Efficacy of Hemoperfusion in Severe and Critical Cases of COVID-19

Abstract

<b><i>Introduction:</i></b> Uncontrolled overproduction of inflammatory mediators is predominantly observed in patients with severe COVID-19. The excessive immune response gives rise to multiple organ dysfunction. Implementing extracorporeal therapies may be useful in omitting inflammatory mediators and supporting different organ systems. We aimed to investigate the effectiveness of hemoperfusion in combination with standard therapy in critically ill COVID-19 patients. <b><i>Method:</i></b> We conducted a single-center, matched control retrospective study on patients with confirmed SARS-CoV-2 infection. Patients were treated with hemoperfusion in combination with standard therapy (hemoperfusion group) or standard treatment (matched group). Hemoperfusion or hemoperfusion and continuous renal replacement therapies were initiated in the hemoperfusion group. The patients in the matched group were matched one by one with the hemoperfusion group for age, sex, oxygen saturation (SPO2) at the admission, and the frequency of using invasive mechanical ventilation during hospitalization. Two types of hemoperfusion cartridges used in this study were Jafron<sup>©</sup> (HA330) and CytoSorb® 300. <b><i>Result:</i></b> A total of 128 COVID-19-confirmed patients were enrolled in this study; 73 patients were allotted to the matched group and 55 patients received hemoperfusion. The median SPO2 at the admission day in the control and hemoperfusion groups was 80% and 75%, respectively (<i>p</i> value = 0.113). The mortality rate was significantly lower in the hemoperfusion group compared to the matched group (67.3% vs. 89%; <i>p</i> value = 0.002). The median length of ICU stay was statistically different in studied groups (median, 12 days for hemoperfusion group vs. 8 days for the matched group; <i>p</i> < 0.001). The median final SPO2 was statistically higher in the hemoperfusion group than in the matched group, and the median PaCO2 was lower. <b><i>Conclusion:</i></b> Among critically ill COVID-19 patients, based on our study, the use of hemoperfusion may reduce the mortality rate and improve SPO2 and PaCO2.

Evaluation of clinical features and laboratory findings in critical intensive care unit patients with severe coronavirus disease‐19 who underwent extracorporeal cytokine adsorption

“…The mortality rate of our patients who received MV support was 88.2% at the end of the first month, while the mortality rate was 94.1% at the end of the third month. In the study of Darazam et al, the mortality rate was 67.3% in the patients who underwent hemoperfusion, while the mortality rate in the control group was 89.0% [39].…”

Efficacy of supplemental hemoadsorption therapy on severe and critical patients with COVID-19: an evidence-based analysis

“…The pooled results demonstrated that HAT in critically ill patients with COVID-19 significantly decreased mortality at the longest follow-up compared with conventional therapy. Hemoadsorption therapy was reported to have a positive effect on clinical indicators and a significant improvement in mortality in five of the included studies (30–32,34,41). Similar results were observed by Soleimani et al (12) and Lebreton et al (40), all of which indicated a lower mortality rate of patients with severe COVID-19 receiving hemoadsorption therapy, with no statistical significance difference observed.…”

“…Furthermore, 446 studies were excluded after screening the title and abstract, according to the inclusion and exclusion criteria, resulting in 23 studies that underwent full-text assessment. Finally, 14 published studies and 2 ongoing trials were enrolled in this systematic living review and meta-analysis (12,13,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43).…”

“…The characteristics of the published studies are shown in Table 1 and Table 2. Among these studies, three articles were randomized trials (13,37,38), one article was a prospective cohort study (34), 9 articles were retrospective cohort studies (12,(30)(31)(32)(33)36,(39)(40)(41), and one article was a case-control study (35), which was actually designed as a retrospective cohort study. Six articles were published in 2022, six in 2021, and two in 2020.…”

“…All studies were performed in patients with severe COVID-19 in the medical ICU under various hyperinflammatory conditions. Most of the included patients with severe COVID-19 that remained in a compensatory state of oxygen saturation (12,(30)(31)(32)(33)(34)(35)(36)(37)(38). All the included studies were completed at 2020-2021 period, with seven studies recruiting COVID-19 patients in 2020, and seven studies recruiting patients from 2020 to 2021.…”