The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study

Abstract

<b><i>Introduction:</i></b> Currently, the effect of hemoperfusion on outcome in severe COVID-19 patients is still unknown. Therefore, we aimed to investigate the effects of early HA-330 hemoperfusion in severe COVID-19 patients. <b><i>Methods:</i></b> We conducted a single center, prospective cohort study on patients who were diagnosed with severe COVID-19 patients and admitted to ICU. Patients in hemoperfusion group (defined as patients who were treated with hemoperfusion therapy at least 3 sessions in combination with standard therapy) were compared with the control group (defined as patients who received standard treatment alone or received less than 3 sessions of hemoperfusion therapy). The primary outcome was daily sequential organ failure assessment (SOFA) scores. Secondary outcomes were all-cause mortality at 28 days, mechanical ventilator-free day, daily C-reactive protein (CRP), oxygenation (defined by PaO<sub>2</sub>/FiO<sub>2</sub> ratio), and severity score of lung infiltration on the chest X-ray (CXR RALE score). All outcomes were adjusted by regression analysis to reduce the confounders due to some difference in baseline characteristics. <b><i>Results:</i></b> A total number of 29 severe and critical COVID-19 confirmed patients were enrolled. Fifteen patients were defined as hemoperfusion group and 14 were control group. The median of CRP and SOFA score at the baseline (the day after severe pneumonia diagnosis or before hemoperfusion) in hemoperfusion and control groups were comparable, 96.79 mg/L and 87.3 mg/L, <i>p</i> = 0.53, 3.53 ± 0.99 versus 4.3 ± 1.89, <i>p</i> = 0.15, respectively. Clinical improvement associated with decreased SOFA score and improvement of CXR RALE score were found in hemoperfusion group compared to control group (<i>p</i> = 0.008 and <i>p</i> = 0.005, respectively). The 28-day mortality rate was significantly lower in hemoperfusion group compared to control group (6.67% vs. 85.71%, <i>p</i> < 0.001) and the adjusted hazard ratio of death was 0.017 (95% confidence interval = 0.008–0.351, <i>p</i> = 0.008). <b><i>Conclusions:</i></b> The addition of early HA-330 hemoperfusion to standard therapy improved severity of organ failure and might reduce the mortality rate. However, the results were affected by the baseline confounders and limited sample size.

Application of Extracorporeal Apheresis in Treatment of COVID-19: a Rapid Review

“…It means that early initiation of hemoadsorption can be extremely effective in patients with severe COVID-19. Surasit et al [ 62 ] conducted a prospective cohort study to compare 2 groups: patients with standard therapy and patients who received at least 3 hemoadsorption procedures using an HA 330 (Jafron Biomedical Co., China). The result of this study was that in the group of patients who had the hemoadsorption procedure, there was a marked improvement in laboratory parameters, and the 28-day mortality rate was significantly lower in the hemoperfusion group compared to the control group (6.67% vs 85.71%, p < 0.001).…”

“…Trials 21(1):577 10.1186/s13063-020-04,501-0 HA 330 (Jafron, Biomedical Co, China) Due to the macroporous structure and high specific surface area removes target molecules from the bloodstream [ 11 ]. Two comparative studies demonstrated a decrease in the pateints’ mortality, compared with the control group [ 51 , 62 ] When used in the early stages of the disease may have a beneficial effect on improving the patient's condition and decreasing mortality [ 62 ] Yang X–H, Ren-Hua S, Ming-Yan Z, Er-Zhen C, Jiao L, Hong-Liang W, Rong-Li Y, De-Chang C (2020) Expert recommendations on blood purification treatment protocol for patients with severe COVID-19. Chronic Diseases and Translational Medicine 2/9 10.1016/j.cdtm.2020.04.002 Surasit K, Srisawat N (2022) The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study.…”

“…Due to the macroporous structure and high specific surface area removes target molecules from the bloodstream [ 11 ]. Two comparative studies demonstrated a decrease in the pateints’ mortality, compared with the control group [ 51 , 62 ]…”

“…When used in the early stages of the disease may have a beneficial effect on improving the patient's condition and decreasing mortality [ 62 ]…”

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

“…HA330 showed favorable outcomes in acute respiratory distress syndrome in terms of oxygenation, reduction of lung edema, and circulating and alveolar cytokine levels in patients with sepsis shock and acute respiratory distress syndrome (ARDS) [ 98 ]. Specifically, in patients with COVID-19, a single-center prospective cohort study demonstrated that the early use of HA-330 hemoperfusion in addition to standard therapy improves organ failure outcomes (SOFA score, mechanical ventilator-free day) and may indirectly reduce the mortality rate [ 99 ]. The limited sample size of this study and the lack of confirmation studies in COVID-19 patients complicate the interpretation of these results.…”