School of Medicine, Class 2017, Nanchang University, Nanchang, China.
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Blood Purif. 2022;51(5):410-416. doi: 10.1159/000517721. Epub 2021 Aug 18.
Systematic inflammatory response occurred in some critically ill patients with COVID-19. Cytokine reduction by hemadsorption is a mechanism of treatment. However, whether CytoSorb hemoperfusion works for critically ill COVID-19 patients remains unknown.
We observed case series of critically ill COVID-19 patients receiving CytoSorb hemoperfusion as rescue therapy from 3 hospitals in Hubei, China from February 28, 2020, to April 7, 2020. Their demographic, laboratory, and clinical data were collected. The parameters for organ function and IL-6 levels were compared before and after treatments.
A total of 10 cases were included. The median age of the patients was 67.7 years (range = 50-85) with APACHE II (23.5) and SOFA (11.4). Patients received a median of 3 attempts of hemoperfusion (range = 1-6). The median CytoSorb perfusion time was 47 h (12-92 h). The level of IL-6 significantly decreased after treatments (712.6 [145-5,000] vs. 136.7 [46.3-1,054] pg/mL, p = 0.005). Significant improvement was found in PaO2/FiO2 (118 [81-220] vs. 163 [41-340] mm Hg, p = 0.04) and lactate levels (2.5 [1-18] vs. 1.7 [1.1-10] mmol/L, p = 0.009). The hemodynamics measured by norepinephrine/MAP slightly improved after treatment (17 [0-68] vs. 8 [0-39], p = 0.09). Albumin mildly decreased after CytoSorb. No significant changes were found in red blood cell counts, white cell counts, and platelets.
Treatment with CytoSorb in critically ill COVID-19 patients was associated with decreased IL-6 improvement in oxygenation. However, these effects cannot be confirmed as the direct effects of CytoSorb owing to lack of controls. Establishing causality requires large-scale randomized clinical trials.
系统性炎症反应发生在一些 COVID-19 重症患者中。通过血液吸附减少细胞因子是一种治疗机制。然而，细胞吸附血液灌流是否对 COVID-19 重症患者有效仍不清楚。
我们观察了 2020 年 2 月 28 日至 4 月 7 日期间，来自中国湖北省的 3 家医院对 COVID-19 重症患者进行细胞吸附血液灌流作为抢救治疗的病例系列。收集了他们的人口统计学、实验室和临床数据。比较了治疗前后器官功能和 IL-6 水平的参数。
共纳入 10 例患者。患者中位年龄为 67.7 岁（范围=50-85），APACHE II（23.5）和 SOFA（11.4）评分较高。患者接受了中位 3 次（范围=1-6）血液灌流。细胞吸附血液灌流中位时间为 47 小时（12-92 小时）。治疗后 IL-6 水平显著下降（712.6[145-5000] vs. 136.7[46.3-1054]pg/ml，p=0.005）。PaO2/FiO2（118[81-220] vs. 163[41-340]mmHg，p=0.04）和乳酸水平（2.5[1-18] vs. 1.7[1.1-10]mmol/L，p=0.009）显著改善。去甲肾上腺素/MAP 测量的血流动力学在治疗后略有改善（17[0-68] vs. 8[0-39]，p=0.09）。细胞吸附后白蛋白轻度下降。红细胞计数、白细胞计数和血小板无明显变化。
在 COVID-19 重症患者中使用细胞吸附治疗与 IL-6 降低和氧合改善相关。然而，由于缺乏对照，这些影响不能被确认为细胞吸附的直接作用。建立因果关系需要大规模的随机临床试验。
