Inpatient Utilization of Therapeutic Plasma Exchange in the United States: 2016-2021.

RATIONALE &

OBJECTIVE

Therapeutic plasma exchange (TPE) is used in a variety of autoimmune, inflammatory, hematological, and metabolic disorders. We described the contemporary scope of inpatient utilization of TPE in the United States.

STUDY

DESIGN

A cross-sectional study.

SETTING &

PARTICIPANTS

The national inpatient sample dataset from year of 2016 to 2021.

EXPOSURES: Inpatient utilization of TPE.

OUTCOMES: We described demographics, associated comorbid conditions, hospital characteristics, and hospital costs by comparing patients treated with those not treated by TPE. We reported the top 25 clinical conditions treated by TPE. We described the top 10 diseases or conditions for the first discharge diagnosis as acute kidney injury (AKI) (International Classification of Diseases, Tenth Revision code: N17.9) treated by TPE.

ANALYTICAL APPROACH: All descriptive and multivariable analyses considered the complex survey design for every calendar year sampling of national inpatient sample; the results were weighted to reflect national estimates.

RESULTS

During 2016-2021, a total of 106,035 hospitalizations (∼0.051% of the total hospitalizations) were treated by TPE. The 5 most common conditions treated by TPE were myasthenia gravis with (acute) exacerbation (9.53%), Guillain-Barre syndrome (6.19%), thrombotic microangiopathy (6.18%), kidney transplant rejection (5.42%), and sepsis, unspecified organism (3.62%). AKI was the 13th most common condition, accounting for 1.82% of all cases treated by TPE, while the most common underlying condition for AKI was multiple myeloma (without achieving remission). The temporal trend of indications used by TPE in the US practice from 2016 to 2021 aligns well with the updated guideline by the American Society of Apheresis. The TPE utilization was associated with higher inpatient costs after accounting for length of stay; odds ratio ranges: 3.47 (2.99-4.03)-11.07 (10.19-12.03).

LIMITATIONS: Lack of laboratory data.

CONCLUSIONS

The TPE continues to be used to treat a variety of serious autoimmune and inflammatory diseases, in accordance with published clinical practice guidelines.