A Comparison of 30-Day Survival Rate Between Hemoperfusion and Non Hemoperfusion Group in Severe COVID-19 Pneumonia Patients
Keywords:
severe COVID-19 pneumonia, cytokine storm, hemoperfusionAbstract
The cytokine storm is a severe complication of SARS-CoV-2 infection. Hemoperfusion (HP) is an extracorporeal blood purification that can remove cytokines effectively. However, little is known about the efficacy of HP on severe COVID-19 infection. We aimed to study the efficacy of HP in severe COVID-19 pneumonia. This study was a retrospective study in severe COVID-19 pneumonia with CRP ³50 mg/L. All participants received standard treatment and were admitted to ICU at Chaophrayayommarat (Pan Sukhum) Suphanburi Hospital from April, 2021 to October, 2021. The study group defined as patients who were treated with HP ³3 sessions (the HP group) and the control group defined as patients were treated with the standard treatment alone (the non-HP group). The primary outcome was 30-day survival rate. One hundred thirty-eight patients were enrolled in this study, 69 patients in the HP group and 69 patients in the non-HP group. The 30-day survival rate in the HP group was 58% (95%CI 45-70%) and in the non-HP group was 42 % (95%CI 30-55%), p = 0.061. On day 3, the reduction of CRP level was significantly higher in the HP group than the non-HP group, p=0.032. For non-intubated patients before treatment, the rate of intubation in the HP group was 34.5% and in the non-HP group was 52.6%, p=0.05. In the HP group, the non-intubated patients (n = 58) before HP had a survival rate of 65.5% and the intubated patients (n = 11) before hemoperfusion had a survival rate of 18.2%, p=0.005. In a multivariable model, the significant variables independently associated with survival rate are age (adjusted odds ratio 0.94 (95%CI 0.91, 0.98; p=0.003)) and ROX index level (adjusted odds ratio 2.20 (95%CI1.55, 3.12; p<0.001)). In conclusion, the 30-day survival rate in severe COVID-19 pneumonia patients who received standard treatment and HP was higher than in standard treatment alone and interestingly, the rate of intubation was also lower in the HP group. Well design randomized control trial is still warranted.
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World Health Organization. Archived: WHO timeline COVID-19. [Internet]. 2020 [cited 2022 Aug 19]. Available from: https://www.who.int/news/item/27- 04-2020-who-timeline---covid-19
World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. 2020 [cited 2020 Oct 13]. Available from: https://www.who.int/director-general/ speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11- march-2020
Yang X, Yu Y, Xu J. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, ob¬servational study. Lancet Respir Med [Internet]. 2020 [cited 2022 Jun 15];8(5):475–81. Available from: https://doi.org/10.1016/S2213-2600(20)30079-5
World Health Organization. Therapeutics and COVID-19 [Internet]. 2022 [cited 2022 Aug 19]. Available from: https://www.who.int/teams/health-care-readiness/ covid-19/therapeutics
Kim JS, Lee JY, Yang JW, Lee KH, Effenberger M, Szpirt W, et al. Immunopathogenesis and treatment of cytokine storm in Covid-19. Theranostic [Internet]. 2021 [cited 2022 Jun 22];11(1):316-292. Available from: https://doi.org/10.7150/thno.49713
Hertanto DM, Wiratama BS, Sutanto H, Wungu CDK. Immunomodulation as a potent COVID-19 pharmacotherapy: past, present and future. J Inflamm Res [Internet]. 2021 [cited 2022 Jul 2];14:3419–28. Available from: https://doi.org/10.2147/JIR.S322831
RECOVERY Collaborative Group; Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med [Internet]. 2021 [cited 2022 Jul 22];384(8):693-704. Available from: https://doi.org/10.1056/NEJMoa 2021436
Wu C, Chen X, Cai Y, Xia Ja, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med [Internet]. 2020 [cited 2022 Jun 22];180(7):1–11. Available from: https://doi.org/10.1001/jamainternmed.2020.0994
Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, et al. A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia. Signal Transduct Target Ther [Internet]. 2020 [cited 2022 Aug 22];5(1):57. Available from: https://doi. org/10.1038/s41392-020-0158-2
Chatterjee K, Wu CP, Bhardwaj A, Siuba M. Steroids in COVID-19: an overview. Cleve Clin J Med [Internet]. 2020 [cited 2022 Aug 10]doi:10.3949/ccjm.87a. ccc059. Online ahead of print. Available from: https:// www.ccjm.org/content/early/2020/08/18/ccjm.87a. ccc059
Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nat Rev Nephrol [Internet]. 2020 [cited 2022 Aug 10];16:308-10. Available from: https://doi.org/10.1038/s41581- 020-0284-7
Khaled ALS, Mohsen B. Cytokine blood filtration responses in Covid-19. Blood Purif [Internet]. 2021 [cited 2022 Aug 22];50(2):141-9. Available from: https://doi.org/10.1159/000508278
Soleimani A, Taba SMM, Taheri SH, Loghman AH, Shayestehpour M. The effect of hemoperfusion on the outcome, clinical and laboratory findings of patients with severe COVID-19: a retrospective study. New MicrobesNew Infect [Internet]. 2021 [cited 2022 Aug 2];44:1- 4. Available from: https://doi.org/10.1016/j. nmni.2021.100937
Rampino T, Gregorini M, Perotti L, Ferrari F, Pattonieri EF, Grignano MA. Hemoperfusion with CytoSorb as adjuvant therapy in critically ill patients with SARS-CoV2 pneumonia. Blood Purif [Internet]. 2020 [cited 2021 Aug 2];50(4-5):566–71. Available from: https://doi. org/10.1159/000511725
Darazam IA, Kazempour M, Pourhoseingholi MA, Ha¬tamia F, Rabieia MM, Gharehbagh FJ, et al. Efficacy of hemoperfusion in severe and critical cases of COVID-19. Blood Purif [Internet]. 2023 [cited 2023 Jan 22];52(1):8-16 Available from: https://doi. org/10.1159/000524606
Rifkin BS, Stewart IJ. Seraph-100 hemoperfusion in SARS-CoV-2-infected patients early in critical illness: a case series. Blood Purif [Internet]. 2022 [2022 Au¬g 19];51(4):317-20. Available from: https://doi. org/10.1159/000517430
Abbasi S, Naderi Z, Amra B, Atapour A, Dadkhahi SA, Eslami MJ, et al. He¬moperfusion in patients with severe COVID-19 respi¬ratory failure, lifesaving or not? J Res Med Sci. [Internet]. 2021 [cited 2022 Aug 19];26(1):34. Available from: https://doi.org/10.4103/jrms. JRMS_1122_20
Vardanjani AE, Ronco C, Rafiei H, Golitaleb M, Pish¬- vaei MH, Mostafa MM. Early hemoperfusion for cytokine removal may contribute to prevention of intubation in patients infected with COVID-19. Blood Purif [Internet]. 2021 [cited 2022 Aug 19];50(2):57-260. Avail-able from: https://doi.org/10.1159/000509107
Asgharpour M, Mehdinezhad H, Bayani M, Zavareh MSH, Hamidi SH, Akbari R, et al. Effectiveness of extracorporeal blood purification (hemoadsorption) inpatients with severe Coronavirus disease 2019 (COVID19). BMC Nephrology [Internet]. 2020 [cited 2022 Oct 13];(21):356. Epub 2020 Aug 20. Available from: https://doi.org/10.1186/s12882-020-02020- 3
Rosa SD, Cutuli SL, Ferrer R, Antonelli M, Ronco C, Group CEC. Polymyxin B hemoperfusion in coronavirus disease 2019 patients with endotoxic shock: case series from EUPHAS2 registry. Artif Organs [Internet]. 2021 [cited 2022 Oct 13];45(6):E187-E194. Available from: https://doi.org/10.1111/aor.13900
Peerapornratana S, Sirivongrangson P, Tungsanga S, Tiankanon K, Kulvichit W, Putcharoen O, et al. Endo¬- toxin adsorbent therapy in severe COVID-19 pneumonia. Blood Purif [Internet]. 2020 [cited 2022 Oct 13]; 51(1):47-54. Available from: https://doi.org/ 10.1159/000515628
Alexander S, Enya W, Marina R, Achim L. Cytokine adsorption in patients with severe COVID-19 pneumo¬nia requiring extracorporeal membrane oxygenation (CY¬COV): a single centre, open-label, randomised, controlled trial. Lancet Respir Med [Internet]. 2020 [cited 2022 Aug 19];9:755–62. Available from: https://doi.org/10.1016/S2213-2600(21)00177-6
Putzu A, Schorer R. Hemoadsorption in critically ill patients with or without COVID-19: A word of caution. Crit Care [Internet]. 2021 [cited 2022 Aug 19];65:140– 1. Available from: https://doi.org/10.1016/j.jcrc. 2021.06.007
Surasita K, Srisawat N. The efficacy of early additional hemoperfusion therapy for severe COVID-19 patients: a prospective cohort study. Blood Purif [Internet]. 2022 [cited 2022 August 19];51(11):879-88. Available from: https://doi.org/10.1159/000521713
Mikaeili H, Taghizadieh A, Nazemiyeh M, Rezaeifar P, Vahed SZ, Safiri S, et al. The early start of hemoperfusion decreases themortality rate among severe COVID-19 patients: a preliminary study. Hemodial Int [Internet]. 2022 [cited 2022 Aug 2];26:176–82. Available from: https://doi.org/10.1111/hdi.12982
National Institutes of Health. Clinical spectrum of SARSCoV-2 infection[internet]. 2022 [cited 2022 Aug 19]. Available from https://www.covid19treatmentguidelines. nih.gov/overview/clinical-spectrum/
Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. New York: Pearson; 2010.
Liu F, Li L, Xu M, Wu J, Lao D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein and procalcitonin in patients with Covid-19. Clin Virol [Internet]. 2020 [cited 2022 Aug 10];127:104370. Available from: https://doi.org/10.1016/j.jcv. 2020.104370
Chitty SA, Mobbs S, Rifkin BS, Stogner SW, Lewis MS, Betancourt J, et al. A multicenter evaluation of the Seraph 100 microbind affinity blood filter for the treatment of severe COVID-19. Crit Care Explor [Internet]. 2022 [cited 2022 Aug 10];4(4):e0662. Available from: https://doi.org/10.1097/CCE.0000000000000662
Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the Spo2/Fio2 ratio and the Pao2/Fio2 ratio in patients with acute lung injury or ARDS. Chest [Internet]. 2007 [cited 2022 Aug 2];132(2):410–7. Available from: https://doi.org/ 10.1378/chest.07-0617
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