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Published on: February 16, 2022
Critical risks of haemoadsorption for COVID-19 patients and directions for future evaluations: a nationwide
Jan Andreas Kloka1, Thomas Jasny1, Oliver Old1
1Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University, University Hospital Frankfurt, Frankfurt, Germany.
Insights
Haemoadsorption therapy for COVID-19 patients showed higher in-hospital mortality and increased risks of coagulopathy and cardiac arrhythmia. This treatment adjunct should be restricted to clinical trials due to potential harm.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Medical Technology
Background:
- Haemoadsorption is explored as an adjunct therapy for critical conditions including sepsis and COVID-19.
- Previous randomized trials yielded inconclusive evidence, with some suggesting risks in COVID-19 patients.
Purpose of the Study:
- To evaluate the efficacy and safety of haemoadsorption therapy in intensive care unit (ICU) patients with COVID-19.
- To assess the impact of haemoadsorption on in-hospital mortality and associated complications.
Main Methods:
- Retrospective observational cohort study using German hospital remuneration data (2020-2021).
- Propensity score matching (1:1) for 2058 COVID-19 ICU patients.
- Regression modeling with spline functions and interaction variables.
Main Results:
- Haemoadsorption was linked to significantly higher in-hospital mortality (74.6% vs. 70.3%, p=0.0299).
- Associated with increased coagulopathy (68.0% vs. 54.9%), cardiac arrhythmia (49.2% vs. 44.2%), and cardiopulmonary resuscitation (19.3% vs. 13.1%).
- Increased mortality risk in non-septic shock patients (OR 1.40) and showed no survival benefit in septic shock patients (OR 1.19).
Conclusions:
- Haemoadsorption therapy in COVID-19 ICU patients demonstrated higher mortality and adverse events.
- Evidence does not support routine clinical use; further investigation in rigorous clinical trials is warranted.
- Therapeutic timing did not influence patient outcomes.
Abstract:
Haemoadsorption has been suggested as treatment adjunct for sepsis and septic shock, cardiac surgery, acute respiratory distress syndrome, and coronavirus disease 2019 (COVID-19). Randomised clinical trials did not provide conclusive evidence for benefits and even suggest risks in COVID-19 patients. Retrospective observational cohort study based on hospital remuneration data from all COVID-19 patients treated in intensive care units in Germany between 01/01/2020 and 12/31/2021. Regression modelling was performed for 1:1 propensity score matching of 2058 patients. Two-sided probability values for group comparisons and regression models with spline functions controlling for non-linear relationships and medically relevant interaction variables were calculated. In-hospital mortality of patients supported with haemoadsorption was significantly higher compared to matched control patients (74.6% vs. 70.3%, p = 0.0299). Haemoadsorption was associated with coagulopathy (68.0% vs. 54.9%, p < 0.0001), cardiac arrhythmia (49.2% vs. 44.2%, p = 0.0272), and cardiopulmonary resuscitation (CPR, 19.3% vs. 13.1%, p = 0.0002). Further, haemoadsorption increased the chance of death for COVID-19 patients without septic shock (odds ratio, OR [within a 95% confidence interval, CI]; 1.40 [1.05-1.86]) and did not improve survival of septic shock patients (1.19 [0.85-1.67]). Independent variables with a significant impact on mortality included the use of extracorporeal membrane oxygenation (ECMO, 2.15 [1.68-2.76]) and CPR (1.60 [1.03-2.45]). The timing of the haemoadsorption therapy had no effect on patients´ outcomes. Due to inconclusive evidence for benefit and potential harm, haemoadsorption therapy should be limited to thoroughly designed clinical trials before introduced into clinical routine in the context of COVID-19.
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