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Published on: July 31, 2016
Efficacy of additional hemoperfusion in hospitalized patients with severe to critical COVID-19 disease
Supattra Chiewroongroj1, Ranistha Ratanarat2, Thummaporn Naorungroj1
1Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Insights
Additional hemoperfusion (HP) using cytokine adsorbents did not reduce hospital mortality in severe COVID-19 patients. However, this treatment shortened ICU stays and reduced mechanical ventilation days, sepsis, and DIC.
Area of Science:
- Critical care medicine
- Infectious diseases
- Renal replacement therapy
Background:
- Severe to critical coronavirus disease 2019 (COVID-19) is associated with high mortality and morbidity.
- Cytokine storm plays a significant role in the pathophysiology of severe COVID-19.
- The efficacy of hemoperfusion (HP) with cytokine adsorbents in improving outcomes for these patients is not well-established.
Purpose of the Study:
- To evaluate the impact of additional hemoperfusion (HP) with cytokine adsorbents on clinical outcomes in severe to critical COVID-19 patients.
- To compare hospital mortality, ICU length of stay, and duration of mechanical ventilation between patients receiving HP and standard medical treatment (SMT).
- To assess the incidence of pulmonary complications, sepsis, and disseminated intravascular coagulopathy (DIC) in both groups.
Main Methods:
- A retrospective matched-cohort study comparing 45 severe to critical COVID-19 patients who received additional HP with cytokine adsorbents to 45 matched controls receiving SMT.
- Matching was based on key clinical parameters.
- Primary outcome was hospital mortality; secondary outcomes included ICU stay, mechanical ventilation duration, and incidence of specific complications.
Main Results:
- Hospital mortality rates were similar between the HP group (33%) and the SMT group (38%) (p=0.83).
- The HP group experienced significantly shorter ICU stays (22 vs 32 days; p=0.017) and reduced mechanical ventilation duration (15 vs 35 days; p<0.001).
- Incidences of pulmonary complications (20% vs 42%; p=0.04), sepsis (38% vs 64%; p=0.02), and DIC (13% vs 33%; p=0.046) were significantly lower in the HP group.
Conclusions:
- Additional hemoperfusion with cytokine adsorbents did not improve hospital mortality in severe to critical COVID-19 patients.
- However, HP demonstrated benefits by reducing ICU length of stay, mechanical ventilator days, and the incidence of pulmonary complications, sepsis, and DIC.
- Further research may be warranted to explore the role of HP in managing specific complications of severe COVID-19.
Abstract:
The evidence supporting additional hemoperfusion (HP) with cytokine adsorbents for improving clinical outcomes in severe to critical coronavirus disease 2019 (COVID-19) patients remains limited. We compared severe to critical COVID-19 patients who received additional HP with a cytokine adsorbent to matched cases receiving standard medical treatment (SMT). The primary outcome was hospital mortality. In our study, we matched 45 patients who received additional HP 1:1 with the SMT group based on key clinical parameters. The hospital mortality rates did not differ between the groups (33% vs 38%, p = 0.83). The HP group had a significantly shorter ICU stay (22 vs 32 days; p = 0.017) and reduced mechanical ventilation duration (15 vs 35 days; p < 0.001). Additionally, the incidence of pulmonary complications (20% vs 42%; p = 0.04), sepsis (38% vs 64%; p = 0.02), and disseminated intravascular coagulopathy (DIC) (13% vs 33%; p = 0.046) were significantly lower in the HP group. In conclusion, among severe to critical COVID-19 patients, additional HP with a cytokine adsorbent did not improve hospital mortality. However, it reduced ICU length of stay, mechanical ventilator days, and incidences of lung complications, sepsis, and DIC. Trial registration: TCTR20231002006. Registered 02 October 2023 (retrospectively registered).
