indication, text right to circles – ASFA grade (full data set available in supplementary table S1). Abbreviations: ASFA – American Society for Apheresis, TPE – therapeutic plasma exchange, TTP – Thrombotic thrombocytopenic purpura, TMA – Thrombotic microangiopathy, ICU – intensive care unit.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-1708237/v1/b3385a1accf30e91ed70d511.png"},{"id":22225170,"identity":"f77cac2c-f820-4b4b-b631-d499fba7cc3c","added_by":"auto","created_at":"2022-06-03 14:10:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":637127,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1708237/v1/42914ec1-fae9-4919-9fd0-a8b3fc3da3dc.pdf"},{"id":22225169,"identity":"92ff64cb-024e-45d3-8e2d-fbc2291804c7","added_by":"auto","created_at":"2022-06-03 14:10:34","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":173183,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphical abstract\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCaption\u003c/strong\u003e: Retrospective, multiparametric (patient, PEX and ICU-specific parameters) single center study of n=105 patients encompassing n=405 PEX sessions. 1 – TTP, 2 – infection associated, 3 – complement mediated.\u003c/p\u003e","description":"","filename":"GA.png","url":"https://assets-eu.researchsquare.com/files/rs-1708237/v1/72e3a8592600aac52899b555.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Indications and outcomes of patients receiving therapeutic plasma exchange under critical care conditions: a retrospective eleven-year single-center study at a tertiary care center","fulltext":[{"header":"Background","content":"\u003cp\u003eIntensive care units (ICUs) are specialized treatment departments for patients requiring close monitoring and often life-saving critical care, including pharmacological or mechanical organ support due to hemodynamic instability or organ failure. Despite developments in diagnosis and treatment, mortality rates in ICUs remain high (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Therapeutic plasma exchange (TPE or PEX) is a life-saving therapeutic intervention for otherwise untreatable and severe conditions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) commonly used as primary or adjunct therapy for a variety of indications with relevance to intensivists (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTPE is an automated, extracorporeal process that allows the replacement of large volumes of plasma with a substitute solution (e.g., human albumin, healthy donor plasma, mixtures). The procedure can benefit patients in two broad disease categories: 1) Removal of pathologic elements from the blood circulation (e.g., autoantibodies, toxins, cytokines, adhesion molecules) via apheresis to reverse a pathologic process. Examples are (auto-) immune mediated conditions including neurological disorders, graft rejections following solid organ transplantation, or infectious diseases (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). 2) Substitution of missing or inactivated protective plasma factors through healthy donor plasma. The classic example for this application is thrombotic microangiopathy (TMA) caused by thrombotic thrombocytopenic purpura (TTP), a potentially fatal condition resulting from an acquired or inherited reduced activity of the von Willebrand cleaving protease ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTwo principal methods are used to separate plasma and cellular components: centrifugal forces or membrane filtration (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). While cellular components are usually returned to the patient they can also be deliberately removed (e.g., in patients at risk for leukostasis) or harvested (i.e., cytapheresis) to perform hematopoietic stem cell transplantation (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe American Society for Apheresis (ASFA), supported by the European Society for Hemapheresis (ESFH), publishes regularly updated evidence-based treatment guidelines for TPE (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Yet, these guidelines are not tailored towards ICU patients and only a limited number of studies have specifically addressed TPE in an ICU setting (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the current study we performed a comprehensive, single-center 11-year retrospective analysis of TPE indications in critically ill patients at a University Hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and research design\u003c/h2\u003e \u003cp\u003eWe performed a retrospective, single-center study using data from January 2010 through September 2021 for patients treated with TPE at the Institute of Intensive Care Medicine (6 units, 72 beds total capacity) at the University Hospital Zurich (USZ). The key aim of our study was to analyze indications, technical details as well as patient- and ICU-specific parameters. Patients were identified from our electronic health record systems using specific search terms: \u0026ldquo;plasmapheresis\u0026rdquo;, \u0026ldquo;plasma exchange\u0026rdquo; and/or \u0026ldquo;PEX\u0026rdquo;. We included all patients age\u0026thinsp;\u0026ge;\u0026thinsp;18 years treated for any indication with TPE in the ICU setting. Recorded and analyzed variables included patient socio-demographic data (age and gender), BMI, underlying disease (according to ASFA classification), major comorbidities, laboratory parameters, ICU-specific data (sequential organ failure assessment (SOFA) score, mechanical support (renal, ventilatory, circulatory), vasoactive-inotropic treatment, duration of ICU stay, ICU survival), TPE-specific procedural parameters (number of TPE sessions, type and amount of replacement fluids, vascular access and complications).\u003c/p\u003e \u003cp\u003eApheresis was performed in collaboration with the Department of Hematology using the COBE Specta or Spectra Optia Apheresis System (Terumo, Tokio, Japan), which apply continuous-flow centrifugation for separation of cellular components from plasma. Plasma volumes were calculated using each patient\u0026rsquo;s weight and hematocrit value. Regional citrate anticoagulation was used in all cases.\u003c/p\u003e \u003cp\u003e The study was approved by the cantonal ethics committee Zurich (BASEC reference number 2021\u0026thinsp;\u0026minus;\u0026thinsp;01130) and performed in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData presentation\u003c/h2\u003e \u003cp\u003eRaw data was processed using Excel (Microsoft, Redmond, Washington) or GraphPad Prism (GraphPad Software, San Diego, California). No power calculation was performed. Categorical variables are presented as median and range, continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026plusmn;\u0026thinsp;SD) or percentage of the whole.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003e We identified a total of 105 patients that met the inclusion criteria for our study. The median number of patients treated per year in our ICU setting was 8 (range 3\u0026ndash;18). The socio-demographic and other patient specific data (including BMI, comorbidities, and ICU specific) are presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The median age of our cohort was 56 (range 17\u0026ndash;85) years, with similar distribution of female and male patients (50.5% vs. 49.5%, respectively). The most common comorbidities were hypertension (36.2%), obesity (defined as a BMI \u0026ge; 30 kg/m2) (19%), and chronic kidney disease (CKD) (11.4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003ePatient characteristics.\u003c/b\u003e Data are shown as patients per category and percentage of the total population. Abbreviations: COPD \u0026ndash; chronic obstructive pulmonary disease, CAD \u0026ndash; coronary artery disease, IMV \u0026ndash; invasive mechanical ventilation, NIV \u0026ndash; non-invasive ventilation, ECMO \u0026ndash; extracorporeal membrane oxygenation. SOFA \u0026ndash; Sequential Organ Failure Assessment. BMI \u0026ndash; body mass index. ICU \u0026ndash; intensive care unit. SD \u0026ndash; standard deviation. TPE \u0026ndash; therapeutic plasma exchange. *mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. \u003csup\u003e#\u003c/sup\u003eSOFA score was available for n\u0026thinsp;=\u0026thinsp;64 (61%) and only recorded after 2013.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWomen\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (50.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMen\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (49.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAges n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;18\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e18\u0026ndash;29\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (12.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e30\u0026ndash;49\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (26.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e50\u0026ndash;64\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (34.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e65\u0026ndash;79\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e80+\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003emedian age (range)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (17\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eObesity\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHypertension\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (36.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDiabetes\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCOPD\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHeart failure\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (8.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (7.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (11.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of ICU stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU specifics n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003enon-ventilated\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIMV\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (49.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNIV\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ehigh flow\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003erenal replacement\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (24.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eECMO\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVasoactive-inotropic treatment\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSOFA score\u003csup\u003e#\u003c/sup\u003e, 1st day of TPE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTPE indications and laboratory findings\u003c/h2\u003e \u003cp\u003eOverall, these critically ill patients were treated for a total 25 indications with TPE (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the eight most common indications and their numerical distribution. TMA was the most common indication (n\u0026thinsp;=\u0026thinsp;40, 46.5%), with TTP representing most TMA cases (n\u0026thinsp;=\u0026thinsp;29, 33.7%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eLaboratory parameters before initiation of TPE per indication\u003c/b\u003e. Data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Abbreviations: TTP \u0026ndash; Thrombotic thrombocytopenic purpura, TMA \u0026ndash; Thrombotic microangiopathy, TPE \u0026ndash; therapeutic plasma exchange, SD \u0026ndash; standard deviation. \u003csup\u003e#\u003c/sup\u003e Transplantation-associated included: n\u0026thinsp;=\u0026thinsp;3 desensitization, n\u0026thinsp;=\u0026thinsp;9 antibody- mediated rejections, n\u0026thinsp;=\u0026thinsp;1 cellular rejection, n\u0026thinsp;=\u0026thinsp;1 rejection prophylaxis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndication (total n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHematocrit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHemoglobin (g/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLeukocytes\u003c/p\u003e \u003cp\u003e(G/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThrombocytes\u003c/p\u003e \u003cp\u003eG/l\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCRP (mg/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eProcalcitonin\u003c/p\u003e \u003cp\u003e(\u0026micro;g/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLDH\u003c/p\u003e \u003cp\u003e(U/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBilirubin\u003c/p\u003e \u003cp\u003e(\u0026micro;mol/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003cp\u003e(\u0026micro;mol/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eeGFR\u003c/p\u003e \u003cp\u003e(ml/min)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e172\u0026thinsp;\u0026plusmn;\u0026thinsp;160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.7\u0026thinsp;\u0026plusmn;\u0026thinsp;81.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;18.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1632\u0026thinsp;\u0026plusmn;\u0026thinsp;3560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e210\u0026thinsp;\u0026plusmn;\u0026thinsp;235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e61\u0026thinsp;\u0026plusmn;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, all (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80.6\u0026thinsp;\u0026plusmn;\u0026thinsp;81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;20.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1768\u0026thinsp;\u0026plusmn;\u0026thinsp;1009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;45.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e309\u0026thinsp;\u0026plusmn;\u0026thinsp;302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40\u0026thinsp;\u0026plusmn;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, TTP (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e107\u0026thinsp;\u0026plusmn;\u0026thinsp;155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78\u0026thinsp;\u0026plusmn;\u0026thinsp;86.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;24.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1598\u0026thinsp;\u0026plusmn;\u0026thinsp;1095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45.1\u0026thinsp;\u0026plusmn;\u0026thinsp;52.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e236\u0026thinsp;\u0026plusmn;\u0026thinsp;280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e53\u0026thinsp;\u0026plusmn;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, complement-mediated (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59\u0026thinsp;\u0026plusmn;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74.2\u0026thinsp;\u0026plusmn;\u0026thinsp;80.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1877\u0026thinsp;\u0026plusmn;\u0026thinsp;425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e625\u0026thinsp;\u0026plusmn;\u0026thinsp;309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, infection associated (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u0026thinsp;\u0026plusmn;\u0026thinsp;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e103.4\u0026thinsp;\u0026plusmn;\u0026thinsp;58.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2086\u0026thinsp;\u0026plusmn;\u0026thinsp;1107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e342\u0026thinsp;\u0026plusmn;\u0026thinsp;172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransplantation-associated\u003csup\u003e#\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u0026thinsp;\u0026plusmn;\u0026thinsp;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e182\u0026thinsp;\u0026plusmn;\u0026thinsp;92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.6\u0026thinsp;\u0026plusmn;\u0026thinsp;65.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.09\u0026thinsp;\u0026plusmn;\u0026thinsp;32.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1057\u0026thinsp;\u0026plusmn;\u0026thinsp;1362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e232\u0026thinsp;\u0026plusmn;\u0026thinsp;254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e57\u0026thinsp;\u0026plusmn;\u0026thinsp;43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasculitis (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e412\u0026thinsp;\u0026plusmn;\u0026thinsp;168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e148\u0026thinsp;\u0026plusmn;\u0026thinsp;100.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e643\u0026thinsp;\u0026plusmn;\u0026thinsp;327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e283\u0026thinsp;\u0026plusmn;\u0026thinsp;281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuillain-Barr\u0026eacute; Syndrome (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u0026thinsp;\u0026plusmn;\u0026thinsp;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e286\u0026thinsp;\u0026plusmn;\u0026thinsp;92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e374\u0026thinsp;\u0026plusmn;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e63\u0026thinsp;\u0026plusmn;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e98\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAutoimmune encephalitis (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e284\u0026thinsp;\u0026plusmn;\u0026thinsp;193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.8\u0026thinsp;\u0026plusmn;\u0026thinsp;108.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e326\u0026thinsp;\u0026plusmn;\u0026thinsp;146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e93\u0026thinsp;\u0026plusmn;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyasthenia gravis (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u0026thinsp;\u0026plusmn;\u0026thinsp;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e292\u0026thinsp;\u0026plusmn;\u0026thinsp;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.2\u0026thinsp;\u0026plusmn;\u0026thinsp;53.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e337\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e102\u0026thinsp;\u0026plusmn;\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoodpasture's Syndrome (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u0026thinsp;\u0026plusmn;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e287\u0026thinsp;\u0026plusmn;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e381\u0026thinsp;\u0026plusmn;\u0026thinsp;153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e154\u0026thinsp;\u0026plusmn;\u0026thinsp;63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e54\u0026thinsp;\u0026plusmn;\u0026thinsp;33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute liver failure (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u0026thinsp;\u0026plusmn;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;25.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31\u0026thinsp;\u0026plusmn;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81.5\u0026thinsp;\u0026plusmn;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4070\u0026thinsp;\u0026plusmn;\u0026thinsp;3789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e78.5\u0026thinsp;\u0026plusmn;\u0026thinsp;48.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e86\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrophage-activating Syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e32976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgressive bulbar palsy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertriglyceridemia, idiopathic (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoagulopathy after polytrauma (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-IgLON5-associated encephalopathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic sclerosis (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic inflammatory demyelinating neuropathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostpartum microangiopathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiller-Fisher Syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyradiculoneuritis (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaneoplastic neurological syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatastrophic antiphospholipid syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eacute demyelinating neuropathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperviscosity in hypergammaglobulinemia (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEleven cases of TMA were treated with TPE, nine (82%) of which had normal ADAMTS13 activity or lack of inhibitor. One patient died and analysis was canceled. Transplantation associated (n\u0026thinsp;=\u0026thinsp;14, 16.3%), vasculitis (n\u0026thinsp;=\u0026thinsp;12, 14%) and Guillain-Barr\u0026eacute; Syndrome (n\u0026thinsp;=\u0026thinsp;9, 10.5%) were the second, third and fourth most common indication in our cohort, respectively. In the group of transplantation associated TPE 9 patients received TPE due to antibody mediated rejection, 3 due to desensitization, 1 for rejection prophylaxis and 1 because of cellular rejection. Of all 105 patients, 62 (59%) could be classified into ASFA category I, five (4.8%) were ASFA category II and 27 (25.7%) were ASFA category III (supplementary table S1). Out of the 10 most common indications, five are ASFA category I (TTP, Guillain-Barr\u0026eacute; Syndrome (GBS), Autoimmune encephalitis, Myasthenia gravis, Goodpasture\u0026rsquo;s Syndrome) one was ASFA category III (TMA, infection associated) and four indications had variable ASFA categories depending on more detailed knowledge about the disease.\u003c/p\u003e \u003cp\u003eAnalysis of clinical routine laboratory parameters showed that most patients were anemic (mean hematocrit 0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07 and hemoglobin levels 87\u0026thinsp;\u0026plusmn;\u0026thinsp;25 g/l) (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Inflammation parameters were elevated in 94 patients: CRP 76.7\u0026thinsp;\u0026plusmn;\u0026thinsp;81.5 mg/l, procalcitonin 5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;18.3 \u0026micro;g/l, leukocyte count 13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3 G/L. Kidney function was decreased in 54 patients (estimated glomerular filtration rate (eGFR) 61\u0026thinsp;\u0026plusmn;\u0026thinsp;40 ml/min, creatinine 210\u0026thinsp;\u0026plusmn;\u0026thinsp;235 \u0026micro;mol/l) and mean bilirubin-levels were 28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;36 \u0026micro;mol/l (elevated in 38 patients). Considering abnormal findings categorized by disease showed that leukocyte count was highest in patients with acute liver failure (22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;25.3 G/l) and vasculitis (20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9 G/l). Patients with acute liver failure (n\u0026thinsp;=\u0026thinsp;2) additionally presented with the most severe thrombocytopenia (31\u0026thinsp;\u0026plusmn;\u0026thinsp;30 G/l) and the highest LDH levels (4070\u0026thinsp;\u0026plusmn;\u0026thinsp;3789 U/l). Procalcitonin levels were highest in patients with transplantation-associated indications for TPE (25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;32.4 \u0026micro;g/l). The most severe impairment of renal function was recorded for complement-mediated (12\u0026thinsp;\u0026plusmn;\u0026thinsp;12 ml/min) and infection associated TMAs (n\u0026thinsp;=\u0026thinsp;6) (15\u0026thinsp;\u0026plusmn;\u0026thinsp;7 ml/min).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eICU specific findings and outcome\u003c/h2\u003e \u003cp\u003eMedian length of stay in the ICU across all patients and indications was 8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4 days and SOFA score was 7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 (on day 1 of TPE initiation). A total of 59 (56.2%) patients required ventilator support (52 (49.5%) invasive mechanical ventilation (IMV), three (2.9%) non-invasive ventilation (NIV) and four (3.8%) high flow oxygen via nasal cannula). Renal replacement therapy or vasoactive-inotropic treatment during the ICU stay was needed in 27 (25.7%) and 35 (33.3%) patients, respectively. Six (5.7%) patients required extracorporeal membrane oxygenation (ECMO) (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Overall ICU survival rate was 88.6%.\u003c/p\u003e \u003cp\u003eLooking at TMA as the most common indication for TPE in our ICU setting, one fifth (20%) of cases were ventilated, 25.7% had renal replacement therapy and 12.5% needed vasoactive inotropic treatment (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean SOFA score for these patients was 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 and 90% survived the ICU. Complement-mediated TMA had a lower-than-average ICU survival rate with 83.3%. All patients presenting with Guillain-Barr\u0026eacute; Syndrome (n\u0026thinsp;=\u0026thinsp;9) required invasive mechanical ventilation (IMV) and all survived their ICU stay. The highest mean SOFA score on the first day of TPE was recorded patients with liver failure (15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2) and only survived the ICU. Patients with autoimmune encephalitis (n\u0026thinsp;=\u0026thinsp;6) had the longest ICU stay with 36\u0026thinsp;\u0026plusmn;\u0026thinsp;29.9 days. Notably, a high percentage of these patients required IMV (83.3%) and vasoactive-inotropic support (66.7%). The ICU survival for patients suffering from autoimmune encephalitis was 83.3%. Patients with Goodpasture\u0026rsquo;s syndrome (n\u0026thinsp;=\u0026thinsp;3) had a poor outcome in our cohort (66.6% ICU mortality).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eTPE procedural details and level of evidence\u003c/h2\u003e \u003cp\u003eDuring the 11-year observation period, the total of 408 (mean of 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 per patient) TPE sessions were performed, representing 10.2% of all TPE\u0026rsquo;s performed at the USZ during the study period (n\u0026thinsp;=\u0026thinsp;4008. Patients with TMA required 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 TPE sessions, and TTP being exchanged most often (3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 TPE session). Nine TMA patients (31%) underwent only one TPE session (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). At our institution, TPE for TPA was performed daily and stopped after thrombocyte count reaches\u0026thinsp;\u0026gt;\u0026thinsp;150G/l three times in a row. The overall highest number of sessions was documented for Goodpasture\u0026rsquo;s syndrome (7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3). Autoimmune-related diseases were usually exchanged every 2\u0026ndash;3 days to allow transfer into of IgG from tissues and subsequent removal from the bloodstream.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes all indications including number of patients, mean TPE session count and their respective ASFA category and grade of recommendation.\u003c/p\u003e \u003cp\u003eWe evaluated several TPE procedural aspects in more detail. The amount of replacement fluid averaged at 3.4 liters per session and the type of replacement fluid was fresh frozen plasma (FFP) in 84\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eIndications with ICU specifics.\u003c/b\u003e Data are shown as patients per category and percentage of the total population. Abbreviations: TTP \u0026ndash; Thrombotic thrombocytopenic purpura, TMA \u0026ndash; Thrombotic microangiopathy, SOFA score \u0026ndash; Sequential Organ Failure Assessment score, ICU \u0026ndash; intensive care unit, ECMO \u0026ndash;extracorporeal membrane oxygenation, TPE \u0026ndash; plasma exchange, SD \u0026ndash; standard deviation. * Data expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. \u003csup\u003e#\u003c/sup\u003e Transplantation-associated included: n\u0026thinsp;=\u0026thinsp;3 desensitization, n\u0026thinsp;=\u0026thinsp;9 antibody-mediated rejections, n\u0026thinsp;=\u0026thinsp;1 cellular rejection, n\u0026thinsp;=\u0026thinsp;1 rejection prophylaxis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications (total n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-ventilated\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIMV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNIV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ehigh flow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRenal replacement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eECMO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVasopressors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLength of ICU stay\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLength of hospital stay\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eICU survival\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSOFA score ICU submission*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eSOFA score 1st day TPE*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e36.6\u0026thinsp;\u0026plusmn;\u0026thinsp;30.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e93 (88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, all (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e19.2\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e36 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, TTP (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;18.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e26 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, complement-mediated (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMA, infection associated (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransplantation-associated\u003csup\u003e#\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21.1\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e57.4\u0026thinsp;\u0026plusmn;\u0026thinsp;34.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12 (85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasculitis (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuillain-Barr\u0026eacute; Syndrome (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;33.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e40.6\u0026thinsp;\u0026plusmn;\u0026thinsp;36.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAutoimmune encephalitis (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e36\u0026thinsp;\u0026plusmn;\u0026thinsp;29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e78.8\u0026thinsp;\u0026plusmn;\u0026thinsp;38.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyasthenia gravis (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e61.6\u0026thinsp;\u0026plusmn;\u0026thinsp;36.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoodpasture\u0026rsquo;s Syndrome (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e46.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute liver failure (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrophage-activating Syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgressive bulbar palsy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertriglyceridemia, idiopathic (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoagulopathy after polytrauma (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-IgLON5-associated encephalopathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic sclerosis (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic inflammatory demyelinating neuropathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostpartum microangiopathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiller-Fisher Syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyradiculoneuritis (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaneoplastic neurological syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatastrophic antiphospholipid syndrome (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eacute demyelinating neuropathy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperviscosity in hypergammaglobulinemia (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e(80%) patients, human albumin in 13 (12.4%) patients and a mixture of both in five (4.8%) patients (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Three patient records (2.9%) did not have documentation of the replacement fluid used. Most patients (n\u0026thinsp;=\u0026thinsp;97, 92.4%) received a central vascular catheter for the procedure, five (4.8%) had a peripheral access and three (2.8%) had incomplete records.\u003c/p\u003e \u003cp\u003eComplications occurred in 10 (9.5%) of patients and were mostly mild to moderate transfusion-related anaphylactic reactions (grade 1 n\u0026thinsp;=\u0026thinsp;4, 3.8%; grade 2 n\u0026thinsp;=\u0026thinsp;3, 2.9%) that responded well to guideline confirm treatment (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). More severe complication occurred in 3 patients (noted as others in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e): one patient with progressive bulbar palsy suffered repeat bleeding while receiving human albumin and required substitution of fibrinogen, cryoprecipitated factor concentrates and Factor XIII. After switching replacement fluid to FFP no further complications occurred. Another patient with TTP went into cardiac arrest and died during TPE, which was posthumously classified as disease related due to massive thrombi in both ventricles. A third patient developed atrial fibrillation, which was successfully treated with cardioversion.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eTPE specific parameters\u003c/b\u003e. Data are shown as patients per category and percentage of the total population. * Data expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Abbreviations: FFP \u0026ndash; fresh frozen plasma, TPE \u0026ndash; therapeutic plasma exchange. SD \u0026ndash; standard deviation.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPE sessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003etotal TPE sessions\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e408\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eaverage TPE sessions per patient\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReplacement fluid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eamount per session (L)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFFP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHuman albumin\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (12.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMix\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ecentral\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (92.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eperiphery\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003etransfusion reaction, anaphylaxis grade 1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003etransfusion reaction, anaphylaxis grade 2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ebleeding complications\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eothers\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur retrospective study spanning 11 years and a sizeable number of patients (n\u0026thinsp;=\u0026thinsp;105) treated with TPE in the ICU setting demonstrated that TPE is overall save and beneficial, with ICU survival reaching 88.6% across all indications, reaffirming the role of TPE in the treatment of ICU patients. Indication for TPE according to ASFA was grade I in 59% of cases, demonstrating the overall robustness of decision making but also encouraging further investigations towards rigorous standards. The spectrum of indications for TPE in the critically ill in our cohort was to a large degree comparable to common indications in non-ICU cohorts published previously (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), including TMA (TTP), catastrophic antiphospholipid syndrome, Guillain-Barr\u0026eacute; Syndrome or acute liver failure. Other explorative indications such as sepsis (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) or drug overdoses / poisoning (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) were not present in our cohort.\u003c/p\u003e \u003cp\u003e While ASFA guidelines are comprehensive, currently listing 89 diseases or 179 indications supported by various levels of evidence (I-III), uncertainties remain. For example, TMAs were the most common indication for TPE in our study (n\u0026thinsp;=\u0026thinsp;40, 38.1%), which represent a heterogeneous group of disorders characterized by similar clinical laboratory findings, but markedly different underlying pathophysiology (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The striking success of TPE as upfront emergency therapy in TTP, reducing morbidity and mortality from 90% in untreated patients to below 20% led to application in other forms of TMA, often before confirmation of ADAMTS13 status (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In our cohort 11 (10.5%) patients received TPE for TMAs other than TTP and subsequent analysis normal ADAMTS13 activity or lack of inhibitor in nine (82%). The underlying pathology for these entities may not be circulatory factors purgeable via TPE, and could be associated with endothelial cell related factors or enterotoxins, thus potentially limiting benefit or causing harm in these conditions (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). A retrospective evaluation of TPE used during the EHEC-HUS pandemic in 2011 revealed lack of efficiency of plasma exchange in enterotoxin-mediated HUS in adults (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). On the other hand, current tests do not detect all ADAMTS13 deficiencies in patients presenting with TTP (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and lack of specific criteria complicate decision making. Further studies are warranted, also regarding management of refractory TMA cases (e.g., TPE regimens; combination with caplacizumab) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), ideally in randomized trials. A growing number of explorative indications for TPE further underline the potential and at the same time the necessity for standardization. Some examples include infections for example utilized in a) pediatric patients with H1N1 influenza A related respiratory failure and hemodynamic compromise (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), b) COVID-19 coagulopathy (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), c) septic shock (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) or d) enhanced removal of inflammatory cytokines by combining conventional TPE with specific adsorbers, has been applied in enveloped viral disease (e.g., Ebola) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn terms of procedural aspects, strong evidence for recommendations regarding the ideal treatment initiation and duration time-points, amount of the exchange volume, anticoagulation, type and composition of the substitute solution or vascular access are lacking and often locally defined in standard operating procedures within individual institutions. For example, the choice of replacement fluid, though important, partially lacks solid standards. The predominant use of FFP in our study can be partially explained by the high percentage of TMAs (TTP) compared to other studies (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) where FFP is the obligatory replacement solution to increase ADAMTS13 activity. A contrary example is the use of FFP in patients with GBS, which showed no benefit but an association with greater risks of citrate and transfusion reactions (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In our study one third (n\u0026thinsp;=\u0026thinsp;3) of GBS patients received FFP and one patient experienced atrial fibrillation during TPE with FFP, which was resolved with cardioversion. Still, the adverse advent rate for TPE in GBS vs. comparable to the overall complication rate (was 11% vs. 9.5%). Previously reported TPE-associated complication rates vary significantly, ranging from 1\u0026ndash;2% up to 39%) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Anaphylactic reactions were the primary complications as reported by others in conjunction with plasma use (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Only a single bleeding event was found which compares favorably with previous reports of up to 8.7% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Hypotension as a complication of TPE was not recorded in any patient, despite being the most common complications according to literature and correlating with a low hematocrit as present in most of our patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Patients in our study received on average 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 TPE sessions, similar to other studies in the ICU setting (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Unlike the report from Lemaire et al. we did not see a higher amount of TPE procedures required in patients with TMAs compared to other indications (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). On the contrary, several other indications (Guillain-Barr\u0026eacute; Syndrome (5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5), autoimmune encephalitis (5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6) and Goodpasture Syndrome (7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6)) resulted in more TPE sessions than all TMAs (3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7). The median length of ICU stay (8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4 days) was similar to previously results, but has also been reported with a median of 20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;25 days (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Since cost and patient outcome are correlated with length of ICU stay (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) this difference is of importance and warrants further investigation of underlying factors.\u003c/p\u003e \u003cp\u003e A strength of our study is the substantial amount of critically ill patients from a large tertiary care center in Switzerland with a total of 408 analyzed TPE sessions. Another strength is the detailed analysis of patient characteristics and laboratory findings as well as procedural aspects of TPE.\u003c/p\u003e \u003cp\u003eLimitations of our study include its retrospective character and non-uniform documentation over the study period. Bias might occur through inconsistent reporting of minor complications. SOFA scores have only been recorded systematically in Switzerland after 2013 and 41 patients had no SOFA score available, which hindered a thorough assessment of the severity of illness. Finally, our analysis did not allow us to reliably distinguish solid indications for ICU treatment vs. other factors leading to TPE in the ICU.\u003c/p\u003e \u003cp\u003eIn conclusion, we provide a comprehensive analysis of TPE indications in patients requiring ICU treatment according to our in-house clinical practice at the University Hospital of Zurich. Overall, specific disease remission and ICU survival with almost 90% was excellent. We believe that our study is representative and could serve as a point of reference for other similar hospitals and might encourage similar research to form a basis for comparative analysis. Such shared experiences may be translated into reliable treatment standards and ultimately improved patient outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTPE \u0026ndash; therapeutic plasma exchange\u003c/p\u003e\n\u003cp\u003eICU \u0026ndash; intensive care unit\u003c/p\u003e\n\u003cp\u003eTTP \u0026ndash; Thrombotic thrombocytopenic purpura\u003c/p\u003e\n\u003cp\u003eTMA \u0026ndash; Thrombotic microangiopathy\u003c/p\u003e\n\u003cp\u003eASFA \u0026ndash; American Society for Apheresis\u003c/p\u003e\n\u003cp\u003eESFH \u0026ndash; European Society for Hemapheresis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eECMO \u0026ndash; extracorporeal membrane oxygenation\u003c/p\u003e\n\u003cp\u003eSD \u0026ndash; standard deviation\u003c/p\u003e\n\u003cp\u003eCOPD \u0026ndash; chronic obstructive pulmonary disease\u003c/p\u003e\n\u003cp\u003eCAD \u0026ndash; coronary artery disease\u003c/p\u003e\n\u003cp\u003eIMV \u0026ndash; invasive mechanical ventilation\u003c/p\u003e\n\u003cp\u003eNIV \u0026ndash; non-invasive ventilation\u003c/p\u003e\n\u003cp\u003eSOFA score \u0026ndash; Sequential Organ Failure Assessment score\u003c/p\u003e\n\u003cp\u003eFFP \u0026ndash; fresh frozen plasma\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the cantonal ethics committee Zurich (reference number 2021-01130).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAR and AWS analyzed and interpreted the patient data regarding TPE indications in ICU patients, designed figures and tables and wrote the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Michael Fetzer (USZ IT department) for helping with data retrieval.\u003c/p\u003e\n\u003cp\u003eAlso, we are grateful to our apheresis nursing staff who have spent endless nights and weekends on the ICU to perform TPEs.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVincent JL, Marshall JC, Namendys-Silva SA, Fran\u0026ccedil;ois B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014 May;2(5):380\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePadmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apheresis. 2019 Jun;34(3):171\u0026ndash;354.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStegmayr B, M\u0026ouml;rtzell Henriksson M, Newman E, Witt V, Derfler K, Leitner G, et al. Distribution of indications and procedures within the framework of centers participating in the WAA apheresis registry. Transfus Apher Sci Off J World Apher Assoc Off J Eur Soc Haemapheresis. 2017 Feb;56(1):71\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinenberger ML, Price TH. Use of cellular and plasma apheresis in the critically ill patient: Part II: Clinical indications and applications. J Intensive Care Med. 2005 Apr;20(2):88\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKremer Hovinga JA, Coppo P, L\u0026auml;mmle B, Moake JL, Miyata T, Vanhoorelbeke K. Thrombotic thrombocytopenic purpura. Nat Rev Dis Primer. 2017 Apr 6;3:17020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinenberger ML, Price TH. Use of cellular and plasma apheresis in the critically ill patient: part 1: technical and physiological considerations. J Intensive Care Med. 2005 Feb;20(1):18\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlum W, Porcu P. Therapeutic apheresis in hyperleukocytosis and hyperviscosity syndrome. Semin Thromb Hemost. 2007 Jun;33(4):350\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStatkute L, Verda L, Oyama Y, Traynor A, Villa M, Shook T, et al. Mobilization, harvesting and selection of peripheral blood stem cells in patients with autoimmune diseases undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant. 2007 Mar;39(6):317\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLemaire A, Parquet N, Galicier L, Boutboul D, Bertinchamp R, Malphettes M, et al. Plasma exchange in the intensive care unit: Technical aspects and complications. J Clin Apheresis. 2017 Dec;32(6):405\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaria R, Bucur A, Gordinho A, Falc\u0026atilde;o L, Carr\u0026atilde;o A, Fernandes S, et al. Therapeutic Plasmapheresis: Seven Year Experience of an Intensive Care Unit in Portugal. Acta Med Port. 2021 Aug 20;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaton E, Baldwin IC. Plasma exchange in the intensive care unit: a 10 year retrospective audit. Aust Crit Care Off J Confed Aust Crit Care Nurses. 2014 Aug;27(3):139\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYilmaz AA, Can OS, Oral M, Unal N, Ayyildiz E, Ilhan O, et al. Therapeutic plasma exchange in an intensive care unit (ICU): a 10-year, single-center experience. Transfus Apher Sci Off J World Apher Assoc Off J Eur Soc Haemapheresis. 2011 Oct;45(2):161\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanchez AP, Balogun RA. Therapeutic Plasma Exchange in the Critically Ill Patient: Technology and Indications. Adv Chronic Kidney Dis. 2021 Jan;28(1):59\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavid S, Bode C, Putensen C, Welte T, Stahl K, EXCHANGE study group. Adjuvant therapeutic plasma exchange in septic shock. Intensive Care Med. 2021 Mar;47(3):352\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLatimer ME, L\u0026rsquo;Etoile N, Seidlitz J, Swedo SE. Therapeutic plasma apheresis as a treatment for 35 severely ill children and adolescents with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Child Adolesc Psychopharmacol. 2015 Feb;25(1):70\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchutt RC, Ronco C, Rosner MH. The role of therapeutic plasma exchange in poisonings and intoxications. Semin Dial. 2012 Apr;25(2):201\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinters JL. Plasma exchange in thrombotic microangiopathies (TMAs) other than thrombotic thrombocytopenic purpura (TTP). Hematol Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):632\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol. 2012 Aug;158(3):323\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBell WR, Braine HG, Ness PM, Kickler TS. Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. N Engl J Med. 1991 Aug 8;325(6):398\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcMinn JR, Thomas IA, Terrell DR, Duvall D, Vesely SK, George JN. Complications of plasma exchange in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: a study of 78 additional patients. Transfusion (Paris). 2003 Mar;43(3):415\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenne J, Nitschke M, Stingele R, Abu-Tair M, Beneke J, Bramstedt J, et al. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study. BMJ. 2012 Jul 19;345:e4565.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVesely SK, George JN, L\u0026auml;mmle B, Studt JD, Alberio L, El-Harake MA, et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood. 2003 Jul 1;102(1):60\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen L, Li X, Duvall D, Terrell DR, Vesely SK, George JN. Twice-daily plasma exchange for patients with refractory thrombotic thrombocytopenic purpura: the experience of the Oklahoma Registry, 1989 through 2006. Transfusion (Paris). 2008 Feb;48(2):349\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScully M, Cataland SR, Peyvandi F, Coppo P, Kn\u0026ouml;bl P, Kremer Hovinga JA, et al. Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura. N Engl J Med. 2019 Jan 24;380(4):335\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel P, Nandwani V, Vanchiere J, Conrad SA, Scott LK. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A\u0026ndash;an associated respiratory failure and hemodynamic shock. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2011 Mar;12(2):e87-89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A. A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19. Crit Care Lond Engl. 2020 Apr 2;24(1):128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeith P, Day M, Choe C, Perkins L, Moyer L, Hays E, et al. The successful use of therapeutic plasma exchange for severe COVID-19 acute respiratory distress syndrome with multiple organ failure. SAGE Open Med Case Rep. 2020;8:2050313X20933473.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnaup H, Stahl K, Schmidt BMW, Idowu TO, Busch M, Wiesner O, et al. Early therapeutic plasma exchange in septic shock: a prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers. Crit Care Lond Engl. 2018 Oct 30;22(1):285.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026uuml;ttner S, Koch B, Dolnik O, Eickmann M, Freiwald T, Rudolf S, et al. Extracorporeal virus elimination for the treatment of severe Ebola virus disease\u0026ndash;first experience with lectin affinity plasmapheresis. Blood Purif. 2014;38(3\u0026ndash;4):286\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouget J, Chevret S, Chastang C, Raphael JC. Plasma exchange morbidity in Guillain-Barr\u0026eacute; syndrome: results from the French prospective, randomized, multicenter study. The French Cooperative Group. Crit Care Med. 1993 May;21(5):651\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEfficiency of plasma exchange in Guillain-Barr\u0026eacute; syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barr\u0026eacute; syndrome. Ann Neurol. 1987 Dec;22(6):753\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026ouml;rtzell Henriksson M, Newman E, Witt V, Derfler K, Leitner G, Eloot S, et al. Adverse events in apheresis: An update of the WAA registry data. Transfus Apher Sci Off J World Apher Assoc Off J Eur Soc Haemapheresis. 2016 Feb;54(1):2\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRapoport J, Teres D, Lemeshow S, Gehlbach S. A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study. Crit Care Med. 1994 Sep;22(9):1385\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"plasmapheresis, indications, ASFA category, intensive care unit (ICU), academic medical center, thrombotic microangiopathy","lastPublishedDoi":"10.21203/rs.3.rs-1708237/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1708237/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Therapeutic plasma exchange (TPE) to remove harmful or replace missing circulating plasma components is a well-established procedure with a wide range of disease indications. While per se is not among the daily routine of the intensivist TPE is frequently be performed under critical care conditions. However, data regarding TPE indications, patient characteristics and technical details on the intensive care unit (ICU) are sparse. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We performed a retrospective, single-center study using data from January 2010 until August 2021 for patients treated with TPE in an ICU setting at the University Hospital Zurich. Data was collected from de-identified electronic patient medical records using specific search terms. Patient characteristics (including demographics, BMI, comorbidities, lab values and ICU-specific parameters, outcome), apheresis-specific technical parameters and complications were recorded and analyzed.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: We identified n=105 patients meeting our inclusion criteria, with an even sex distribution (50.5% women) and median age of 56 (17-85) years. These 105 patients received a total of n=408 TPE treatments for 25 different indications. The most common indication were thrombotic microangiopathies (TMA) (38%), with thrombotic thrombocytopenic purpura (TTP) being the most prevalent sub-indication (27.6%). Level of evidence according to ASFA (American Society for Apheresis) guidelines varied and was well established in 63.8% of cases. Ten patients presented with TPE-related complications, with anaphylaxis being the most common. Bleeding complications were rare (1%). Median duration of ICU treatment was 8 ± 14 days. A total of 59 (56.2%), 26 (24.8%), and 35 (33.3%) patients needed ventilator, renal replacement or vasopressor support, respectively, with 6 (5.7%) needing extracorporeal membrane oxygenation. The overall survival in our critically ill patients treated with TPE was 88.6%.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Our study provides a comprehensive overview of TPE indications in ICU patients at a major tertiary academic medical center and could serve as a point of reference for other comparable hospitals. Similar studies should be encouraged to establish reliable standards and ultimately improved treatment outcomes.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Indications and outcomes of patients receiving therapeutic plasma exchange under critical care conditions: a retrospective eleven-year single-center study at a tertiary care center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-06-03 14:05:32","doi":"10.21203/rs.3.rs-1708237/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5dac69ae-8987-4c55-946c-245a50756572","owner":[],"postedDate":"June 3rd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-06-03T14:05:33+00:00","versionOfRecord":[],"versionCreatedAt":"2022-06-03 14:05:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1708237","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1708237","identity":"rs-1708237","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}