International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Advanced organ support and rescue therapies in critically ill adults with severe yellow fever: a scoping review.
СтатьяНазвание и аннотация: Перевод в очереди
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Morales-Olivera Jeison Andres, Robayo-Amortegui Henry, Forero-Delgadillo Alex Julián, Sanchez-Rubio Jhoana Andrea, Diaz-Aldana Ana Maria, Sanabria-Herrera Natalia, Bustos Ingrid G, Aguirre-Gutiérrez Valeria, Torres-Jaramillo Sebastián, Reyes Luis Felipe
Аннотация
BACKGROUND: Severe yellow fever (YF) is associated with acute liver failure, multiorgan dysfunction, and mortality exceeding 60% among critically ill patients. In the absence of effective antiviral therapy, advanced organ support and rescue interventions have been increasingly used, although their clinical benefit remains uncertain.
METHODS: We conducted a scoping review following the Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. PubMed/MEDLINE, EMBASE, Scopus, Web of Science Core Collection, and LILACS were searched from inception to December 31, 2025. Eligible studies included adults with laboratory-confirmed severe YF receiving advanced organ support or rescue therapies.
RESULTS: Eight studies met the inclusion criteria, all conducted in Brazil during the 2017-2019 epidemic. Three retrospective ICU cohorts, one comparative observational study, one observational study, and three case reports were included. In-hospital mortality ranged from 47.4% to 67.0%. Intensive twice-daily therapeutic plasma exchange was associated with lower mortality than standard care (14% vs 85%; P < 0.001) in one nonrandomized study. Liver transplantation was feasible in selected patients with documented long-term survival, although graft reinfection was reported. No eligible evidence was identified for extracorporeal membrane oxygenation, hemoperfusion, or most extracorporeal liver support systems.
CONCLUSION: Evidence remains limited and predominantly observational. Intensive therapeutic plasma exchange yielded the most favorable observational signal, but its efficacy remains unproven; liver transplantation may be a rescue option for selected patients. Prospective multicenter studies are needed.
METHODS: We conducted a scoping review following the Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. PubMed/MEDLINE, EMBASE, Scopus, Web of Science Core Collection, and LILACS were searched from inception to December 31, 2025. Eligible studies included adults with laboratory-confirmed severe YF receiving advanced organ support or rescue therapies.
RESULTS: Eight studies met the inclusion criteria, all conducted in Brazil during the 2017-2019 epidemic. Three retrospective ICU cohorts, one comparative observational study, one observational study, and three case reports were included. In-hospital mortality ranged from 47.4% to 67.0%. Intensive twice-daily therapeutic plasma exchange was associated with lower mortality than standard care (14% vs 85%; P < 0.001) in one nonrandomized study. Liver transplantation was feasible in selected patients with documented long-term survival, although graft reinfection was reported. No eligible evidence was identified for extracorporeal membrane oxygenation, hemoperfusion, or most extracorporeal liver support systems.
CONCLUSION: Evidence remains limited and predominantly observational. Intensive therapeutic plasma exchange yielded the most favorable observational signal, but its efficacy remains unproven; liver transplantation may be a rescue option for selected patients. Prospective multicenter studies are needed.