Successful treatment with plasma exchange followed by intravenous immunoglobulin in a critically ill patient with COVID-19

Shi, Hua; Zhou, Chaomin; He, Pinghong; Huang, Sheng; Duan, Youjun; Wang, Xuesheng; Lin, Kexiong; Zhou, Chao; Zhang, Xiangyan; Zha, Yan

doi:10.1016/j.ijantimicag.2020.105974

Cited by 108 publications

(132 citation statements)

References 8 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…These main results are in line with case reports describing recovery of deteriorating severely ill patients suffering from COVID-19 after initiation of IVIG treatment [7][8][9][10][11] and a small prospective open-label randomized clinical trial in the US showing in a patient subgroup with an alveolar-arterial gradient of >200 mm Hg at enrollment a lower rate of progression to mechanical ventilation requirement, shorter hospital and ICU stay and greater improvement in PaO2/FiO2 at 7 days when treated with the combination of IVIG and SOC than with SOC alone [16]. Our study also con rmed results of two retrospective cohort studies in China [12,13], one of which demonstrated IVIG to signi cantly reduce 28day mortality, to decrease in ammatory response, and to improve some organ functions in a subgroup of 103 critically ill patients only.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Esen¹,

Özcan²,

Orhun³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: There is some evidence from case reports and a few studies in China that critically ill COVID-19 patients may benefit from treatment with intravenous immunoglobulins (IVIG). We compared clinical outcomes and biomarkers in a Turkish cohort of patients with severe COVID-19 who were treated with the institution's standard of care (SOC), either alone or in combination with IVIG.Methods: Data from COVID-19 patients treated in two intensive care units at the University hospital of Istanbul was analyzed retrospectively. Patients received preliminary SOC according to the institution's treatment algorithm, to which Octagam 5% at 30 g/day for 5 days was added in one of the two wards. Both groups were compared regarding baseline characteristics, survival, and changes in inflammation markers (C-reactive protein=CRP, ferritin, procalcitonin, interleukin-6, D‑dimer, leukocytes). Imbalance in baseline APACHE II scores was addressed by propensity-score-matching; otherwise Kaplan-Meier and multiple logistic regression models were used.Results: Data from 93 patients was analyzed, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index (BMI) and blood group distribution. IVIG-treated patients were younger (means 65 vs. 71 years) and had slightly lower baseline disease scores (APACHE II: 20.6 vs. 22.4; SOFA: 5.0 vs. 7.0). Overall survival (OS) was 61% in the IVIG and 38% in the control group. After controlling for imbalances at baseline, there was still a trend for better OS (OR: 2.2, 95%CI: 0.9-5.4, p=0.091) and a significantly longer median survival time with IVIG (68 vs. 18 days, p=0.014). IVIG significantly reduced CRP levels, but had no relevant effect on other inflammation markers.Conclusion: Adjunct treatment with IVIG might add to the COVID-19 armamentarium, but results need to be confirmed in a randomized, controlled trial.

show abstract

Section: Discussionsupporting

confidence: 90%

“…Recently, two marketed IVIG products were shown to react with SARS-CoV 2 antigens in vitro [6]. In line with all this, there have been case reports of COVID-19 patients who bene ted from IVIG treatment [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 83%

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Esen¹,

Özcan²,

Orhun³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…COVID-19 has been reported to arise from an in ammatory cytokine storm due to SARS-CoV-2 infection; therefore, suppression of the cytokine storm is a key approach for the treatment of patients with COVID-19. Extracorporeal treatment approaches have been used to remove in ammatory cytokines in patients with septic shock and ARDS, whereas several studies have reported the e cacy of PE, PMX-DHP and CHDF in patients with COVID-19 [10]. In the present case, three extracorporeal treatment approaches were utilised.…”

Section: Discussionmentioning

confidence: 94%

Continuous extracorporeal treatments in a dialysis patient with COVID-19

Nihei

Nagasawa

Fukao

et al. 2020

Preprint

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. Herein, we report our experience with a 66-year-old male patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome (ARDS) repeatedly and subacute cerebral infarction and finally died for respiratory failure on day 30 after admission, these attempts appeared to dampen the cytokine storm based on the observed decline in serum IL-6 levels and were effective against ARDS and secondary haemophagocytic lymphohistiocytosis. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critically ill patients with COVID-19.

show abstract

“…COVID-19 has been reported to arise from an in ammatory cytokine storm due to SARS-CoV-2 infection; therefore, suppression of the cytokine storm is a key approach for the treatment of patients with COVID-19. Extracorporeal treatment approaches have been used to remove in ammatory cytokines in patients with septic shock and ARDS, whereas several studies have reported the e cacy of PE, PMX-DHP and CHDF in patients with COVID-19 [8]. In the present case, three extracorporeal treatment approaches were utilised.…”

Section: Discussionmentioning

confidence: 94%

Continuous extracorporeal treatments in a dialysis patient with COVID-19

Nihei

Nagasawa

Fukao

et al. 2020

Preprint

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. We herein report our experience with a 66-year-old male patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome (ARDS) repeatedly and subacute cerebral infarction and finally died for respiratory failure on day 30 after admission, these attempts appeared to somewhat dampen the cytokine storm based on the observed decline in serum IL-6 levels and were effective against ARDS and secondary haemophagocytic lymphohistiocytosis. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critical ill patients with COVID-19.

show abstract

Successful treatment with plasma exchange followed by intravenous immunoglobulin in a critically ill patient with COVID-19

Cited by 108 publications

References 8 publications

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Continuous extracorporeal treatments in a dialysis patient with COVID-19

Continuous extracorporeal treatments in a dialysis patient with COVID-19

Contact Info

Product

Resources

About