Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, 9188Eberhard-Karls-University, Tübingen, Germany.
Department I-General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany.
J Intensive Care Med. 2021 Jun;36(6):681-688. doi: 10.1177/0885066621997365. Epub 2021 Mar 5.
The COVID-19 pandemic reached Germany in spring 2020. No proven treatment for SARS-CoV-2 was available at that time, especially for severe COVID-19-induced ARDS. We determined whether the infusion of mesenchymal stromal cells (MSCs) would help to improve pulmonary function and overall outcome in patients with severe COVID-19 ARDS. We offered MSC infusion as an extended indication to all critically ill COVID-19 patients with a Horovitz index <100. We treated 5 out of 23 patients with severe COVID-19 ARDS with an infusion of MSCs. One million MSCs/kg body weight was infused over 30 minutes, and the process was repeated in 3 patients twice and in 2 patients 3 times.
Four out of 5 MSC-treated patients compared to 50% of control patients (9 out of 18) received ECMO support (80%). The MSC group showed a higher Murray score on admission than control patients, reflecting more severe pulmonary compromise (3.5 ± 0.2 versus 2.8 ± 0.3). MSC infusion was safe and well tolerated. The MSC group had a significantly higher Horovitz score on discharge than the control group. Compared to controls, patients with MSC treatment showed a significantly lower Murray score upon discharge than controls. In the MSC group, 4 out of 5 patients (80%) survived to discharge and exhibited good pulmonary function, whereas only 8 out of 18 patients (45%) in the control group survived to discharge.
MSC infusion is a safe treatment for COVID-19 ARDS that improves pulmonary function and overall outcome in this patient population.
2020 年春季，COVID-19 疫情在德国蔓延。当时，尚无针对 SARS-CoV-2 的有效治疗方法，尤其是针对严重 COVID-19 诱导的急性呼吸窘迫综合征（ARDS）。我们旨在确定输注间充质基质细胞（MSCs）是否有助于改善严重 COVID-19 ARDS 患者的肺功能和整体预后。我们将 MSC 输注作为所有患有严重 COVID-19 ARDS 和 Horovitz 指数 <100 的危重症 COVID-19 患者的扩展适应证。我们用 MSC 治疗了 23 例严重 COVID-19 ARDS 患者中的 5 例。将 100 万 MSCs/kg 体重于 30 分钟内输注完毕，3 例患者重复两次，2 例患者重复 3 次。
与对照组（9/18，50%）相比，5 例 MSC 治疗患者中有 4 例（80%）接受了 ECMO 支持，而对照组仅有 9 例（50%）。MSC 组入院时的 Murray 评分高于对照组，反映出更严重的肺损伤（3.5±0.2 比 2.8±0.3）。MSC 输注安全且耐受良好。与对照组相比，MSC 组出院时的 Horovitz 评分显著更高。与对照组相比，接受 MSC 治疗的患者出院时的 Murray 评分明显更低。在 MSC 组中，5 例患者中有 4 例（80%）存活出院且肺功能良好，而对照组仅有 18 例患者中的 8 例（45%）存活出院。
MSC 输注是 COVID-19 ARDS 的一种安全治疗方法，可改善此类患者人群的肺功能和整体预后。
