Extracorporeal Blood Purification in Moderate and Severe COVID-19 Patients: A Prospective Cohort Study

Abstract

<b><i>Introduction:</i></b> Coronavirus disease 2019 (COVID-19) is characterized by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and with critical cases progressing to acute respiratory distress syndrome. Control of hyperinflammation has been proposed as a possible therapeutic avenue for COVID-19; extracorporeal blood purification (EBP) modalities offer an attractive mean to ameliorate maladaptive inflammation. With this work, we evaluated the longitudinal changes of systemic inflammatory markers in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) haemofilter. <b><i>Methods:</i></b> We performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing haemofilter (CAH) according to local practice; we visualize longitudinal results of biochemical, inflammatory, blood gas, and vital sign parameters focussing on systemic levels of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin. <b><i>Results:</i></b> All patients were treated with ≥1 cycle extracorporeal continuous venovenous haemofiltration (CVVH) with CAH; of these, 30 severe patients received CVVH-CAH within 4–12 h of admission after recognizing a hyper-inflammatory state. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and were placed on EBP during hospitalization. The treatment was associated with a reduction of ferritin, CRP, fibrinogen, several inflammatory markers, and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3%. <b><i>Conclusion:</i></b> EBP with CAH was associated with a decrease in CRP, and control of IL-6 and procalcitonin.

Blood Purification in Severe and Critical COVID-19 Patients: A Case Series of 5 Patients

“…With the aid of blood purification, the excess fluid could be efficiently eliminated to achieve negative volume balance. Consistently, current studies have also indicated the application of the absorbing filter Oxiris in moderate or severe or critically-ill COVID-19 patients with acute respiratory distress syndrome (ARDS), CSS or secondary infections (26)(27)(28)(29).…”

Use of extracorporeal blood purification therapy (ECBPT) as an adjuvant to high-dose corticosteroids in a severely ill COVID-19 patient with concomitant bacterial infection

“…However, there is still insufficient evidence on the optimum timing and indication for initiation of CRRT with oXiris filter in order to achieve the best outcome. 8 Furthermore, the high cost of CRRT with such filters and its limited availability may limit its usage. In addition, the need for insertion of haemodialysis catheters into central veins prior to commencement of CRRT, carry the risks of pneumothorax, bleeding and catheter-related sepsis.…”

Continuous Renal Replacement Therapy in the Critically Ill Patient: From Garage Technology to Artificial Intelligence

“…Other sorbents, assembled in special filters or cartridges, are currently used for the treatment of sepsis (oXiris, CytoSorb, etc. ), although robust evidence in this field is still lacking for most long-term outcomes (e.g., 90-day mortality rate) [ 43 , 44 ].…”