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体外血液净化与危重症 COVID-19 患者的生化和临床变量的改善有关。

Extracorporeal blood purification is associated with improvement in biochemical and clinical variables in the critically-ill COVID-19 patients.

机构信息

Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb, Croatia.

Department of Intensive Care Medicine, University Hospital Center Zagreb, Zagreb, Croatia.

出版信息

Ther Apher Dial. 2022 Apr;26(2):316-329. doi: 10.1111/1744-9987.13730. Epub 2021 Sep 16.

Abstract

This study tried to investigate the impact of oXiris filter on both clinical and laboratory parameters in critically-ill COVID-19 intensive care unit (ICU) patients receiving extracorporeal blood purification and the clinical setting for the initiation of therapy. A consecutive sample of 15 ICU patients with COVID-19 was treated with oXiris membrane for blood purification or for support of renal function due to acute kidney injury. We have included 19 non treated ICU COVID-19 patients as a control group. Two chest x-rays were analyzed for determining the chest x-ray severity score. We have found a significant decrease of SOFA score, respiratory status improved and the chest x-ray severity score was significantly decreased after 72 h of treatment. IL-6 significantly decreased after 72 h of treatment while other inflammatory markers did not. Respiratory status in the control group worsened as well as increase in SOFA score and chest x-ray severity score. Survived patients have shorter time from the onset of symptoms before starting with extracorporeal blood purification treatment and shorter time on vasoactive therapy and invasive respiratory support than deceased patients. Critically-ill patients with COVID-19 treated with extracorporeal blood purification survived significantly longer than other ICU COVID-19 patients. Treatment with oXiris membrane provides significant reduction of IL-6, leads to improvement in respiratory status, chest x-ray severity score, and reduction of SOFA score severity. Our results can suggest that ICU COVID-19 patients in an early course of a disease could be potentially a target group for earlier initiation of extracorporeal blood purification.

摘要

本研究试图探讨 oXiris 过滤器对接受体外血液净化的 COVID-19 重症监护病房(ICU)危重症患者的临床和实验室参数的影响,以及开始治疗的临床环境。对 15 名因 COVID-19 而接受 oXiris 膜血液净化或因急性肾损伤而支持肾功能的 ICU 患者进行了连续样本治疗。我们纳入了 19 名未接受治疗的 ICU COVID-19 患者作为对照组。分析了两张胸部 X 光片,以确定胸部 X 光严重程度评分。我们发现,在治疗 72 小时后,SOFA 评分显著下降,呼吸状况改善,胸部 X 光严重程度评分显著降低。IL-6 在治疗 72 小时后显著降低,而其他炎症标志物没有。对照组患者的呼吸状况恶化,SOFA 评分和胸部 X 光严重程度评分增加。存活患者在开始体外血液净化治疗前,从症状发作到开始治疗的时间较短,接受血管活性药物治疗和有创性呼吸支持的时间也较短。与其他 ICU COVID-19 患者相比,接受体外血液净化治疗的 COVID-19 危重症患者存活时间显著延长。oXiris 膜治疗可显著降低 IL-6,改善呼吸状况、胸部 X 光严重程度评分和 SOFA 评分严重程度。我们的研究结果表明,在疾病早期的 ICU COVID-19 患者可能是早期启动体外血液净化治疗的潜在目标人群。

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