Continuous hemodiafiltration with the oxiris filter ameliorates cytokine storm and induces rapid clinical improvement in COVID-19 – A case report

Abstract

Delayed interferon secretion and cytokine dysregulation are responsible for the life-threatening acute respiratory distress syndrome (ARDS), multiorgan dysfunction and shock in COVID 19, which closely resembles secondary hemophagocytic lymphohistiocytosis (sHLH). IL-6, a marker of hypercytokinemia in patients with COVID-19 is positively correlated with disease severity, development and progression of ARDS, and mortality. Therapy to either reduce IL-6 or inhibit its action with either non-specific inhibitors of inflammation like dexamthasone or Toclizumab a specific inhibitor of IL-6 has produced decrease in mortality. We describe a novel method of treatment in a patient with multiorgan involvement in COVID 19, using the oXiris hemofilter which delivers renal replacement therapy while also reducing cytokines like IL-6.

Critically Ill Patients with COVID-19 Pneumonia Requiring Continuous Renal Replacement Therapy with oXiris^® Membrane in a Third-Level Hospital in Northeast Mexico

“…In this scenario, ECMO occurs, and in a more novel way, through the use of filters and cartridges with specialized characteristics that may participate in a septic patient or with acute respiratory distress syndrome. The need for RRT in patients with sepsis and AKI tends to occur more frequently in the setting of hemodynamic instability and fluid overload; therefore, if available, CRRT would be the first option of treatment [9].…”

“…Multiple studies have proven the efficacy of the modified AN69 membrane for the management of patients with sepsis due to COVID-19. Lobo et al [9] reported an improvement in respiratory failure and encephalopathy after hemodiafiltration using oXiris. There was a reduction in IL-6, and serum creatinine, indicating adequate control of inflammation and metabolic clearance [9].…”

“…Lobo et al [9] reported an improvement in respiratory failure and encephalopathy after hemodiafiltration using oXiris. There was a reduction in IL-6, and serum creatinine, indicating adequate control of inflammation and metabolic clearance [9]. Ma et al [10] reported a significant decrease in inflammatory markers in 3 patients with COVID-19 treated with plasma exchange and modified AN69 membrane in a hospital in Wuhan, China.…”

Case Report: Successful Treatment of a Child With COVID-19 Reinfection-Induced Fulminant Myocarditis by Cytokine-Adsorbing oXiris® Hemofilter Continuous Veno-Venous Hemofiltration and Extracorporeal Membrane Oxygenation

“…However, the effectiveness of this novel treatment modality in COVID-19- related cytokine storm remains unclear, particularly in the pediatric population with limited data. In adults, successful treatment of critically ill COVID-19-induced fulminant cytokine release by cytokine hemoadsorption was demonstrated but mainly from a handful of case studies, noting improvement in clinical recovery, multiple organ dysfunction scoring systems, coagulopathy, and a reduction in hyperinflammatory ( 9 , 30 – 32 ). Contrarily, a single-central study from Kang et al ( 33 ) concluded that CRRT with oXiris ® hemofilter might not effectively alleviate hypercytokinemia in critical COVID-19 without acute kidney injury.…”

“…While many reports reinforce the key role of IL-6 in exacerbating cardiotoxicity induced by cytokine storm ( 7 , 30 , 34 ), the intriguing question is whether clinical outcomes in COVID-19 are favorable if relatively low levels of circulating IL-6? Of note, Bagate F et al highlighted the prominent contribution of IL-10, GM-CSF, and IP-10 in the pathology of cardiac dysfunction in COVID-19 ( 35 ).…”