Hemadsorption as a Treatment Option for Multisystem Inflammatory Syndrome in Children Associated With COVID-19. A Case Report

Ruiz‐Rodríguez, Juan Carlos; Chiscano-Camón, Luis; Palmada, Clara; Ruiz‐Sanmartin, Adolf; García-de-Acilu, Marina; Plata-Menchaca, Erika P.; Perurena-Prieto, Janire; Hernández‐González, Manuel; Pérez-Carrasco, Marcos; Soler‐Palacín, Pere; Ferrer, Ricard

doi:10.3389/fimmu.2021.665824

Cited by 4 publications

(6 citation statements)

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“… 12 Ruiz Rodriguez et al recently also reported the use of hemadsorption as part of the supportive treatment in a 17-year old boy with severe MIS-C (described as patient C in Table 1 ). 13 Including our present case (described as patient A in Table 1 ), these three patients all developed shock secondary to severe myocardial dysfunction requiring inotropic support and IMV ( Table 1 ).…”

Section: Discussionmentioning

confidence: 83%

“… Lower section: biomarkers of inflammation before and after blood purification (Cytosorb plus CKRT) and clinical outcomes in clinical case reported (Patient A) and in the other two pediatric clinical cases previous reported by authors (Patient B and Patient C). 12 , 13 IMV: invasive mechanical ventilation; CKRT: continuous kidney replacement therapy; Igev, Immunoglobulines endovenous; CRP, C reactive protein; NT-proBNP, N-terminal (NT)-pro hormone BNP; Hs-TnI, High Sensivity Troponin I; EF%, percentage of ejection fraction. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hemoadsorption for severe MIS-C in critically ill children, should we consider it as a therapeutic opportunity?

et al. 2022

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Multisystem inflammatory syndrome (MIS-C) is a new severe clinical condition that has emerged during the COVID-19 pandemic. MIS-C affects children and the young usually after a mild or asymptomatic COVID-19 infection. MIS-C has a high tropism for the cardiovascular system with need for inotropes and vasopressor support in 62% of cases. As of today a mortality from 1.5% to 1.9% related to MIS-C is reported. Hemoadsorption via the inflammatory mediator adsorber CytoSorb (CytoSorbents Europe, Berlin Germany) has been used as adjunctive therapy with the aim to restore the host response in septic shock and other hyper-inflammatory syndromes. We present the clinical experience of an adolescent boy with a refractory shock secondary to left ventricular dysfunction (LVD) in the context of MIS-C, treated with hemoadsorption, and continuous kidney replacement therapy (CKRT) in combination with immunomodulatory therapies. The therapeutic strategy resulted in hemodynamic and clinical stabilization as well as control of the hyperinflammatory response. Treatment appeared to be safe and feasible. Our findings are in line with previously published clinical cases on Cytosorb use in MIS-C showing the beneficial role of the hemoperfusion with Cytosorb in severe MIS-C to manage the cytokine storm. We provide an analysis and comparison of recent evidence on the use of hemoadsorption as an adjuvant therapy in critically ill children with severe forms of MIS-C, suggesting this blood purification strategy could be a therapeutic opportunity in severe LVD due to MIS-C, sparing the need for extracorporeal membrane oxygentation (ECMO) and other mechanical cardiocirculatory supports.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Hemoadsorption for severe MIS-C in critically ill children, should we consider it as a therapeutic opportunity?

et al. 2022

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“…In the case of a 14‐year‐old MIS‐C patient, it is reported that hemoadsorption with Cytosorb filter achieved a safe and rapid reduction of cytokine levels and improvement in multiorgan dysfunction parameters 36 . The authors suggested that hemoadsorption with Cytosorb filter provided a safe and rapid reduction of cytokine levels in another case report of a 17‐year‐old male patient with a diagnosis of acute myocarditis secondary to MIS‐C 37 . In this study, we observed a significant clinical and laboratory improvement by charcoal hemoperfusion in our MIS‐C patients who had a severe clinical course and multi‐organ failure.…”

Section: Discussionmentioning

confidence: 99%

Can charcoal hemoperfusion treatment be an option for pediatric MIS‐C patients? A single‐center experience in a tertiary pediatric intensive care unit

Varol¹,

Şahin²,

Cengiz³

et al. 2022

J of Clinical Apheresis

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Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a hyper-inflammatory disorder that develops following SARS-CoV-2 infection and has clinical signs that overlap with Kawasaki disease. Immunomodulatory treatments can be used in these patients. One of the alternative treatments reported in the literature is hemoperfusion therapy. In this study, we aim to evaluate our experience of charcoal hemoperfusion therapy in children admitted and followed up with a diagnosis of MIS-C at our Pediatric Intensive Care Unit (PICU). Material and Methods: We performed a retrospective evaluation of children diagnosed with MIS-C and children treated with charcoal hemoperfusion who are admitted to our PICU. Results: Among 49 MIS-C patients, hemoperfusion therapy was performed on 14 patients. Duration of hospitalization, duration of invasive/non-invasive ventilation, VIS, OFI, PR _ ISM 3 scores, and mortality rates were significantly higher in the charcoal hemoperfusion group before treatment. In patients who did not respond to conventional therapies, we observed a statistically significant decrease in the need for inotrope and invasive mechanical ventilation support and statistically significant improvements in clinical indicators after hemoperfusion therapy.Discussion: In our study, we observed a significant clinical and laboratory improvement by charcoal hemoperfusion in our MIS-C patients who had a severe clinical course and multiple organ failure. Conclusion:In our opinion, this study is the first report regarding the use of charcoal hemoperfusion therapy in MIS-C patients, and the choice of charcoal hemoperfusion as an initial or rescue therapy is needed to be investigated in large patient groups both in children and adults who are diagnosed with COVID-19 and MIS-C.

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“…Another potential application of cytokine hemoadsorption is the adjunctive therapy in pediatric patients with multiorgan dysfunction due to multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. In a previous report [ 68 ], rapid improvements in shock and multiorgan dysfunction parameters were achieved, and cytokine levels (IL-6 and IL-10) decreased considerably. C-reactive protein, soluble CD25 [sCD25], and ferritin levels decreased following the attenuation of hyperinflammation.…”

Section: Introductionmentioning

confidence: 93%

Blood purification in sepsis and COVID-19: what´s new in cytokine and endotoxin hemoadsorption

Ruiz‐Rodríguez

Plata-Menchaca

Chiscano-Camón

et al. 2022

J Anesth Analg Crit Care

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Sepsis and COVID-19 are two clinical conditions that can lead to a dysregulated inflammatory state causing multiorgan dysfunction, hypercytokinemia, and a high risk of death. Specific subgroups of critically ill patients with particular characteristics could benefit from rescue treatment with hemoadsorption. There is a lack of adequately designed randomized controlled trials evaluating the potential benefits of cytokine or endotoxin hemoadsorption. Critically ill COVID-19 patients with severe acute respiratory failure poorly responsive to conventional treatment could be candidates to receive cytokine hemoadsorption in the presence of high levels of interleukin 6. This treatment can also be suitable for patients with refractory septic shock and hypercytokinemia. In the context of high endotoxin activity, hemoadsorption with polymyxin B could improve clinical parameters and the prognosis of patients with refractory septic shock. Predictive enrichment, using biomarkers or other individual features, identifies potential responders to cytokine, endotoxin, or sequential hemoadsorption. Besides, recognizing the particular subsets of patients likely to respond to one or both types of hemoadsorption will aid the design of future studies that accurately validate the effectiveness of these therapies.

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Hemadsorption as a Treatment Option for Multisystem Inflammatory Syndrome in Children Associated With COVID-19. A Case Report

Abstract: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is characterized by hypercytokinemia leading to overwhelming inflammation. We describe the use of a hemadsorption device as part of the supportive treatment for cytokine storm.

Cited by 4 publications

References 22 publications

Hemoadsorption for severe MIS-C in critically ill children, should we consider it as a therapeutic opportunity?

Hemoadsorption for severe MIS-C in critically ill children, should we consider it as a therapeutic opportunity?

Can charcoal hemoperfusion treatment be an option for pediatric MIS‐C patients? A single‐center experience in a tertiary pediatric intensive care unit

Blood purification in sepsis and COVID-19: what´s new in cytokine and endotoxin hemoadsorption

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