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Therapeutic plasma exchange (TPE) is a treatment paradigm used to remove harmful molecules from the body. In short, it is a technique that employs a process that functions partially outside the body and involves the replacement of the patient’s plasma. It has been used in the ICU for a number of different disease states, for some as a first-line treatment modality and for others as a type of salvage therapy. This paper provides a brief review of the principles, current applications, and potential future directions of TPE in critical care settings.

Cardiovascular disease (CVD) is a leading complication after liver transplantation and has a significant impact on patients’ outcomes posttransplant. The major risk factors for post–liver transplant CVD are age, preexisting CVD, nonalcoholic fatty liver disease, chronic kidney disease, and metabolic syndrome. This review explores the contemporary strategies and approaches to minimizing cardiometabolic disease burden in liver transplant recipients. We highlight areas for potential intervention to reduce the mortality of patients with metabolic syndrome and CVD after liver transplantation.

Abstract Background Acute respiratory failure is one of the most common causes of hospitalizations in the US. By 2030, the number of Americans with dementia is expected to reach nearly 9 million and 12 million in 2040. Dementia increases the risk of respiratory illnesses, including pneumonia. This study delves into the intricate interplay between dementia and acute respiratory failure. Methods Our retrospective study analyzed adult patients with acute respiratory failure and secondary diagnosis of dementia using ICD-10 codes in the National Inpatient Sample (NIS) Database from 2017 to 2020. An analysis was conducted on various demographic factors such as age, race, and gender. The study's primary endpoint was mortality, with mechanical ventilation, tracheostomy, and length of stay as secondary endpoints. To account for other variables that could have affected the results, we utilized a multivariate logistic regression with p < 0.05 considered significant. Results The study included 1,795,630 patients admitted with ARF, 112,175 of whom had dementia. The mean age in the dementia group was 80 years, compared to 65 years in the control group. Additionally, 62% of the dementia group were females, while the control group had 55% females. 73% of both groups were Caucasian white. Comorbidities observed in the dementia group include hypertension (81% vs. 72%), diabetes mellitus (36% vs. 35%), supraventricular tachycardia (29% vs. 20%), and sepsis (6% vs. 5%) with p-value less than 0.01. Rates and odds of mortality were higher in the dementia group (15,704 (14%) vs. 151,511 (9%), p-value < 0.01, aOR 1.08, p-value < 0.01). Patients with dementia had lower rates of in-hospital mechanical ventilation, but higher adjusted odds (27% vs. 28%; p < 0.01; aOR + 1.2, p < 0.01). Patients with dementia had lower rates and adjusted odds of undergoing a tracheostomy during their stay (762 (0.7) vs. 16,834 (1), p-value < 0.01, aOR 0.91 p-value 0.33).. Patients with dementia had a longer length of stay (LOS) than those without, with a mean difference of + 0.3 days and p-value < 0.01. Conclusions Clinicians should be aware that dementia was found to be an independent risk factor for mortality in patients admitted with acute respiratory failure.

Background Janus kinase inhibitors are actively investigated for treating various hematological, rheumatological, gastrointestinal and dermatological indications. Thus, we have initiated a living systematic review to define the toxicity profile of JAKi agents. Here, we report an up-to-date assessment of toxicity profile of JAKi in patients with myelofibrosis. Methods MEDLINE, EMBASE and CENTRAL were systematically searched from each database's inception through June 13, 2023, to identify phase I/II/III clinical trials assessing JAKi in myelofibrosis reporting adverse events. The main outcomes of interest included incidence rates of all-cause and treatment-related grade ≥ 3, grade 5 and all-grade AEs of interest (infections, hematological, gastrointestinal, and cardiovascular adverse events). Incidence rates (incidence per 100-person-years) for AEs of interest were calculated at the level of each trial. A random-effects meta-analysis was conducted to pool the incidence rates of AEs using an inverse-variance approach. Results The literature search identified 2044 studies from which 28 clinical trials (33 references) met the inclusion criteria - 4 (14%) trials were phase I, 4 (14%) trials were phase I/II, 13 (46%) trials were phase II, and 7 (25%) trials were phase III. A total of 4505 participants received JAKi and were eligible for analysis. All-cause and treatment-related hematological toxicities were reported in 28 (100%) and 18 (64%) trials, all-cause and treatment-related gastrointestinal toxicities were reported in 28 (100%) and 18 (64%) trials, all-cause and treatment-related cardiovascular toxicities were reported in 20 (71%) and 12 (43%) trials whereas all-cause and treatment-related infections were reported in 26 (93%) and 14 (50%) trials, respectively. The incidence rate per 100-person years for all-cause and treatment related adverse events of interest are summarized in Table 1a and 1b respectively. For treatment-related AEs, the incidence of grade ≥ 3 diarrhea with JAKi is 8.50 (95% CI: 5.34-13.53) events per 100-person years. The incidence of treatment-related grade ≥ 3 anemia and thrombocytopenia is 39.40 (95% CI: 25.57-60.71) and 29.25 (95% CI: 20.12-42.51) events per 100-person years respectively. The incidence of treatment-related grade 5 diarrhea with JAKi is 2.15 (95% CI: 1.07-4.29) events per 100-person years whereas the incidence of treatment-related grade 5 anemia and thrombocytopenia is 2.03 (95% CI: 1.04-3.97) and 2.01 (95% CI: 1.02-3.93) events per 100-person years respectively. For all-cause AEs, the incidence of grade ≥ 3 nausea, vomiting and diarrhea with JAKi is 1.72 (95% CI: 0.97-3.05), 3.56 (95% CI: 1.92-6.61) and 5.29 (95% CI: 3.48-8.04) events per 100-person years respectively. The incidence of all-cause grade ≥ 3 infections with JAKi is 4.38 (95% CI: 1.95-9.83) events per 100-person years whereas the incidence of all-cause grade ≥ 3 respiratory tract infections with JAKi is 4.21 (95% CI: 2.41-7.36) events per 100-person years. The incidence of all-cause grade ≥ 3 anemia, neutrophil decrease and thrombocytopenia is 46.83 (95% CI: 32.68-67.11), 29.11 (95% CI: 14.86-57.02) and 34.39 (95% CI: 23.82-49.64) events per 100-person years respectively. Moreover, the incidence of all-cause grade 5 nausea, vomiting and diarrhea with JAKi is 1.25 (95% CI: 0.72-2.18), 2.01 (95% CI: 1.08-3.74) and 1.60 (95% CI: 0.94-2.72) events per 100-person years respectively. In addition, the incidence of all-cause grade 5 infections and infestations is 3.71 (95% CI: 1.96-7.04) events per 100-person years with the incidence of grade 5 respiratory tract infections being 1.66 (95%CI: 0.89-3.10) events per 100-person years. Furthermore, the incidence of all-cause grade 5 anemia, neutrophil decrease and thrombocytopenia is 2.10 (95% CI: 1.26-3.52), 3.00 (95% CI: 1.25-7.21) and 1.95 (95% CI: 1.15-3.33) events per 100-person years respectively. Conclusions This report of living systematic review provides the best current evidence on toxicity profile of JAKi in patients with myelofibrosis. Current evidence suggests an overall higher incidence of all grade and grade ≥ 3 treatment related gastrointestinal adverse events in patients receiving JAKi. This living review will be updated as soon as new data becomes available.