International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
September 12, 2026 · via Europe PMC
Advanced Organ Support and Rescue Therapies in Critically Ill Adults with Severe Yellow Fever: A Scoping Review.
Morales-Olivera JA, Robayo-Amortegui H, Forero-Delgadillo AJ, +6 more, Reyes LF.
AI summary — for doctors, generated from the abstract only
For critically ill patients with severe yellow fever, intensive plasma exchange showed the most promising (though still unproven) survival signal among advanced rescue therapies, with mortality still exceeding 60% overall.
What was studied
A scoping review of 8 studies (all from Brazil's 2017-2019 epidemic) on advanced organ support and rescue therapies — including plasma exchange and liver transplantation — used in critically ill adults with severe yellow fever.
Key findings
- In-hospital mortality across studies ranged from 47.4% to 67.0%
- Intensive twice-daily therapeutic plasma exchange was associated with markedly lower mortality than standard care (14% vs. 85%)
- Liver transplantation was used as a rescue option in select patients
- Evidence remains limited, observational, and from a single epidemic context
Clinical relevance
Suggests therapeutic plasma exchange may be worth considering as a rescue intervention in severe yellow fever, given the very high baseline mortality and lack of antiviral treatment.
Limitations
All evidence is observational and from one outbreak; no randomized trials have tested these interventions.
Consider intensive plasma exchange as a rescue option in critically ill yellow fever patients at centers with capability, while awaiting prospective trial data.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
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 PRISMA-ScR 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.
Conclusions
Evidence remains limited and predominantly observational. Intensive TPE 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.
DOI
10.1016/j.ijid.2026.109118
PMID
42731667
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed