Inflammatory and Coagulation Marker Changes in PMX-DHP-Treated COVID-19 Patients

Introduction Direct hemoperfusion using polymyxin B-immobilized polystyrene fiber column (PMX-DHP) removes endotoxin and inflammatory mediators from the blood. This study aimed to evaluate the changes in the levels of cytokines, coagulation factors, and a microbiota-derived proapoptotic peptide in COVID-19 patients treated with PMX-DHP. Methods We conducted a multicenter, prospective, single-arm interventional study of 21 oxygen-requiring patients with COVID-19 admitted between September 28, 2020, and March 31, 2022. PaO₂/FiO₂ (P/F) ratio and biomarkers of inflammation, fibrosis, coagulation, and microbiota-derived peptide were analyzed on PMX-DHP treatment days 1, 4, and 15. Results The P/F ratio significantly improved on Day 4 (87.1, 95% CI: 14.8-159.3) and Day 15 (140.6, 95% CI: 56.2-224.9) compared to baseline values. Among the inflammatory cytokines, IL-8 and IL-10 levels significantly decreased on Day 15 (-8.5, 95% CI: -13.4 to -3.5) and Day 4 (-2.3, 95% CI: -5.2 to 0.5) respectively compared to baseline values. Regarding coagulation markers, levels of thrombomodulin increased on Day 4 (1.1, 95% CI: 0.4-1.7) and Day 15 (0.8, 95% CI: 0.3-1.4), and those of tissue plasminogen activator-plasminogen activator-1 significantly decreased on Day 15 (-35.1, 95% CI: -57.6 to -12.6). Microbiota-derived corisin levels significantly decreased on Day 4 (-1740.6, 95% CI: -2860.2 to -621.0) and Day 15 (-1436.7, 95% CI: -2615.8 to -257.6). Conclusion Our study revealed improvement in the P/F ratio and the time course of various biomarkers in COVID-19 patients treated with PMX-DHP.