Evaluation of the Role of Hemoperfusion on Mortality and Morbidity in Patients with Severe Coronavirus Disease 2019 (COVID- 19)
-
Atabak Najafi
,
Arezoo Ahmadi
,
Mojtaba Mojtahed-Zadeh
,
Nasim Zarrin
,
Reza Shariat Moharrari
,
Mohammad Reza Khajavi
,
Farhad Etezadi
,
Pejman Pourfakhr
,
Mohammad Reza Neishaboury
Abstract
Background: Cytokine storm in severe Covid-19 disease is one of the leading causes of death in these patients. Hemoperfusion is a method used to purify the blood from toxins and inflammatory factors. The aim of this study was to evaluate the effect of hemoperfusion on mortality and morbidity in patients with severe Covid - 19 disease.
Methods: This was a retrospective study which performed by reviewing the files of 30 patients with severe Covid-19 disease referred to Sina Hospital affiliated to Tehran University of Medical Sciences in 2020. Thirty patients with severe covid-19 disease and positive PCR participated in the study. All patients received routine treatment protocol for covid-19. Hemoperfusion was used for 15 patients in addition to receiving routine care. The remaining 15 patients were included in the control group. Patients in the hemoperfusion group underwent four sessions of hemoperfusion using continuous renal replacement therapy with continuous venovenous hemofiltration.
Results: the ICU length of stay in the control and hemoperfusion groups was 3.40 ± 11.40 and 9.65 ± 16.33 days, respectively (P= 0.075). 8 patients died and 7 patients were discharged in the control group, but 11 patients died and 4 patients were discharged in the hemoperfusion group (P= 0.256). The respiratory rate of patients in the control and hemoperfusion groups decreased from 7.43 ± 29.40 to 4.03 ± 24.60 and from 6.11 ± 31.60 to 5.04 ± 24.46, respectively (P < 0.001). The percentage of arterial blood oxygen saturation in the control and hemoperfusion groups increased from 90.86 ± 5.61 to 93.06 30 4.30 and from 92.33 26 3.26 to 92.06 31 5.31, respectively (P= 0.456).
Conclusion: Hemoperfusion could not prevent the mortality of patients and finally out of 15 patients, 11 patients died and 4 patients were discharged. Also, no significant difference was observed between the two groups in terms of arterial blood oxygen saturation.
[1] Siddell SG, Ziebuhr J, Snijder E. Coronaviruses, toroviruses, and arteriviruses. Topley & Wilson's Microbiology and Microbial Infections. 2010.
[2] Weiss SR, Navas-Martin S. Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Microbiol Mol Biol Rev. 2005; 69(4):635-64.
[3] Rota PA. Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science. 2003; 300(5624):1394-9.
[4] van Boheemen S. Genomic characterization of a newly discovered coronavirus associated with acute respiratory distress syndrome in humans. MBio. 2012; 3(6):473-12.
[5] Peiris J, Guan Y, Yuen K. Severe acute respiratory syndrome. Nature medicine. 2004;10(12):S88-S97.
[6] Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012; 367(19):1814-20.
[7] Kong SL. Elucidating the molecular physiopathology of acute respiratory distress syndrome in severe acute respiratory syndrome patients. Virus research. 2009; 145(2):260-9.
[8] Baas T. SARS-CoV virus-host interactions and comparative etiologies of acute respiratory distress syndrome as determined by transcriptional and cytokine profiling of formalin-fixed paraffin-embedded tissues. J Interferon Cytokine Res. 2006; 26(5):309-17.
[9] Wong C. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol. 2004;136(1):95-103.
[10] Chen J. Cellular immune responses to severe acute respiratory syndrome coronavirus (SARS-CoV) infection in senescent BALB/c mice: CD4+ T cells are important in control of SARS-CoV infection. J Virol. 2010; 84(3):1289-301.
[11] Belz GT. Distinct migrating and nonmigrating dendritic cell populations are involved in MHC class I-restricted antigen presentation after lung infection with virus. Proc Natl Acad Sci U S A. 2004; 101(23):8670-5.
[12] Norbury CC. Visualizing priming of virus-specific CD8+ T cells by infected dendritic cells in vivo. Nat Immunol. 2002; 3(3):265-71.
[13] Wherry EJ, Ahmed R. Memory CD8 T-cell differentiation during viral infection. J Virol. 2004; 78(11):5535-45.
[14] Saha B. Gene modulation and immunoregulatory roles of Interferonγ. Cytokine. 2010; 50(1):1-14.
[15] Cerwenka A, Morgan TM, Dutton RW. Naive, effector, and memory CD8 T cells in protection against pulmonary influenza virus infection: homing properties rather than initial frequencies are crucial. J Immunol. 1999; 163(10):5535-43.
[16] Li T. Significant changes of peripheral T lymphocyte subsets in patients with severe acute respiratory syndrome. J Infect Dis. 2004; 189(4):648-51.
[17] Wong RS. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. Bmj. 2003; 326(7403):1358-62.
[18] Cai C. Study on T cell subsets and their activated molecules from the convalescent SARS patients during two follow-up surveys. Xi bao yu fen zi mian yi xue za zhi= Chinese journal of cellular and molecular immunology. 2004; 20(3):322-4.
[19] Yu XY, Zhang YC, Han CW, Wang P, Xue XJ, Cong YL. [Change of T lymphocyte and its activated subsets in SARS patients]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003; 25(5):542-6.
[20] Cameron MJ, Ran L, Xu L, Danesh A, Bermejo-Martin JF, Cameron CM, et al. Interferon-mediated immunopathological events are associated with atypical innate and adaptive immune responses in patients with severe acute respiratory syndrome. J Virol. 2007; 81(16):8692-706.
[21] Lu H, Zhao Y, Zhang J, Wang Y, Li W, Zhu X, et al. Date of origin of the SARS coronavirus strains. BMC Infect Dis. 2004; 4(1):3.
[22] Vega VB. Mutational dynamics of the SARS coronavirus in cell culture and human populations isolated in 2003. BMC Infect Dis. 2004; 4(1):32.
[23] Spruth M. A double-inactivated whole virus candidate SARS coronavirus vaccine stimulates neutralising and protective antibody responses. Vaccine. 2006; 24(5):652-61.
[24] Chu Y-K. The SARS-CoV ferret model in an infection–challenge study. Virology. 2008; 374(1):151-63.
[25] Martin JE. A SARS DNA vaccine induces neutralizing antibody and cellular immune responses in healthy adults in a Phase I clinical trial. Vaccine. 2008; 26(50):6338-43.
[26] Nicholls JM. Lung pathology of fatal severe acute respiratory syndrome. The Lancet. 2003; 361(9371):1773-8.
[27] Prompetchara E, Ketloy C, Palaga T. Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pacific J allergy Immunol. 2020; 38(1):1-9.
[28] Schadler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial. PLoS One. 2017;12(10):e0187015.
[29] Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clin Immunol. 2020; 214:108408.
[30] Monard C, Rimmelé T, Ronco C. Extracorporeal Blood Purification Therapies for Sepsis. Blood Purif. 2019;47 Suppl 3:1-14.
[31] Naicker S, Yang C-W, Hwang S-J, Liu B-C, Chen J-H, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney International. 2020; 97(5):824-8.
[32] Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nature Reviews Nephrology. 2020;16(6):308-10.
[33] Honoré PM, De Bels D, Barreto Gutierrez L, Spapen HD. Hemoadsorption therapy in the critically ill: solid base but clinical haze. Annals of Intensive Care. 2019; 9(1):22.
[34] Harm S, Schildböck C, Hartmann J. Cytokine Removal in Extracorporeal Blood Purification: An in vitro Study. Blood Purif. 2020; 49(1-2):33-43.
[35] Stokes E, Zambrano L, Anderson K, Marder E, Raz K, Felix S, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(24):759-765.
[36] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242.
[37] Soleimani A, Taba SMM, Hasibi Taheri S, Loghman AH, Shayestehpour M. The effect of hemoperfusion on the outcome, clinical and laboratory findings of patients with severe COVID-19: a retrospective study. New Microbes New Infect. 2021; 44:100937.
[38] Schädler D, Porzelius C, Jörres A, Marx G, Meier-Hellmann A, Putensen C, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial. PLoS One. 2017; 12(10):e0187015.
[39] Dastan F, Saffaei A, Mortazavi SM, Jamaati H, Adnani N, Samiee Roudi S, et al. Continues renal replacement therapy (CRRT) with disposable hemoperfusion cartridge: A promising option for severe COVID-19. J Glob Antimicrob Resist. 2020; 21:340-341.
[40] Asgharpour M, Mehdinezhad H, Bayani M, Zavareh MSH, Hamidi SH, Akbari R, et al. Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19). BMC nephrology. 2020; 21(1):1-10.
[41] Shadvar K, Tagizadiyeh A, Gamari AA, Soleimanpour H, Mahmoodpoor A. Hemoperfusion as a Potential Treatment for Critically Ill COVID-19 Patients with Cytokine Storm. Blood Purif. 2021; 50(3):405-407.
[2] Weiss SR, Navas-Martin S. Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Microbiol Mol Biol Rev. 2005; 69(4):635-64.
[3] Rota PA. Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science. 2003; 300(5624):1394-9.
[4] van Boheemen S. Genomic characterization of a newly discovered coronavirus associated with acute respiratory distress syndrome in humans. MBio. 2012; 3(6):473-12.
[5] Peiris J, Guan Y, Yuen K. Severe acute respiratory syndrome. Nature medicine. 2004;10(12):S88-S97.
[6] Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012; 367(19):1814-20.
[7] Kong SL. Elucidating the molecular physiopathology of acute respiratory distress syndrome in severe acute respiratory syndrome patients. Virus research. 2009; 145(2):260-9.
[8] Baas T. SARS-CoV virus-host interactions and comparative etiologies of acute respiratory distress syndrome as determined by transcriptional and cytokine profiling of formalin-fixed paraffin-embedded tissues. J Interferon Cytokine Res. 2006; 26(5):309-17.
[9] Wong C. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol. 2004;136(1):95-103.
[10] Chen J. Cellular immune responses to severe acute respiratory syndrome coronavirus (SARS-CoV) infection in senescent BALB/c mice: CD4+ T cells are important in control of SARS-CoV infection. J Virol. 2010; 84(3):1289-301.
[11] Belz GT. Distinct migrating and nonmigrating dendritic cell populations are involved in MHC class I-restricted antigen presentation after lung infection with virus. Proc Natl Acad Sci U S A. 2004; 101(23):8670-5.
[12] Norbury CC. Visualizing priming of virus-specific CD8+ T cells by infected dendritic cells in vivo. Nat Immunol. 2002; 3(3):265-71.
[13] Wherry EJ, Ahmed R. Memory CD8 T-cell differentiation during viral infection. J Virol. 2004; 78(11):5535-45.
[14] Saha B. Gene modulation and immunoregulatory roles of Interferonγ. Cytokine. 2010; 50(1):1-14.
[15] Cerwenka A, Morgan TM, Dutton RW. Naive, effector, and memory CD8 T cells in protection against pulmonary influenza virus infection: homing properties rather than initial frequencies are crucial. J Immunol. 1999; 163(10):5535-43.
[16] Li T. Significant changes of peripheral T lymphocyte subsets in patients with severe acute respiratory syndrome. J Infect Dis. 2004; 189(4):648-51.
[17] Wong RS. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. Bmj. 2003; 326(7403):1358-62.
[18] Cai C. Study on T cell subsets and their activated molecules from the convalescent SARS patients during two follow-up surveys. Xi bao yu fen zi mian yi xue za zhi= Chinese journal of cellular and molecular immunology. 2004; 20(3):322-4.
[19] Yu XY, Zhang YC, Han CW, Wang P, Xue XJ, Cong YL. [Change of T lymphocyte and its activated subsets in SARS patients]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003; 25(5):542-6.
[20] Cameron MJ, Ran L, Xu L, Danesh A, Bermejo-Martin JF, Cameron CM, et al. Interferon-mediated immunopathological events are associated with atypical innate and adaptive immune responses in patients with severe acute respiratory syndrome. J Virol. 2007; 81(16):8692-706.
[21] Lu H, Zhao Y, Zhang J, Wang Y, Li W, Zhu X, et al. Date of origin of the SARS coronavirus strains. BMC Infect Dis. 2004; 4(1):3.
[22] Vega VB. Mutational dynamics of the SARS coronavirus in cell culture and human populations isolated in 2003. BMC Infect Dis. 2004; 4(1):32.
[23] Spruth M. A double-inactivated whole virus candidate SARS coronavirus vaccine stimulates neutralising and protective antibody responses. Vaccine. 2006; 24(5):652-61.
[24] Chu Y-K. The SARS-CoV ferret model in an infection–challenge study. Virology. 2008; 374(1):151-63.
[25] Martin JE. A SARS DNA vaccine induces neutralizing antibody and cellular immune responses in healthy adults in a Phase I clinical trial. Vaccine. 2008; 26(50):6338-43.
[26] Nicholls JM. Lung pathology of fatal severe acute respiratory syndrome. The Lancet. 2003; 361(9371):1773-8.
[27] Prompetchara E, Ketloy C, Palaga T. Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pacific J allergy Immunol. 2020; 38(1):1-9.
[28] Schadler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial. PLoS One. 2017;12(10):e0187015.
[29] Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clin Immunol. 2020; 214:108408.
[30] Monard C, Rimmelé T, Ronco C. Extracorporeal Blood Purification Therapies for Sepsis. Blood Purif. 2019;47 Suppl 3:1-14.
[31] Naicker S, Yang C-W, Hwang S-J, Liu B-C, Chen J-H, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney International. 2020; 97(5):824-8.
[32] Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nature Reviews Nephrology. 2020;16(6):308-10.
[33] Honoré PM, De Bels D, Barreto Gutierrez L, Spapen HD. Hemoadsorption therapy in the critically ill: solid base but clinical haze. Annals of Intensive Care. 2019; 9(1):22.
[34] Harm S, Schildböck C, Hartmann J. Cytokine Removal in Extracorporeal Blood Purification: An in vitro Study. Blood Purif. 2020; 49(1-2):33-43.
[35] Stokes E, Zambrano L, Anderson K, Marder E, Raz K, Felix S, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(24):759-765.
[36] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242.
[37] Soleimani A, Taba SMM, Hasibi Taheri S, Loghman AH, Shayestehpour M. The effect of hemoperfusion on the outcome, clinical and laboratory findings of patients with severe COVID-19: a retrospective study. New Microbes New Infect. 2021; 44:100937.
[38] Schädler D, Porzelius C, Jörres A, Marx G, Meier-Hellmann A, Putensen C, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial. PLoS One. 2017; 12(10):e0187015.
[39] Dastan F, Saffaei A, Mortazavi SM, Jamaati H, Adnani N, Samiee Roudi S, et al. Continues renal replacement therapy (CRRT) with disposable hemoperfusion cartridge: A promising option for severe COVID-19. J Glob Antimicrob Resist. 2020; 21:340-341.
[40] Asgharpour M, Mehdinezhad H, Bayani M, Zavareh MSH, Hamidi SH, Akbari R, et al. Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19). BMC nephrology. 2020; 21(1):1-10.
[41] Shadvar K, Tagizadiyeh A, Gamari AA, Soleimanpour H, Mahmoodpoor A. Hemoperfusion as a Potential Treatment for Critically Ill COVID-19 Patients with Cytokine Storm. Blood Purif. 2021; 50(3):405-407.
| Files | ||
| Issue | Vol 9 No 3 (2023): Summer |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i3.13120 | |
| Keywords | ||
| Severe Covid-19 disease Hemoperfusion Mortality & Morbidity | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Najafi A, Ahmadi A, Mojtahed-Zadeh M, Zarrin N, Shariat Moharrari R, Khajavi MR, Etezadi F, Pourfakhr P, Neishaboury MR. Evaluation of the Role of Hemoperfusion on Mortality and Morbidity in Patients with Severe Coronavirus Disease 2019 (COVID- 19). Arch Anesth & Crit Care. 2023;9(3):238-245.
