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EFFICACY OF SUPPLEMENTAL HEMOADSORPTION THERAPY ON SEVERE AND CRITICAL PATIENTS WITH COVID-19: AN EVIDENCE-BASED
Junbing He1, Yao Lin1, Weiming Cai1
1Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China.
Insights
Hemoadsorption therapy (HAT) significantly reduces mortality in severe COVID-19 patients by removing cytokines. However, its benefit is not observed in patients requiring extracorporeal membrane oxygenation (ECMO) support.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Biomedical Engineering
Background:
- Severe COVID-19 can cause life-threatening hyperinflammation and tissue damage via a cytokine storm.
- Extracorporeal hemoadsorption therapy (HAT) is explored to mitigate these effects, but its efficacy remains debated.
- Existing research presents conflicting evidence on the benefits of supplemental HAT in severe COVID-19 cases.
Approach:
- A systematic review and meta-analysis of randomized controlled trials and observational studies was conducted.
- Searched Cochrane Library, Embase, and PubMed databases up to August 20, 2022.
- Analyzed data from 648 patients with severe COVID-19 to assess mortality and cytokine levels.
Key Points:
- Supplemental HAT significantly improved mortality rates in severe COVID-19 patients compared to conventional therapy (RR = 0.74).
- HAT demonstrated significant mortality reduction in patients not on ECMO support (RR = 0.59) but not in those requiring ECMO (RR = 1.61).
- HAT effectively removed IL-6 (SMD = 0.46), with trends for C-reactive protein and IL-8 removal.
Conclusions:
- HAT offers clinical benefits for severe COVID-19 patients, primarily through cytokine removal, leading to improved mortality outcomes.
- The use of cytokine adsorption via HAT should be approached with caution in severe COVID-19 patients requiring ECMO.
- Further large-scale, multicenter randomized trials are necessary to validate these findings due to the low quality of existing evidence.
Abstract:
Background: The COVID-19 pandemic has posed a disproportionately high threat to the global health system and social stability. COVID-19 damage can lead to hyperinflammation and tissue damage due to a "cytokine storm," which in turn contributes to an increase in the mortality rate. Extracorporeal hemoadsorption therapy (HAT) in patients with severe COVID-19 may improve organ function and stabilize hemodynamic status; however, the effects of supplemental HAT remain controversial. Methods: The Cochrane Library, Embase, and PubMed databases were comprehensively searched from inception to August 20, 2022, for potential studies. Results: A total of 648 patients with severe COVID-19 in three randomized controlled trials and 11 observational studies met the inclusion criteria. A meta-analysis indicated that supplemental HAT significantly improved the mortality rate of patients with severe COVID-19 compared with conventional therapy (relative risk [RR] = 0.74, 95% confidence interval [CI] = 0.56 to 0.96, P = 0.026). In subgroup analyses, supplemental HAT significantly decreased mortality rates in patients without extracorporeal membrane oxygenation (ECMO) support (RR = 0.59, 95% CI = 0.44-0.79, P < 0.0001), while a significant difference was not observed in patients requiring ECMO support (RR = 1.61, 95% CI = 0.63-4.09, P = 0.316). Standardized mean difference (SMD) meta-analysis showed that IL-6 removal was more significant in HAT group than conventional therapy group (SMD = 0.46, 95% CI = 0.01 to 0.91, P = 0.043), followed by C-reactive protein (SMD = 0.70, 95% CI = -0.04 to 1.44, P = 0.065) and IL-8 (SMD = 0.36, 95% CI = -0.34 to 1.07, P = 0.311). No evidence of substantial publication bias concerning mortality was observed. Conclusion: Given the better mortality outcomes, HAT confers clinical benefits to patients with severe COVID-19, which correlated with cytokine removal by HAT. Cytokine adsorption may not provide clinical benefits for patients with severe COVID-19 requiring ECMO and should be used with caution. However, because of the very low quality of evidence, multicenter randomized trials with large sample sizes are required to verify these findings.
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