Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase

Abstract

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.

Seven COVID-19 Patients Treated with C-Reactive Protein (CRP) Apheresis

“…Further, CRP serum levels exceeded 100 mg/L. CRP apheresis significantly decreased the elevated CRP plasma levels in all seven patients, which supports the efficacy of this therapy and is in line with all patients treated with CRP apheresis so far [19][20][21][22][23][24].…”

“…Based on the existing literature and our results, we assume that fluid retention in the lungs and the hypoxia induced by it provide for the induction of CRP (Sheriff et al, 2021, Ringel et al, 2021. The CRP kinetics then depends on the kinetics of the fluid retention and also on the kinetics of the disappearance of the fluid.…”

CRP-Apherese bei akutem Myokardinfarkt bzw. COVID-19

“…Dieses innovative therapeutische Verfahren für die Frühphase von COVID-19 wird derzeit vielversprechend in 3 deutschen Kliniken eingesetzt. Drei der behandelten Fälle und eine Fallserie wurden bereits publiziert [ 61 , 63 , 77 , 78 ] und eine weitere Publikation zu einer Fallserie ist eingereicht (persönliche Kommunikation). Zur breiteren Verwendung der CRP-Apherese bei COVID-19 fehlt jedoch derzeit eine größere klinische Studie, wobei eine investigatorinitiierte Studie von der Universitätsklinik Essen kürzlich angemeldet wurde [ 21 ].…”

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV) Registry

“…CRP apheresis is performed using a highly selective CRP adsorber developed by Pentracor GmbH [ 17 ]. After publishing 3 case reports describing individual healing attempts [ 16 , 18 – 19 ], we have initiated the “ C -reactive protein A pheresis in COV ID” ( CACOV ) registry to treat COVID-19 disease by selective CRP apheresis within a reputable scientific framework for Health Services Research. In parallel, the randomized “ C -reactive protein A pheresis for Attenuation of P ulmonary, My ocardial and/or K idney Injury in CO VID-19” ( CAPMYKCO ) trial ( https://clinicaltrials.gov/ct2/show/NCT04898062 ) was initiated.…”