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Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019
Masoumeh Asgharpour1, Hamed Mehdinezhad1, Masoumeh Bayani2
1Department of Internal Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
Insights
Hemoperfusion, a blood purification technique, improved oxygen saturation and reduced inflammatory markers in critically ill COVID-19 patients. Further large-scale trials are needed to confirm its efficacy in treating severe coronavirus disease.
Area of Science:
- Critical Care Medicine
- Nephrology
- Infectious Diseases
Background:
- Extracorporeal blood purification is explored for treating coronavirus infection due to its anti-inflammatory cytokine effects.
- Critically ill COVID-19 patients often experience severe inflammation and organ dysfunction.
Purpose of the Study:
- To evaluate the efficacy of resin-directed hemoperfusion in critically ill COVID-19 patients.
- To assess the impact of hemoperfusion on oxygen saturation and inflammatory markers.
Main Methods:
- A controlled trial involving critically ill COVID-19 patients who did not respond to standard treatments.
- Three sessions of resin-directed hemoperfusion using continuous venovenous hemofiltration (CVVH).
Main Results:
- Six out of ten patients showed clinical improvement after hemoperfusion.
- Mean SpO2 increased significantly from 89.60% to 92.13% (p < 0.001).
- Serum IL-6 and C-reactive protein levels decreased post-intervention (p=0.073 and p=0.016, respectively).
Conclusions:
- Extracorporeal hemoadsorption may improve the condition of severe COVID-19 patients.
- Larger prospective multicenter trials are necessary to definitively establish hemoperfusion efficacy in COVID-19.
Background:
Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines.
Methods:
This controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH).
Results:
Five men and five women with a mean age of 57.30 ± 18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60% ± 3.94% and increased to 92.13% ± 3.28% after them (p < 0.001). Serum IL-6 showed a reduction from 139.70 ± 105.62 to 72.06 ± 65.87 pg/mL (p = 0.073); and c-reactive protein decreased from 136.25 ± 84.39 to 78.25 ± 38.67 mg/L (P = 0.016).
Conclusions:
Extracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients.
Trial Registration:
The research protocol has been registered in the website of Iranian Registry of Clinical Trials with the reference number IRCT20150704023055N2 .
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