Red Blood Cell Exchange Transfusion for Severe Babesiosis.
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STOP-BABESIOSIS Investigators, Leaf David E, Monson Audrey E, Dias Julie-Alexia, Marcos Luis A, Wu Ulysses, Rossi Michael, Ng Jia H, Patell Rushad, Hundert Joshua, El Khoury Marc Y, Higgs James, Smith Robert P, Ramsaroop Vishali, Green Adam, Abdul Azim Ahmed, Weisenberg Scott, Kirkman Laura A, Ingram David, Hsu Caroline M, Dieckhaus Kevin, Hyson Peter, Burger Zoe, Chengsupanimit Tayoot, Stalmack Tammy, Aber Rachel, Golden Marjorie, Koshy Maria, Wright Kendall, Cortezzo Grace, McLeod Gavin, Wenzel-Rideout Rebecca, Baigorri Julio Javier, Bagchi Aranya, Jaser Ahmad, Socorro Matos Guillermo, Sanchez-Almanzar Daniel, Hoge Steven T, Shenoy Tushar, Krishnamurthy Shobana, Kaunfer Sarah A, Blau Jack A, Woolley Ann, Zamor Rudline, Maczaj Brigitte, Kenison David, Totten Arthur, Bateman Victoria, Mohsin Sabrina, Lee Eun Sun, Garner Joseph, Rath Payal, Wu Quinlan, Guermazi Dorra, London Abby, Arvanitis Panos, Yune Philip S, Abdullah Mahie, Kim Angela, Roy Juby, George Reshma, Kashfi Simon, Hong Susana, Upadrista Pratap, Hirsch Jamie S, Bulteel Alexander, Sharma Riya, Guo Tina, Garcia Daniela, Shaefi Shahzad, Yeb Joseph, Williams George, Verma Eesha, Gouda Nourelhoda, Rosenthal Hannah R, Chan Angelica, Zainah Hadeel, Heithaus Seth, Saldivar Miguel A, Wood Emily, DiPalazzo John, Elias Susan, McAuliffe Matthew, Abbas Ramsha, Orenstein Abigail, Tidswell Mark A, Galiano Peter, Spencer Sanjae, Srinivasan Sidharth, Xu Joyce, Alla Sivani, Alidoost Leila, Jacobson Eliana, Menghani Sanjay V, Kannabran Priyanka, Ogunribido Deborah B, Ssentongo Paddy, Powell Debra, Meyer Leah, Prabhune Kshitij, Griffiths Bianca, Gonzalez Aponte Daphne, Dixon Graham, Vannier Edouard, Roberts Scott C, Farmakiotis Dimitrios, Krause Peter J
Аннотация
OBJECTIVE: To test whether ET improves clinical outcomes among hospitalized adult patients with severe babesiosis.
DESIGN, SETTINGS, AND PARTICIPANTS: This target trial emulation used data from a multicenter cohort study of 3233 consecutive adults hospitalized with babesiosis from 2010 to 2024 at 82 sites across the northeastern US. Patients were eligible if they had parasitemia greater than 10%, or 5% to 10% with either acute organ injury or severe hemolytic anemia. Data were analyzed from April to August 2025.
EXPOSURE: Treatment with ET in the first 7 days of hospitalization.
MAIN OUTCOMES AND MEASURES: A composite of in-hospital death or 30-day readmission. Outcomes were compared between patients who received ET within the first 7 days of admission and those who did not. The analysis used logistic regression, with inverse probability of treatment weighting (IPTW) to adjust for potential confounders.
RESULTS: The analysis included 629 patients (median [IQR] age, 71 [63-79] years; 446 male [70.9%]), among whom 209 (33.2%) received ET in the first 7 days of hospitalization. Patients treated with ET were more severely ill at baseline than those not treated with ET (median parasitemia, 14.0% vs 7.2%); however, severity of illness characteristics were well balanced after applying IPTW. In the main analysis, the primary end point occurred in 3.6% of patients who received ET and in 9.8% who did not (adjusted odds ratio, 0.22; 95% CI, 0.09-0.51). The benefit of ET was confirmed in multiple sensitivity analyses.
CONCLUSIONS AND RELEVANCE: This multicenter cohort study found that among severely ill adults hospitalized with babesiosis, the adjusted risk of in-hospital death or 30-day readmission was nearly 5-fold lower in those treated with ET vs those not treated with ET. These data support ET for severely ill patients with babesiosis, although the findings may be susceptible to unmeasured confounding. Further research is needed to identify which patients are most likely to benefit.