Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series
Introduction: Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia. In this retrospective study we report data from critically ill patients treated with HA during the first and second wave of the pandemic.Patients and Methods: All pati...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.760435/full |
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| author | Marcell Virág Marcell Virág Marcell Virág Máté Rottler Máté Rottler Máté Rottler Klementina Ocskay Tamás Leiner Tamás Leiner Balázs Horváth Daniel Adam Blanco Alexa Vasquez László Bucsi Ágnes Sárkány Zsolt Molnár Zsolt Molnár Zsolt Molnár Zsolt Molnár Zsolt Molnár |
| author_facet | Marcell Virág Marcell Virág Marcell Virág Máté Rottler Máté Rottler Máté Rottler Klementina Ocskay Tamás Leiner Tamás Leiner Balázs Horváth Daniel Adam Blanco Alexa Vasquez László Bucsi Ágnes Sárkány Zsolt Molnár Zsolt Molnár Zsolt Molnár Zsolt Molnár Zsolt Molnár |
| author_sort | Marcell Virág |
| collection | DOAJ |
| description | Introduction: Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia. In this retrospective study we report data from critically ill patients treated with HA during the first and second wave of the pandemic.Patients and Methods: All patients, who received HA therapy with CytoSorb within the first 96 h of intensive care unit (ICU) admission without hospital-acquired bacterial superinfection, were included. Clinical and laboratory data were collected: on admission, before (TB) and after (TA) HA therapy.Results: Out of the 367 COVID-19 cases, 13 patients were treated with CytoSorb, also requiring mechanical ventilation and renal replacement therapy. All patients were alive at the end of HA, but only 3 survived hospital stay. From TB-TA there was a tendency of decreasing norepinephrine requirement: 193.7 [IQR: 34.8–270.4] to 50.2 [6.5–243.5] ug/kg/day and increasing PaO2/FiO2 ratio 127.8 (95% CI: 96.0–159.6) to 155.0 (115.3–194.6) mmHg but they did not reach statistical significance (p = 0.14 and 0.58, respectively). Treatment related adverse events were not reported.Conclusion: The treatment was well-tolerated, and there was a tendency toward an improvement in vasopressor need and oxygenation during the course of HA. These observations render the need for prospective randomized trials. |
| first_indexed | 2024-12-20T21:19:43Z |
| format | Article |
| id | doaj.art-c91d1d25d4744c428e4340e37efbffa7 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-20T21:19:43Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-c91d1d25d4744c428e4340e37efbffa72022-12-21T19:26:18ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-11-01810.3389/fmed.2021.760435760435Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case SeriesMarcell Virág0Marcell Virág1Marcell Virág2Máté Rottler3Máté Rottler4Máté Rottler5Klementina Ocskay6Tamás Leiner7Tamás Leiner8Balázs Horváth9Daniel Adam Blanco10Alexa Vasquez11László Bucsi12Ágnes Sárkány13Zsolt Molnár14Zsolt Molnár15Zsolt Molnár16Zsolt Molnár17Zsolt Molnár18Medical School, Institute for Translational Medicine, University of Pécs, Pécs, HungaryDepartment of Anesthesiology and Intensive Therapy, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, HungaryDoctoral School of Clinical Medicine, University of Szeged, Szeged, HungaryMedical School, Institute for Translational Medicine, University of Pécs, Pécs, HungaryDepartment of Anesthesiology and Intensive Therapy, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, HungaryDoctoral School of Clinical Medicine, University of Szeged, Szeged, HungaryMedical School, Institute for Translational Medicine, University of Pécs, Pécs, HungaryMedical School, Institute for Translational Medicine, University of Pécs, Pécs, HungaryAnaesthetic Department, Hinchingbrooke Hospital, North West Anglia National Health Service (NHS) Foundation Trust, Huntingdon, United KingdomMedical School, Institute for Translational Medicine, University of Pécs, Pécs, HungaryCytoSorbents Europe, Berlin, GermanyCytoSorbents Europe, Berlin, GermanySzent György University Teaching Hospital of Fejér County, Székesfehérvár, HungaryDepartment of Anesthesiology and Intensive Therapy, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, HungaryMedical School, Institute for Translational Medicine, University of Pécs, Pécs, HungaryDoctoral School of Clinical Medicine, University of Szeged, Szeged, HungaryCytoSorbents Europe, Berlin, GermanyDepartment of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, PolandDepartment of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, HungaryIntroduction: Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia. In this retrospective study we report data from critically ill patients treated with HA during the first and second wave of the pandemic.Patients and Methods: All patients, who received HA therapy with CytoSorb within the first 96 h of intensive care unit (ICU) admission without hospital-acquired bacterial superinfection, were included. Clinical and laboratory data were collected: on admission, before (TB) and after (TA) HA therapy.Results: Out of the 367 COVID-19 cases, 13 patients were treated with CytoSorb, also requiring mechanical ventilation and renal replacement therapy. All patients were alive at the end of HA, but only 3 survived hospital stay. From TB-TA there was a tendency of decreasing norepinephrine requirement: 193.7 [IQR: 34.8–270.4] to 50.2 [6.5–243.5] ug/kg/day and increasing PaO2/FiO2 ratio 127.8 (95% CI: 96.0–159.6) to 155.0 (115.3–194.6) mmHg but they did not reach statistical significance (p = 0.14 and 0.58, respectively). Treatment related adverse events were not reported.Conclusion: The treatment was well-tolerated, and there was a tendency toward an improvement in vasopressor need and oxygenation during the course of HA. These observations render the need for prospective randomized trials.https://www.frontiersin.org/articles/10.3389/fmed.2021.760435/fullARDScytokine stormCRRTCOVID-19hemoadsorptionCytosorb |
| spellingShingle | Marcell Virág Marcell Virág Marcell Virág Máté Rottler Máté Rottler Máté Rottler Klementina Ocskay Tamás Leiner Tamás Leiner Balázs Horváth Daniel Adam Blanco Alexa Vasquez László Bucsi Ágnes Sárkány Zsolt Molnár Zsolt Molnár Zsolt Molnár Zsolt Molnár Zsolt Molnár Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series Frontiers in Medicine ARDS cytokine storm CRRT COVID-19 hemoadsorption Cytosorb |
| title | Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series |
| title_full | Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series |
| title_fullStr | Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series |
| title_full_unstemmed | Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series |
| title_short | Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series |
| title_sort | extracorporeal cytokine removal in critically ill covid 19 patients a case series |
| topic | ARDS cytokine storm CRRT COVID-19 hemoadsorption Cytosorb |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.760435/full |
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