Kang Kai, Luo Yunpeng, Gao Yang, Zhang Jiannan, Wang Changsong, Fei Dongsheng, Yang Wei, Meng Xianglin, Ye Ming, Gao Yan, Liu Haitao, Du Xue, Ji Yuanyuan, Wei Jieling, Xie Wanqiu, Wang Jun, Zhao Mingyan, Yu Kaijiang
Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.
Department of Critical Care Medicine, the Sixth Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.
Front Pharmacol. 2022 Feb 4;13:817793. doi: 10.3389/fphar.2022.817793. eCollection 2022.
In this study, we aimed to determine whether continuous renal replacement therapy (CRRT) with oXiris filter may alleviate cytokine release syndrome (CRS) in non-AKI patients with severe and critical coronavirus disease 2019 (COVID-19). A total of 17 non-AKI patients with severe and critical COVID-19 treated between February 14 and March 26, 2020 were included and randomly divided into intervention group and control group according to the random number table. Patients in the intervention group immediately received CRRT with oXiris filter plus conventional treatment, while those in the control group only received conventional treatment. Demographic data were collected and collated at admission. During ICU hospitalization, the concentrations of circulating cytokines and inflammatory chemokines, including IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ, were quantitatively measured daily to reflect the degree of CRS induced by SARS-CoV-2 infection. Clinical data, including the severity of COVID-19 white blood cell count (WBC), neutrophil proportion (NEUT%), lymphocyte count (LYMPH), lymphocyte percentage (LYM%), platelet (PLT), C-reaction protein (CRP), high sensitivity C-reactive protein (hs-CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), albumin (ALB), serum creatinine (SCr), D-Dimer, fibrinogen (FIB), IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, number of hospital days and sequential organ failure assessment (SOFA) score were obtained and collated from medical records, and then compared between the two groups. Age, and SCr significantly differed between the two groups. Besides the IL-2 concentration that was significantly lower on day 2 than that on day 1 in the intervention group, and the IL-6 concentrations that were significantly higher on day 1, and day 2 in the intervention group compared to the control group, similar to the IL-10 concentration on day 5, there were no significant differences between the two groups. To sum up, CRRT with oXiris filter may not effectively alleviate CRS in non-AKI patients with severe and critical COVID-19. Thus, its application in these patients should be considered with caution to avoid increasing the unnecessary burden on society and individuals and making the already overwhelmed medical system even more strained (IRB number: IRB-AF/SC-04).
在本研究中，我们旨在确定使用oXiris滤器的持续肾脏替代疗法（CRRT）是否可缓解2019冠状病毒病（COVID-19）重症和危重症非急性肾损伤（AKI）患者的细胞因子释放综合征（CRS）。纳入了2020年2月14日至3月26日期间接受治疗的17例COVID-19重症和危重症非AKI患者，并根据随机数字表将其随机分为干预组和对照组。干预组患者立即接受使用oXiris滤器的CRRT加常规治疗，而对照组患者仅接受常规治疗。入院时收集并整理人口统计学数据。在重症监护病房（ICU）住院期间，每天定量检测循环细胞因子和炎性趋化因子的浓度，包括白细胞介素-2（IL-2）、白细胞介素-4（IL-4）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）和干扰素-γ（IFN-γ），以反映严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染诱导的CRS程度。从病历中获取并整理临床数据，包括COVID-19的严重程度、白细胞计数（WBC）、中性粒细胞比例（NEUT%）、淋巴细胞计数（LYMPH）、淋巴细胞百分比（LYM%）、血小板（PLT）、C反应蛋白（CRP）、高敏C反应蛋白（hs-CRP）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TB）、白蛋白（ALB）、血清肌酐（SCr）、D-二聚体、纤维蛋白原（FIB）、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、住院天数和序贯器官衰竭评估（SOFA）评分，然后在两组之间进行比较。两组患者的年龄和SCr存在显著差异。除干预组第2天的IL-2浓度显著低于第1天，以及干预组第1天和第2天的IL-6浓度与对照组相比显著更高，与第5天的IL-10浓度情况类似外，两组之间无显著差异。综上所述，使用oXiris滤器的CRRT可能无法有效缓解COVID-19重症和危重症非AKI患者的CRS。因此，在这些患者中应用该疗法时应谨慎考虑，以免增加社会和个人不必要的负担，并使本已不堪重负的医疗系统更加紧张（机构审查委员会编号：IRB-AF/SC-04）。
