The effect of hemoperfusion on the outcome, clinical and laboratory findings of patients with severe COVID-19: a retrospective study

Abstract

Hemoperfusion is a method of blood filtering to remove toxins and inflammatory factors. Cytokine storms and high levels of inflammatory factors play a role in the pathogenesis of coronavirus disease 2019 (COVID-19). The present study aims to evaluate the effect of hemoperfusion on the clinical and laboratory findings and outcomes of patients with severe COVID-19. Forty-eight patients with severe COVID-19 and a positive PCR test who were admitted to the intensive care unit (ICU) participated in the study. All patients were treated by routine treatment protocol for COVID-19. Hemoperfusion was performed for 24 patients in addition to treatment with conventional antiviral therapies. The other 24 patients made up the control group. Demographic data, laboratory findings, and patient outcomes before and after treatment were retrospectively collected and analyzed. There was no significant difference in mortality or length of hospital stays between the control group and the hemoperfusion group. The breathing rate (P-value=0.001) and heart beat rate (P-value=0.028) of patients decreased after hemoperfusion. The hemoperfusion resulted in a significant increase in the SpO2 levels and a significant decrease in the CRP of patients compared to the conventional treatment (P-value=0.009). Hemoperfusion can improve respiratory distress. It can reduce the CRP in patients with severe COVID-19 but has no effect on mortality.

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

“…The release of inflammatory immune cytokines in COVID‐19 patients may increase the inflammation in the lung and the risk of developing ARDS [6, 12]. ARDS can cause hypoxia and lung damage, resulting in the release of inflammatory factors.…”

“…Our patients received routine treatment based on the guidelines of the Ministry of Health [11]. In addition to the routine treatment, the patients with acute respiratory failure underwent noninvasive respiratory support (HFNO and/or NIV) and awake prone position.…”

“…A central venous catheter was inserted and HA330 hemoperfusion was administered to the patients diagnosed with cytokine storm. The criteria for diagnosing cytokine storm based on persistent fever, elevated C-reactive protein (CRP), ferritin, D-dimer elevation, lymphopenia, thrombocytopenia and neutrophilia, impaired liver function tests alanine aminotransferase, aspartate aminotransferase, and LDH [11]. The blood flow rate set between 200 and 300 mL/min during hemoperfusion.…”

Expanding the potential therapeutic options of hemoperfusion in the era of improved sorbent biocompatibility

“…Other case-control and retrospective studies followed, highlighting a potentially beneficial role of adjuvant HP with CytoSorb in the early phase of COVID-19 in terms of cytokine reductions (mainly IL-6 levels), a better clinical course with less need for vasoactive agents, and the improvement of respiratory distress. However, data on mortality rates were inconsistent [72][73][74][75][76][77]. Indeed, in a recent prospective, randomized pilot study with 50 COVID-19 patients receiving CytoSorb for 3 to 7 days or standard therapy, HP did not improve the resolution of vasoplegic shock (primary outcome) or the predefined secondary endpoints, which included mortality, IL-6 concentration, and catecholamine requirement [78].…”

Acute Kidney Injury and Blood Purification Techniques in Severe COVID-19 Patients

“…HP can remove inflammatory mediators such as DAMPs and PAMPS and consequently reduces plasma levels of cytokine/chemokine [ 73 ]. Blood is purified through the removal of plasma solutes by adsorption into either activated charcoal beads or resin beads contained in an adsorbent cartridge [ 74 , 75 ]. Resins have a greater affinity for lipophilic molecules, while charcoal has a greater affinity for hydrophilic molecules.…”