Application of plasma exchange in association with higher dose CVVH in Cytokine Storm Complicating COVID-19

Lin, Jui-Hsiang; Chen, Yu‐Cheng; Lu, Chien-Lu; Hsu, Yuan-Nian; Wang, Weijie

doi:10.1016/j.jfma.2020.04.023

Cited by 32 publications

(35 citation statements)

References 6 publications

(6 reference statements)

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“…In a different, though recent, study describing the autopsy results of 12 SARS-CoV2 patients in a German center, the majority of cases showed massive venous thromboembolism with no arterial thrombosis being reported (73). Mechanisms which may contribute to intracranial arterial thrombosis include the cytokine-induced initiation of thrombin formation that triggers the activation of platelets that subsequently result in the development of micro and macrothrombi (74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87). This is worsened by the free conversion of fibrinogen to fibrin and inflammation-induced depletion of physiological anticoagulants such as antithrombin III, tissue factor pathway inhibitor, and the protein C system (74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88).…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

2020

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Corona virus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is recognized as a global pandemic by WHO 2020 with 5,934 936 infections, 367,166 deaths and affecting over 200 countries as of 30th May 2020. Acute Ischemic Stroke (AIS) in brain is also emerging as an important neurovascular/neurological complication of COVID-19, associated with extreme immune responses leading to dysregulated coagulation system and generalized thrombo-embolic status and increased risk of AIS especially among usually less vulnerable younger adults in this cohort. Thus, in early June 2020, we aimed to review the clinical data on all published cases of COVID-19 and concomitant AIS, with a view to understanding the pertinent clinical, laboratory and imaging features. The neutrophil-lymphocyte ratio (NLR) at time of hospital admission for COVID infection correlates positively with the duration of time before onset of clinical features of AIS. Higher NLR, C-Reactive protein, serum ferritin, D-dimer and fibrinogen levels are associated with poor prognosis of AIS in COVID-19 with 75% of patients dying or being severely disabled at present. Currently it is too early to comment on the long-term outcomes for survivors.

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Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

2020

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“…Furthermore, therapeutic apheresis is an efficient biophysical method to remove metabolic inflammatory immunological and environmental components from the blood of patients. Many patients with severe COVID-19 infection exhibit lymphopaenia which may lead to secretion of high amounts of inflammatory cytokines and cytokine storm [74][75][76].…”

Section: Role Of Lipids Environmental Pollutants and Therapeutic Apmentioning

confidence: 99%

Is There a Role for Environmental and Metabolic Factors Predisposing to Severe COVID-19?

Bornstein

Voit-Bak²,

Schmidt³

et al. 2020

Horm Metab Res

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The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic affects people around the world. However, there have been striking differences in the number of infected individuals and deaths in different countries. Particularly, within Central Europe in countries that are similar in ethnicity, age, and medical standards and have performed similar steps of containment, such differences in mortality rates remain inexplicable. We suggest to consider and explore environmental factors to explain these intriguing variations. Countries like Northern Italy, France, Spain, and UK have suffered from 5 times more deaths from the corona virus infection than neighboring countries like Germany, Switzerland, Austria, and Denmark related to the size of their respective populations. There is a striking correlation between the level of environmental pollutants including pesticides, dioxins, and air pollution such as NO2 known to affect immune function and healthy metabolism with the rate of mortality in COVID-19 pandemic in these European countries. There is also a correlation with the use of chlorination of drinking water in these regions. In addition to the improvement of environmental protective programs, there are possibilities to lower the blood levels of these pollutants by therapeutic apheresis. Furthermore, therapeutic apheresis might be an effective method to improve metabolic inflammation, altered vascular perfusion, and neurodegeneration observed as long-term complications of COVID-19 disease.

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“…Our previous article indicated that the 52-year-old woman under the diagnosis of COVID-19 developed acute respiratory failure with invasive mechanical ventilation for 15 days and the length of stay in hospital is 55 days. 2 All cultures including sputum, stool, urine, blood and fungus showed negative findings. Chlamydia IgA, mycoplasma pneumonia IgM, legionellae urinary antigen, and pneumococcus antigen were negative results.…”

mentioning

confidence: 99%

Reply to Letter to the Editor: Therapeutic plasma exchange resolving COVID-19 related ARDS

Lin¹,

Lu²,

Wu³

et al. 2020

Journal of the Formosan Medical Association

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Application of plasma exchange in association with higher dose CVVH in Cytokine Storm Complicating COVID-19

Cited by 32 publications

References 6 publications

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

Is There a Role for Environmental and Metabolic Factors Predisposing to Severe COVID-19?

Reply to Letter to the Editor: Therapeutic plasma exchange resolving COVID-19 related ARDS

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