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

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.

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

10.21203/rs.3.rs-29229/v3 ◽

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 ◽

Beneficial Impact ◽

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.

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

10.21203/rs.3.rs-29229/v2 ◽

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 ◽

Reference Number ◽

Beneficial Impact ◽

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.

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

10.21203/rs.3.rs-29229/v1 ◽

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 ◽

Beneficial Impact ◽

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.

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

Medical academic journal ◽

10.17816/maj78155 ◽

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 ◽

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.

Coronavirus infection and gut microbiota

Kazan medical journal ◽

10.17816/kmj2021-518 ◽

2021 ◽

Vol 102 (4) ◽

pp. 518-527

Author(s):

D D Safina ◽

S R Abdulkhakov

Keyword(s):

Gastrointestinal Tract ◽

Gut Microbiota ◽

Viral Infections ◽

Subsequent Development ◽

Upper Respiratory Tract ◽

Therapeutic Approaches ◽

Coronavirus Infection ◽

Upper Respiratory ◽

Treatment Of Infection ◽

Tract Disorder

At present time, a number of questions regarding the pathophysiological characteristics and therapeutic approaches to the treatment of the new coronavirus infection COVID-19 remain unresolved. In some cases, patients with COVID-19 may experience symptoms of gastrointestinal tract disorder. According to the literature, the new SARS-CoV-2 coronavirus can replicate in the gastrointestinal tract and may affect the gut microbiota. The article aims to review studies about the possible relationship between the gut microbiota condition and the course of COVID-19 infection, as well as to consider the gut microbiota as a potential therapeutic target and probiotic drugs as possible therapeutic agents in the treatment of viral infections, including COVID-19 infection. It is known that gut microbiota condition is one of the factors determining the susceptibility and features of the bodys response to various infectious agents, possibly including the COVID-19 infection. Currently published studies demonstrate a possible relationship between the gut microbiota condition and the course of COVID-19 infection, however, to confirm this hypothesis, additional studies are required, which will allow to make more unambiguous conclusions with subsequent development of new approaches to the prevention and treatment of infection. Potentially a lot of hope in this direction is inspired by the results of probiotics studies, which showed that their use may reduce the frequency and severity of viral infections of the upper respiratory tract. However, currently, there is insufficient data to extrapolate the results of these studies to COVID-19 patients.

Hypovitaminosis D and COVID-19

Italian Journal of Medicine ◽

10.4081/itjm.2020.1404 ◽

2020 ◽

Vol 14 (4) ◽

pp. 216-218

Author(s):

Gabriele A. Vassallo ◽

Sirio Fiorino ◽

Simone Mori ◽

Tommaso Dionisi ◽

Giuseppe Augello ◽

...

Keyword(s):

Hypovitaminosis D ◽

Point Of View ◽

Diagnostic Tools ◽

Therapeutic Approaches ◽

Front Line ◽

New Therapeutic Approaches ◽

Global Pandemic ◽

Infection Disease ◽

Coronavirus Infection ◽

Second Wave

As the main title ‘COVID-19 revolution: a new challenge for the internist’ states, the global coronavirus infection disease 2019 (COVID-19) pandemic represented a new challenge for the internists. This paper is part of a series of articles written during the difficult period of the ongoing global pandemic and published all together in this fourth issue of the Italian Journal of Medicine, with the aim of sharing the direct experiences of those who were the first to face this severe emergency, expressing each point of view in the management of COVID-19 in relation to other diseases. Each article is therefore the result of many efforts and a joint collaboration between many colleagues from the Departments of Internal Medicine or Emergency Medicine of several Italian hospitals, engaged in the front line during the pandemic. These preliminary studies therefore cover diagnostic tools available to health care personnel, epidemiological reflections, possible new therapeutic approaches, discharge and reintegration procedures to daily life, the involvement of the disease not only in the lung, aspects related to various comorbidities, such as: coagulopathies, vasculitis, vitamin D deficiency, gender differences, etc.. The goal is to offer a perspective, as broad as possible, of everything that has been done to initially face the pandemic in its first phase and provide the tools for an increasingly better approach, in the hope of not arriving unprepared to a possible second wave. This paper in particular deals with hypovitaminosis D and COVID-19.

MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN: DIAGNOSTIC MARKERS AND FEATURES OF PHARMACOTHERAPY

Medical Science of Ukraine (MSU) ◽

10.32345/2664-4738.1.2021.03 ◽

2021 ◽

Vol 17 (1) ◽

pp. 24-28

Author(s):

M.V. Кhaitovych ◽

L.M. Voroniuk ◽

G.Yu. Borisova ◽

N.V. Diudenko ◽

N.M. Miagka

Keyword(s):

Distress Syndrome ◽

The United States ◽

C Reactive Protein ◽

Reactive Protein ◽

Markers Of Inflammation ◽

Laboratory Markers ◽

Mucous Membranes ◽

Coronavirus Infection ◽

Polymerase Chain ◽

Inflammatory Syndrome

Relevance. In 2020, children were hospitalized with fever and multisystem inflammation throughout the world during the COVID-19 pandemic. In the United States, this condition is called MIS-C (Multisystem Inflammatory Syndrome in Children). This syndrome is thought to be similar to the severe course of COVID-19 in adults (cytokine storm). The objective of the work is to evaluate the features of the course and pharmacotherapy of multisystem inflammatory syndrome in children. Materials and methods. The study included 17 children (10 boys and 7 girls) aged 3-16 years (on average – 9.5±3.4 years). Diagnosis of coronavirus infection was performed by polymerase chain reaction with real-time detection, determined the level of immunoglobulins M and G before coronavirus infection. Results. The duration of fever in patients was 5-21 days (average 8.1±4.0 days), the duration of inpatient treatment – 7-35 days (average 15.7±7.0 days). Blood albumin levels were reduced in 53.8% of children; the level of fibrinogen was increased in 88.2% of children, the level of C-reactive protein, ferritin, and D-dimer – in all patients. 15 (88.2%) children had pathology of the digestive system, 13 (76.5%) – cardiovascular system (7 children were diagnosed with carditis, 2 – dilation of coronary arteries, 7 – cardiac arrhythmia). Acute respiratory distress -syndrome was found in a 13-year-old girl, shock - in an 11-year-old boy, 11 children (64.7%) were diagnosed with the pathology of the respiratory system (pleurisy, pneumonia), skin and mucous membranes, and 4 children (23.5%) there were manifestations of central nervous system disorders (meningism, decreased reflexes, ataxia), in 2 (11.8%) – renal failure. On average, each patient had lesions of 3.9 ±1.2 systems. Conclusions. MIS-C was manifested by prolonged fever, high levels of laboratory markers of inflammation, hypoalbuminemia, hypercoagulation, often – pathological manifestations of the cardiovascular, digestive, respiratory systems, skin, and mucous membranes. The treatment included intravenous immunoglobulin, steroids, anticoagulant, and antibacterial therapy and was effective.

Experience of using tocilizumab in the research unit of infectious hospital for patients with coronavirus infection (CoVID-19)

Immunopathology Allergology Infectology ◽

10.14427/jipai.2020.4.27 ◽

2020 ◽

pp. 27-33

Author(s):

M Petrushin ◽

V Leontyeva ◽

A Malygin ◽

M Demidova

Keyword(s):

Pulse Therapy ◽

Research Unit ◽

Lung Lesion ◽

Lesion Volume ◽

Lung Involvement ◽

Cytokine Storm ◽

C Reactive Protein ◽

Case Histories ◽

Reactive Protein ◽

The objective of the study was the evaluation of the effectiveness of tocilizumab in patients with coronavirus infection COVID-19 who were treated in the intensive care unit of an infectious diseases hospital. Material and methods. There was carried out a retrospective analysis of the case histories of 40 patients with confirmed severe and extremely severe coronavirus infection COVID-19. The average age of the patients was 58.3 ± 1.8 years, the total lung lesion volume was 83.2 ± 2.0%. Results: The survival rate of patients who received immunosuppressive therapy with tocilizumab in combination with pulse therapy of glucocorticosteroids was 55%, and 44% of patients with 100% lung involvement. The use of tocilizumab (4-8 mg / kg) led to a statistically significant decrease in the level of C-reactive protein in the blood, which was an indicator of adequate pharmacotherapy of the "cytokine storm" in the ICU.

The case of comorbidity of sinus node dysfunction and new coronavirus infection with Sjogren’s disease and Thompson’s myotonia

Russian Family Doctor ◽

10.17816/rfd71055 ◽

2021 ◽

Vol 25 (3) ◽

pp. 35-40

Author(s):

Maria O. Mohika Estepa ◽

Nadezhda V. Muzhikina

Keyword(s):

Respiratory System ◽

Multidisciplinary Approach ◽

Sinus Node ◽

Cardiovascular Complications ◽

Sinus Node Dysfunction ◽

Therapeutic Approaches ◽

Latent Form ◽

Aged People ◽

Coronavirus Infection ◽

Sjögren’S Disease

Coronavirus infection, according to modern data, poses a threat not only to the respiratory system, in more than 15% of patients it can lead to cardiovascular complications, including in young and middle-aged people. COVID-19 is probably the trigger of a detailed clinical picture of chronic diseases occurring in a latent form. The article considers the case of sinus node dysfunction and polyneuropathy in a young patient after coronavirus infection against the background of concomitant diseases such as Sjogrens disease and Thompsons myotonia. To observe the dynamics of the three diseases, the timely organization of a multidisciplinary approach is important. It is necessary to consider all three diseases in the paradigm of the main and concomitant in order to timely and adequate therapy. Further study of the clinical features, therapeutic approaches and complications in patients with COVID-19 is required.

Utility of inflammatory biomarkers in patients with COVID-19 infections: Bahrain experience

Biomarkers in Medicine ◽

10.2217/bmm-2020-0422 ◽

2021 ◽

Author(s):

Eman Farid ◽

Kannan Sridharan ◽

Ola AM Alsegai ◽

Safa Al Khawaja ◽

Eman J Mansoor ◽

...

Keyword(s):

Serum Ferritin ◽

Predictive Accuracy ◽

Inflammatory Biomarkers ◽

Severe Illness ◽

Positive Real ◽

Receiver Operating Characteristic Curves ◽

Real Time Quantitative Pcr ◽

Reactive Protein ◽

Coronavirus Infection ◽

D Dimer

Aim: COVID-19 pandemic continues and dearth of information remains considering the utility of various inflammatory biomarkers. We carried out the present study to delineate the roles of these biomarkers in various strata of patients with coronavirus infection. Materials & methods: A retrospective study was carried out after obtaining approval from the relevant Ethics Committee. Patients established with COVID-19 infection as shown by positive real-time quantitative PCR test were included. Details on their demographics, diagnosis, whether they received tocilizumab, and the values of the following biomarkers were obtained: IL-6, C-reactive protein (CRP), serum ferritin, D-dimer, procalcitonin, fibrinogen, lactate dehydrogenase and creatinine kinase. Receiver operating characteristic curves were plotted and correlation of biomarkers with IL-6 were estimated. Results: One-hundred and three patients were recruited. We observed that serum ferritin followed by D-dimer had better predictive accuracy in identifying patients with pneumonia compared with asymptomatic; and CRP in addition to the earlier markers had better accuracy for predicting severe illness compared with mild–moderate. Serum IL-6 levels were significantly higher in patients with severe illness admitted in intensive care unit. Significantly, higher levels of IL-6 and serum ferritin were observed in patients receiving tocilizumab. A trend of increased IL-6 levels was observed immediately following the initiation of tocilizumab therapy followed by a drop thereafter. Conclusion: We observed serum ferritin, D-dimer and CRP to accurately predict patients developing severe COVID-19 infections as well as those at risk of developing COVID pneumonia. A trend in IL-6 levels was observed in patients on tocilizumab therapy.