RCE May Reduce Risk of Mortality, Hospital Readmission in Severe Babesiosis

Red blood cell exchange (RCE) was associated with a nearly five-fold lower risk of in-hospital mortality or 30-day readmission in patients hospitalized with severe babesiosis, according to research published in JAMA Internal Medicine.

Researchers from the Yale School of Public Health and Mass General Brigham led the multicenter cohort study, which included 629 adults hospitalized with severe babesiosis across 82 U.S. sites. One-third of patients received RCE within the first seven days of admission.

After adjusting for baseline differences in illness severity, the composite outcome of in-hospital death or 30-day readmission occurred in 3.6% of patients who received RCE, compared with 9.8% of those who did not. Investigators also noted that patients treated with RCE were more severely ill at baseline (median parasitemia, 14% versus 7.2%, respectively) yet experienced better outcomes.

RCE is often used in severe cases to rapidly reduce parasitemia, though evidence supporting its effectiveness has been limited. According to the authors, the findings provide strong evidence that exchange transfusion improves outcomes in high-risk patients, but they noted that further research is needed to identify which patients are most likely to benefit.

“These findings give clinicians clearer guidance when treating the sickest patients,” said Peter J. Krause, MD, a senior research scientist at Yale School of Public Health and Yale School of Medicine, and the study’s senior author.  “For those who meet the criteria used in our study, exchange transfusion should be strongly considered. Using it more consistently could reduce complications, lower readmissions and ultimately save lives.”