Efficacy of Hemoperfusion in Severe and Critical Cases of COVID-19

Abstract

IntroductionIn critically ill COVID-19 patients, uncontrolled over-production of inflammatory mediators is observed, dominantly. The excessive immune response give rise to multiple organ dysfunction. Implementing extracorporeal therapies may be useful in omitting inflammatory mediators and supporting different organ systems. We aimed to investigate the effectiveness of hemoperfusion in combination with standard therapy in critically ill COVID-19 patients.MethodWe conducted a single-center, matched control retrospective study on patients with confirmed SARS-CoV-2 infection. Patients were treated with hemoperfusion in combination with standard therapy (hemoperfusion group) or standard treatment (matched group). Hemoperfusion or hemoperfusion and CRRT (continuous renal replacement therapy) therapies were initiated in hemoperfusion group. The patients in the matched group were matched one by one with the hemoperfusion group for age, sex, the oxygen saturation (SPO2) at the admission and the frequency of using invasive mechanical ventilation during hospitalization. Two types of hemoperfusion cartridges used in this study were Jafron© (HA330) or cytosorb® 300. ResultA total number of 128 COVID- 19 confirmed patients were enrolled in this study; 73 patients were allotted to the matched group and 55 patients received hemoperfusion. The median SPO2 at the admission in control and hemoperfusion groups was 80% and 75%, respectively (P-value=0.113). The mortality rate was significantly lower in hemoperfusion group compared to the matched group (67.3% vs. 89%; P.value=0.002). The median length of ICU stay was statistically different in studied groups (median, 12 days for hemoperfusion group vs. 8 days for the matched group; P<0.001). The median of final oxygen saturation was statistically higher and median of PaCO2 was lower in hemoperfusion group compared to the matched group.ConclusionAmong critically ill COVID-19 patients, the use of hemoperfusion reduces the mortality rate and improves oxygen saturation and PaCO2.

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

“…HA-330 includes a neutral microporous resin that adsorbs pro-inflammatory cytokines such as TNF- α, IL-1, IL-6 [ 12 ]. Using HA-330 as hemoperfusion may be beneficial for the treatment of COVID-19 cytokine storm and may result in decreased mortality [ 13 ]. There are some studies which have the positive effects of hemoperfusion in COVID-19 patients [ 14 ].…”

Effect of extracorporeal hemoadsorption in critically ill patients with COVID-19: A narrative review

“…However, only serum CRP levels in the patients were monitored to evaluate the effect of HA330 hemoperfusion on cytokine removal. Another singlecenter, matched control retrospective study enrolled 128 COVID-19 patients to investigate the efficacy of hemoperfusion in combination with standard therapy in critically ill COVID-19 patients (118). Of 55 patients in the hemoperfusion group, the number of patients who received one, two, and three or four courses of hemoperfusion was 18 (32.7%), 14 (25.4%), and 23 (41.9%), respectively.…”

Advances in Normothermic Machine Perfusion of the Kidney: Evidence for Clinical Practice and Underlying Mechanistic Actions

“…Removing inflammatory mediators from the circulation during NMP may help to reduce the inflammatory response. Haemoadsorber filters remove molecules within a range of 10-50 kDa and have been used to treat sepsis, severe respiratory syndrome and the inflammatory response induced by COVID-19 [45][46][47] . In a porcine NMP model the haemoadsorber reduced inflammation and improved renal blood flow 37 .…”