BackgroundPlasma levels of C-reactive protein (CRP), induced by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) triggering COVID-19, can rise surprisingly high. The increase of the CRP concentration as well as a certain threshold concentration of CRP are indicative of clinical deterioration to artificial ventilation. In COVID-19, virus-induced lung injury and the subsequent massive onset of inflammation often drives pulmonary fibrosis. Fibrosis of the lung usually proceeds as sequela to a severe course of COVID-19 and its consequences only show months later. CRP-mediated complement- and macrophage activation is suspected to be the main driver of pulmonary fibrosis and subsequent organ failure in COVID-19. Recently, CRP apheresis was introduced to selectively remove CRP from human blood plasma.Case ReportA 53-year-old, SARS-CoV-2 positive, male patient with the risk factor diabetes type 2 was referred with dyspnea, fever and fulminant increase of CRP. The patient’s lungs already showed a pattern enhancement as an early sign of incipient pneumonia. The oxygen saturation of the blood was ≤ 89%. CRP apheresis using the selective CRP adsorber (PentraSorb® CRP) was started immediately. CRP apheresis was performed via peripheral venous access on 4 successive days. CRP concentrations before CRP apheresis ranged from 47 to 133 mg/l. The removal of CRP was very effective with up to 79% depletion within one apheresis session and 1.2 to 2.14 plasma volumes were processed in each session. No apheresis-associated side effects were observed. It was at no point necessary to transfer the patient to the Intensive Care Unit or to intubate him due to respiratory failure. 10 days after the first positive SARS-CoV-2 test, CRP levels stayed below 20 mg/l and the patient no longer exhibited fever. Fourteen days after the first positive SARS-CoV-2 test, the lungs showed no sign of pneumonia on X-ray.ConclusionThis is the first report on CRP apheresis in an early COVID-19 patient with fulminant CRP increase. Despite a poor prognosis due to his diabetes and biomarker profile, the patient was not ventilated, and the onset of pneumonia was reverted.

In Deutschland ist die Lipidapherese als Ultima-ratio-Behandlungsoption zugelassen zur Elimination von LDL-Cholesterin und/oder Lipoprotein(a) bei kardiovaskul?ren Hochrisikopatienten. Die Apheresebehandlung stellt besondere Anforderungen an die apparative Ausstattung und die fachliche Qualifikation des medizinischen Personals. Die Aufgaben des Pflegepersonals variieren in Abh?ngigkeit von der Organisationsform der Aphereseeinheit, der Anzahl der betreuten Patienten und der eingesetzten Technologien. Neben der Organisation und technischen Durchf?hrung der Apheresebehandlung sind das vor allem den Arzt unterst?tzende T?tigkeiten im Rahmen der Antragstellung zur Kosten?bernahme bei den lokalen Fachkommissionen sowie Aktivit?ten zur Sicherung der aktiven Mitarbeit von Patienten beim Einhalten begleitender therapeutischer Ma?nahmen (Di?t, ?nderung der Lebensgewohnheiten, sportliche Aktivit?ten, medikament?se Therapie). Dar?ber hinaus kommt in unserem Zentrum dem Pflegepersonal eine besondere Rolle bei der ?berpr?fung und Optimierung der Behandlungseffektivit?t zu. Eine notwendige Voraussetzung f?r eine individualisierte Behandlung ist die Standardisierung von Berechnungsgrundlagen f?r Behandlungsvolumina, Reduktionsraten und Effektivit?tsparameter. Als Beitrag f?r eine Verbesserung der Datenlage beteiligen wir uns aktiv am Internationalen Aphereseregister der ?World Apheresis Association? (WAA) und an einer Pilotphase zur Etablierung eines Deutschen Lipidapherese-Registers (DLAR).