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Aim of the study. To evaluate the value of predictors of hemoadsorption clinical efficacy in patients with COVID-19.Materials and methods. This study analyzed the results of treatment of 62 patients with severe COVID-19 in the intensive care unit using selective hemoadsorption of cytokines. All patients with severe COVID-19 were admitted to the intensive care unit within 14 days from the disease onset were subdivided into two groups. Group 1 patients (n=32) received on a top of standard treatment the hemoperfusion (HP) procedure for 4 hours, for 2–3 days in a row, using a cytokine sorption column composed of mesoporous styrene-divinilbenzen copolymer matrix. Group 2 patients were not subjected to extracorporeal blood purification. All patients received IL-6 inhibitors at a baseline in accordance to the temporary guidelines. We evaluated factors of unfavorable outcomes by analyzing changes in biochemical markers of systemic inflammatory response and mortality rates in patients of both groups.Results. Initiation of HP later than 10 days from NCI onset (P < 0.001), length of stay in the ICU, extent of lung damage (P = 0.036) and the SOFA (Sequential Organ Failure Assessment) score (P = 0.009) were the most powerful predictors of unfavorable outcome. Levels of systemic inflammatory response markers (interleukin-6, CRP, D-dimer) in both groups did not significantly affect the survival rates and length of hospital stay (P > 0.05). HP group demonstrated better survival (P < 0.05). Mean hospital stay was 31 and 27 days, ICU stay — 11 and 8 days for Groups 1 and 2, respectively (P < 0.05).Conclusion. Treatment of severe COVID-19 patients with HP using novel domestic hemosorbent composed of styrene-divinilbenzen copolymer matrix resulted in decrease in CRP levels on the first day after application and, with early onset, contributed to a significant increase in survival and decreased hospital and ICU stay. Additional studies are warranted to clarify the optimal timing of the initiation of HP in severe COVID-19 patients.
Aim of the study. To evaluate the value of predictors of hemoadsorption clinical efficacy in patients with COVID-19.Materials and methods. This study analyzed the results of treatment of 62 patients with severe COVID-19 in the intensive care unit using selective hemoadsorption of cytokines. All patients with severe COVID-19 were admitted to the intensive care unit within 14 days from the disease onset were subdivided into two groups. Group 1 patients (n=32) received on a top of standard treatment the hemoperfusion (HP) procedure for 4 hours, for 2–3 days in a row, using a cytokine sorption column composed of mesoporous styrene-divinilbenzen copolymer matrix. Group 2 patients were not subjected to extracorporeal blood purification. All patients received IL-6 inhibitors at a baseline in accordance to the temporary guidelines. We evaluated factors of unfavorable outcomes by analyzing changes in biochemical markers of systemic inflammatory response and mortality rates in patients of both groups.Results. Initiation of HP later than 10 days from NCI onset (P < 0.001), length of stay in the ICU, extent of lung damage (P = 0.036) and the SOFA (Sequential Organ Failure Assessment) score (P = 0.009) were the most powerful predictors of unfavorable outcome. Levels of systemic inflammatory response markers (interleukin-6, CRP, D-dimer) in both groups did not significantly affect the survival rates and length of hospital stay (P > 0.05). HP group demonstrated better survival (P < 0.05). Mean hospital stay was 31 and 27 days, ICU stay — 11 and 8 days for Groups 1 and 2, respectively (P < 0.05).Conclusion. Treatment of severe COVID-19 patients with HP using novel domestic hemosorbent composed of styrene-divinilbenzen copolymer matrix resulted in decrease in CRP levels on the first day after application and, with early onset, contributed to a significant increase in survival and decreased hospital and ICU stay. Additional studies are warranted to clarify the optimal timing of the initiation of HP in severe COVID-19 patients.
INTRODUCTION: Due to the COVID-19 (infectious disease caused by the SARS-CoV-2 virus) pandemic, we had to take a completely different approach to the nature of critical conditions. The pandemic also made us reconsider many views about it. Moreover, that contributed to the development of new practical approaches for treatment and prevention, including the ones in the field of extracorporeal hemocorrection. OBJECTIVE: Methods for purification of blood and plasma began to be considered as an independent link for the treatment of organ disorders or as a part of extracorporeal support for the life support of the body. MATERIALS AND METHODS: The article consists of three sections: a description of the role of extracorporeal hemocorrection methods in intensive care, their classification and main characteristics; the concept of sequential targeted extracorporeal therapy for a treatable symptom in sepsis; extracorporeal hemocorrection as part of the concept of extracorporeal life support. This article uses literary sources published from January 1, 2022 to July 1, 2023. Materials related to COVID-19 and other specific pathologies (poisoning, acute liver failure, itching, systemic diseases, etc.), requiring separate discussion, are intentionally excluded. RESULTS: Technologies in extracorporeal hemocorrection provide support and/or replacement of organ functions; restoration of body resistance and balance between inflammatory and anti-inflammatory response; restoration of body tolerance (metabolism and regeneration). Nevertheless, despite the convincing pathophysiological rationale for the use of these methods in critical conditions, evidence of its effectiveness is limited. Current trends indicate that future research should be primarily aimed at finding biomarkers that can simultaneously designate specific biological processes; characterize different subgroups of patients; allow targeted choice for the method of therapy. The modulation of biomarkers under the influence of this therapy can show its effectiveness for this particular subgroup of patients at this stage of the disease. CONCLUSIONS: Methods of extracorporeal blood purification should be aimed at prevailing biological processes, at this stage of pathogenesis, and, accordingly, evaluated by the effectiveness of the impact on these processes.
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