Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
Research and Innovation Center, King Saud Medical City, Riyadh, Saudi Arabia.
Artif Organs. 2021 May;45(5):E101-E112. doi: 10.1111/aor.13864. Epub 2020 Dec 26.
Our aim was to investigate continuous renal replacement therapy (CRRT) with CytoSorb cartridge for patients with life-threatening COVID-19 plus acute kidney injury (AKI), sepsis, acute respiratory distress syndrome (ARDS), and cytokine release syndrome (CRS). Of 492 COVID-19 patients admitted to our intensive care unit (ICU), 50 had AKI necessitating CRRT (10.16%) and were enrolled in the study. Upon ICU admission, all had AKI, ARDS, septic shock, and CRS. In addition to CRRT with CytoSorb, all received ARDS-net ventilation, prone positioning, plus empiric ribavirin, interferon beta-1b, antibiotics, hydrocortisone, and prophylactic anticoagulation. We retrospectively analyzed inflammatory biomarkers, oxygenation, organ function, duration of mechanical ventilation, ICU length-of-stay, and mortality on day-28 post-ICU admission. Patients were 49.64 ± 8.90 years old (78% male) with body mass index of 26.70 ± 2.76 kg/m . On ICU admission, mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 22.52 ± 1.1. Sequential Organ Function Assessment (SOFA) score was 9.36 ± 2.068 and the ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen (PaO /FiO ) was 117.46 ± 36.92. Duration of mechanical ventilation was 17.38 ± 7.39 days, ICU length-of-stay was 20.70 ± 8.83 days, and mortality 28 days post-ICU admission was 30%. Nonsurvivors had higher levels of inflammatory biomarkers, and more unresolved shock, ARDS, AKI, and pulmonary emboli (8% vs. 4%, P < .05) compared to survivors. After 2 ± 1 CRRT sessions with CytoSorb, survivors had decreased SOFA scores, lactate dehydrogenase, ferritin, D-dimers, C-reactive protein, and interleukin-6; and increased PaO /FiO ratios, and lymphocyte counts (all P < .05). Receiver-operator-curve analysis showed that posttherapy values of interleukin-6 (cutoff point >620 pg/mL) predicted in-hospital mortality for critically ill COVID-19 patients (area-under-the-curve: 0.87, 95% CI: 0.81-0.93; P = .001). No side effects of therapy were recorded. In this retrospective case-series, CRRT with the CytoSorb cartridge provided a safe rescue therapy in life-threatening COVID-19 with associated AKI, ARDS, sepsis, and hyperinflammation.
我们的目的是研究针对生命垂危的 COVID-19 合并急性肾损伤 (AKI)、脓毒症、急性呼吸窘迫综合征 (ARDS) 和细胞因子释放综合征 (CRS) 的连续肾脏替代治疗 (CRRT) 与 CytoSorb 试剂盒联合应用。在入住我院重症监护病房 (ICU) 的 492 例 COVID-19 患者中，有 50 例 AKI 需要 CRRT（10.16%），并纳入本研究。入住 ICU 时，所有患者均合并 AKI、ARDS、感染性休克和 CRS。除了使用 CytoSorb 进行 CRRT 外，所有患者还接受 ARDS-net 通气、俯卧位以及经验性利巴韦林、干扰素-β1b、抗生素、氢化可的松和预防性抗凝治疗。我们回顾性分析了 ICU 入住后第 28 天的炎症生物标志物、氧合、器官功能、机械通气时间、ICU 住院时间和死亡率。患者年龄为 49.64 ± 8.90 岁（78%为男性），体重指数为 26.70 ± 2.76 kg/m²。入住 ICU 时，急性生理学与慢性健康评估 II 评分（APACHE II）平均为 22.52 ± 1.1。序贯器官衰竭评估（SOFA）评分 9.36 ± 2.068，部分动脉血氧分压与吸入氧浓度比值（PaO/FiO）为 117.46 ± 36.92。机械通气时间为 17.38 ± 7.39 天，ICU 住院时间为 20.70 ± 8.83 天，入住 ICU 后 28 天死亡率为 30%。与幸存者相比，非幸存者的炎症生物标志物水平更高，未解决的休克、ARDS、AKI 和肺栓塞发生率更高（8%比 4%，P<0.05）。使用 CytoSorb 进行 2±1 次 CRRT 后，幸存者的 SOFA 评分、乳酸脱氢酶、铁蛋白、D-二聚体、C 反应蛋白和白细胞介素-6 降低，而动脉血氧分压与吸入氧浓度比值、淋巴细胞计数升高（均 P<0.05）。受试者工作特征曲线分析显示，治疗后白细胞介素-6（>620 pg/ml 时）值可预测 COVID-19 危重症患者院内死亡率（曲线下面积：0.87，95%CI：0.81-0.93；P=0.001）。未记录到治疗相关的副作用。在这项回顾性病例系列研究中，CytoSorb 试剂盒的 CRRT 为生命垂危的 COVID-19 合并 AKI、ARDS、脓毒症和高炎症反应患者提供了一种安全的抢救治疗方法。
