Extracorporeal Blood Purification in Moderate and Severe COVID-19 Patients: A Prospective Cohort Study

  1. Rodney Alexander Rosalia
  2. Petar Ugurov
  3. Dashurie Neziri
  4. Simona Despotovska
  5. Emilija Kostoska
  6. Lidija Veljanovska-Kiridjievska
  7. Dimche Kuzmanov
  8. Aleksandar Trifunovski
  9. Dijana Popevski
  10. Gianluca Villa
  11. Zan Mitrev

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Abstract

<b><i>Introduction:</i></b> Coronavirus disease 2019 (COVID-19) is characterized by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and with critical cases progressing to acute respiratory distress syndrome. Control of hyperinflammation has been proposed as a possible therapeutic avenue for COVID-19; extracorporeal blood purification (EBP) modalities offer an attractive mean to ameliorate maladaptive inflammation. With this work, we evaluated the longitudinal changes of systemic inflammatory markers in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) haemofilter. <b><i>Methods:</i></b> We performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing haemofilter (CAH) according to local practice; we visualize longitudinal results of biochemical, inflammatory, blood gas, and vital sign parameters focussing on systemic levels of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin. <b><i>Results:</i></b> All patients were treated with ≥1 cycle extracorporeal continuous venovenous haemofiltration (CVVH) with CAH; of these, 30 severe patients received CVVH-CAH within 4–12 h of admission after recognizing a hyper-inflammatory state. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and were placed on EBP during hospitalization. The treatment was associated with a reduction of ferritin, CRP, fibrinogen, several inflammatory markers, and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3%. <b><i>Conclusion:</i></b> EBP with CAH was associated with a decrease in CRP, and control of IL-6 and procalcitonin.

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  1. Version published to 10.1159/000515627
  2. ScreenIT

    SciScore for 10.1101/2020.10.10.20210096: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The data were analysed with the statistical programs Graphpad Prism (version 8.43) and Statsdirect (version 3.3.3) Treatment: The general treatment protocol is shown in Figure 2 and follows practice safety recommendations, treatment strategies and up-to-date sepsis management guidelines [18-21].
    Graphpad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Because of the observational design, absence of randomisation and limited cohort size are unable to provide concrete clinical guidance on the optimal EBP strategy to control disease progression and prevent ARDS. Nevertheless, with 3000+ accumulated hours of EBP run-time and real-time data on 44 patients we collected sufficient datapoints to establish biomarker fluctuations over time and evaluate the safety-profile of oXiris® blood purification.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04478539RecruitingExtracorporeal Blood Purification as a Treatment Modality fo…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.10.10.20210096v1 on medRxiv