scholarly journals Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Masoumeh Asgharpour ◽  
Hamed Mehdinezhad ◽  
Masoumeh Bayani ◽  
Mahmoud Sadeghi Haddad Zavareh ◽  
Seyed Hossein Hamidi ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Blood Purification ◽  
Medical Sciences ◽  
Therapeutic Approaches ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Beneficial Impact ◽  
Coronavirus Infection

Abstract Background Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. Methods This controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH). Results Five men and five women with a mean age of 57.30±18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60%±3.94% and increased to 92.13%±3.28% after them (p<0.001). Serum IL-6 showed a reduction from 139.70±105.62 to 72.06±65.87 pg/mL (p=0.073); and c-reactive protein increased from 136.25±84.39 to 78.25±38.67 mg/L (P=0.016). Conclusions Extracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients.

scholarly journals Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Masoumeh Asgharpour ◽  
Hamed Mehdinezhad ◽  
Masoumeh Bayani ◽  
Mahmoud Sadeghi Haddad Zavareh ◽  
Seyed Hossein Hamidi ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Blood Purification ◽  
Medical Sciences ◽  
Therapeutic Approaches ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Beneficial Impact ◽  
Coronavirus Infection

Abstract Background Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. Methods This controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH). Results Five men and five women with a mean age of 57.30 ± 18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60%±3.94% and increased to 92.13%±3.28% after them (p < 0.001). Serum IL-6 showed a reduction from 139.70 ± 105.62 to 72.06 ± 65.87 pg/mL (p = 0.073); and c-reactive protein increased from 136.25 ± 84.39 to 78.25 ± 38.67 mg/L (P = 0.016). Conclusions Extracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients.

scholarly journals Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Masoumeh Asgharpour ◽  
Hamed Mehdinezhad ◽  
Masoumeh Bayani ◽  
Mahmoud Sadeghi Haddad Zavareh ◽  
Seyed Hossein Hamidi ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Blood Purification ◽  
Medical Sciences ◽  
Therapeutic Approaches ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Extracorporeal Blood Purification ◽  
Reference Number ◽  
Beneficial Impact ◽  
Coronavirus Infection

Abstract BackgroundExtracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. MethodsThis controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH). ResultsFive men and five women with a mean age of 57.30±18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60%±3.94% and increased to 92.13%±3.28% after them (p<0.001). Serum IL-6 showed a reduction from 139.70±105.62 to 72.06±65.87 pg/mL (p=0.073); and c-reactive protein decreased from 136.25±84.39 to 78.25±38.67 mg/L (P=0.016).ConclusionsExtracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients.Trial registrationThe research protocol has been registered in the website of Iranian Registry of Clinical Trials with the reference number IRCT20150704023055N2.

Đánh giá hiệu quả lọc máu hấp phụ cytokin trong điều trị bệnh nhân covid-19

2022 ◽  
Author(s):  
Nhu Hiep Pham
Keyword(s):  
Ho Chi Minh City ◽  
Intermittent Hemodialysis ◽  
Therapeutic Approaches ◽  
Field Hospital ◽  
Reactive Protein ◽  
Extracorporeal Blood Purification ◽  
Anticoagulant Drugs ◽  
Beneficial Impact ◽  
Coronavirus Infection ◽  
Hemodialysis Machine

TÓM TẮT Đặt vấn đề: Lọc máu hấp phụ được xem là một phương pháp điều trị ở bệnh nhân Covid-19 nặng do có khả năng loại bỏ cytokine viêm. Nghiên cứu này mục đích để đánh giá hiệu quả lọc máu hấp phụ theo phương thức lọc máu ngắt quãng (IHD) ở bệnh nhân Covid-19. Phương pháp nghiên cứu: Nghiên cứu can thiệp, thực hiện trên các bệnh nhân được chẩn đoán viêm phổi do Covid-19 mức độ nặng ở trung tâm hồi sức tích cực bệnh viện dã chiến số 14, thành phố Hồ Chí Minh. Bệnh nhân được điều trị với thuốc kháng virus, kháng sinh, kháng đông và corticoid và liệu pháp oxy và 3 lần lọc máu hấp phụ sử dụng máy lọc máu ngắt quãng. Các chỉ số lâm sàng và xét nghiệm được thu thập và so sánh ở thời điểm trước và sau lọc máu. Kết quả: Có 6 bệnh nhân nam và 4 bệnh nhân nữ ở độ tuổi trung bình 54,60 ± 14,00 điều trị lọc máu hấp phụ, có 7 bệnh nhân cải thiện và cai dần với liệu pháp oxy. Giá trị SpO2 tăng từ 92,00 ± 2,31% đến 94,40 ± 1,71% với p = 0,02. IL - 6 trong máu bệnh nhân giảm từ 110,80 ± 126,84 pg/mL xuống 26,55 ± 26,80 pg/ mL với p = 0,06, CRP giảm từ 139,90 ± 57,41mg/L xuống 56,10 ± 53,10mg/L với p = 0,03. Kết luận: Lọc máu hấp phụ có thể giúp cải thiện SpO2 và hỗ trợ cai liệu pháp oxy ở hầu hết bệnh nhân trong nhóm nghiên cứu. Tuy nhiên, trong tương lai cần có nghiên cứu đa trung tâm, có đối chứng trên nhiều bệnh nhân để có thể đánh giá chắc chắn hiệu quả lọc máu hấp phụ ở bệnh nhân Covid-19. ABSTRACT EFFECTIVENESS OF HEMOPERFUSION IN COID-19 PATIENTS Backgrounds: Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. This study aims to evaluate the effectiveness of hemoperfusion in coid-19 patients. Methods: This experimental research has been conducted on severe COVID-19 pneumonia patients who admitted in field hospital in Ho Chi Minh city, receiving antiviral, antibacterial drugs, anticoagulant drugs and steroid, and different modalities of respiratory treatments. No randomization and blindness were considered. All of the participants underwent three sessions of resin-directed hemoperfusion using intermittent hemodialysis machine. Results: Six men and four women with a mean age of 54.60 ± 14.00 years has been enrolled in the study, and seven of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after cytokine removal therapy. Mean SpO2 before the three session of hemoperfusion was 92.00 ± 2.31% and increased to 94.40 ± 1.71% after them (p = 0.02). Serum IL - 6 showed a reduction from 110.80 ± 126.84 pg/mL to 26.55 ± 26.80 pg/mL p = 0.06; and C-reactive protein decreased from 139.90 ± 57.41mg/L to 56.10 ± 53.10mg/L p = 0.03. Conclusions: Extracorporeal hemoadsorption using intermittent dialyisis machine could improve the general condition in most of recruited patients with severe coronavirus disease, however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients. Keywords: Intermittent dialyisis machine, hemoperfusion, COVID-19 pneumonia.

scholarly journals Extracorporeal Blood Purification in moderate and severe COVID-19 patients: a prospective cohort study

2020 ◽  
Author(s):  
Rodney Alexander Rosalia ◽  
Petar Ugurov ◽  
Dashurie Neziri ◽  
Simona Despotovska ◽  
Emilja Kostoska ◽  
...  
Keyword(s):  
Acute Phase Proteins ◽  
Severe Disease ◽  
Blood Purification ◽  
Blood Gas ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Extracorporeal Blood ◽  
Variation Of Parameters ◽  
Extracorporeal Blood Purification ◽  
Therapeutic Avenue

AbstractIntroductionCOVID-19 is characterised by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and critical cases progressing to ARDS. 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 describe the longitudinal variation of parameters of systemic inflammation in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) hemodiafilter.MethodsWe performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing hemodiafilter; we visualise longitudinal results of biochemical, inflammatory, blood gas- and vital sign parameters.ResultsBlood purification was indicated for suspected hyperinflammation or hypercoagulation, (= CRP ≥ 100 mg/L and/or IL-6 ≥ 40 pg/mL and/or Ferritin ≥ 500 ng/mL and/or Lactate Dehydrogenase > 365 U/L or D-dimers > 2000 ng/mL). All patients were treated with ≥ 1 cycle extracorporeal continuous venovenous hemofiltration (CVVHF) with cytokine adsorbing hemodiafilter (CAH); of these, 30 severe patients received CVVHF-CAH within 4 – 12 hours of hospitalisation. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and placed on EBP during the course of hospitalisation. The treatment was associated with a reduction of Ferritin, C-reactive protein, Fibrinogen, several inflammatory markers and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3% across the cohort.ConclusionExtracorporeal blood purification with cytokine adsorbing hemofilter was associated with a decrease in the acute phase proteins CRP, Ferritin, and resolution of numerous cytopenias. Repetitive hemofiltration has been associated with lower levels of IL-6 in COVID-19 patients.

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

2021 ◽  
pp. 1-10
Author(s):  
Rodney Alexander Rosalia ◽  
Petar Ugurov ◽  
Dashurie Neziri ◽  
Simona Despotovska ◽  
Emilija Kostoska ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Inflammatory Markers ◽  
Severe Disease ◽  
Blood Purification ◽  
Reactive Protein ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Continuous Venovenous Haemofiltration ◽  
Inflammatory State ◽  
And Control

<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.

scholarly journals Implementation of C-reactive protein point of care testing to improve antibiotic targeting in respiratory illness in Vietnamese primary care (ICAT): a study protocol for a cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040977
Author(s):  
Nga Thi Thuy Do ◽  
Rachel Claire Greer ◽  
Yoel Lubell ◽  
Sabine Dittrich ◽  
Maida Vandendorpe ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Antibiotic Use ◽  
Routine Care ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

IntroductionC-reactive protein (CRP), a biomarker of infection, has been used widely in high-income settings to guide antibiotic treatment in patients presenting with respiratory illnesses in primary care. Recent trials in low- and middle-income countries showed that CRP testing could safely reduce antibiotic use in patients with non-severe acute respiratory infections (ARIs) and fever in primary care. The studies, however, were conducted in a research-oriented context, with research staff closely monitoring healthcare behaviour thus potentially influencing healthcare workers’ prescribing practices. For policy-makers to consider wide-scale roll-out, a pragmatic implementation study of the impact of CRP point of care (POC) testing in routine care is needed.Methods and analysisA pragmatic, cluster-randomised controlled trial, with two study arms, consisting of 24 commune health centres (CHC) in the intervention arm (provision of CRP tests with additional healthcare worker guidance) and 24 facilities acting as controls (routine care). Comparison between the treatment arms will be through logistic regression, with the treatment assignment as a fixed effect, and the CHC as a random effect. With 48 clusters, an average of 10 consultations per facility per week will result in approximately 520 over 1 year, and 24 960 in total (12 480 per arm). We will be able to detect a reduction of 12% to 23% or more in immediate antibiotic prescription as a result of the CRP POC intervention. The primary endpoint is the proportion of patient consultations for ARI resulting in immediate antibiotic prescription. Secondary endpoints include the proportion of all patients receiving an antibiotic prescription regardless of ARI diagnosis, frequency of re-consultation, subsequent antibiotic use when antibiotics are not prescribed, referral and hospitalisation.Ethics and disseminationThe study protocol was approved by the Oxford University Tropical Research Ethics Committee (OxTREC, Reference: 53–18), and the ethical committee of the National Hospital for Tropical Diseases in Vietnam (Reference:07/HDDD-NDTW/2019). Results from this study will be disseminated via meetings with stakeholders, conferences and publications in peer-reviewed journals. Authorship and reporting of this work will follow international guidelines.Trial registration detailsNCT03855215; Pre-results.

The role of coinfection with influenza viruses in the pathogenesis of severe infection in patients with COVID-19

2021 ◽  
Vol 21 (3) ◽  
pp. 159-164
Author(s):  
Tamara N. Shvedova ◽  
Olga S. Kopteva ◽  
Polina A. Kudar ◽  
Anna A. Lerner ◽  
Yuliya A. Desheva
Keyword(s):  
Influenza A ◽  
Fold Increase ◽  
Igg Antibodies ◽  
C Reactive Protein ◽  
S Protein ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Coronavirus Infection

BACKGROUND: Despite the continuing global spread of the coronavirus infection COVID-19 caused by the SARS-CoV-2 coronavirus, the mechanisms of the pathogenesis of severe infections remain poorly understood. The role of comorbidity with other seasonal viral infections, including influenza, in the pathogenesis of the severe course of COVID-19 remains unclear. MATERIALS AND METHODS: The present study used sera left over from ongoing laboratory studies of patients with varying degrees of severity of COVID-19. The study was approved by the Local Ethics Committee of the Federal State Budgetary Scientific Institution IEM (protocol 3/20 from 06/05/2020). We studied 28 paired samples obtained upon admission of patients to the hospital and after 57 days of hospital stay. Paired sera of patients with COVID-19 were tested for antibodies to influenza A and B viruses. The presence of IgG antibodies specific to the SARS-CoV-2 spike (S) protein was studied using an enzyme-linked immunosorbent assay (ELISA). The serum concentration of C-reactive protein and the neutrophil-lymphocyte ratio on the day of hospitalization were also assessed. RESULTS: At least a 4-fold increase in serum IgG antibodies to SARS-CoV-2 S protein was found both in patients with PCR-confirmed SARS-CoV-2 infection and without PCR confirmation. It was shown that out of 18 patients with moderate and severe forms of COVID-19 infection, six of them showed at least a 4-fold increase in antibodies to influenza A/H1N1, in one to influenza A/H3N2 and in two cases to the influenza B. Laboratory data in these two groups were characterized by significant increases in serum C-reactive protein and neutrophil-lymphocyte ratio concentrations compared with the moderate COVID-19 group. CONCLUSIONS: Serological diagnostics can additionally detect cases of coronavirus infection when the virus was not detected by PCR. In moderate and severe cases of COVID-19, coinfections with influenza A and B viruses have been identified. The results obtained confirm the need for anti-influenza immunization during the SARS-CoV-2 pandemic. Influenza virus screening can significantly improve patient management because recommended antiviral drugs (neuraminidase inhibitors) are available.

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