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. 2020 Dec;19(4):291-299.

Blood Purification Techniques, Inflammatory Mediators and Mortality in COVID-19 Patients

Seyed Mohammadreza Hashemian  1 , Navid Shafigh  2 , Golnaz Afzal  3 , Hamidreza Jamaati  1 , Esmaeil Mortaz  4 , Payam Tabarsi  4 , Majid Marjani  4 , Majid Malekmohammad  5 , Farzaneh Dastan  1   3 , Seyed Mehdi Mortazavi  6 , Makan Sadr  7 , Esmaeil Idani  1 , Batoul Khoundabi  8 , Abdolreza Mohamadnia  1 , Atefeh Abedini  1 , Arda Kiani  1 , Afshin Moniri  7 , Seyed Alireza Nadji  7 , Fatemeh Yassari  1 , Mojtaba Mokhber Dezfuli  9 , Mihan Pourabdollah  1 , Mohammad Varahram  10 , Faezeh Eshaghi  1 , Mahdi Malekpour  11 , Aliakbar Velayati  1
Affiliations

Blood Purification Techniques, Inflammatory Mediators and Mortality in COVID-19 Patients

Seyed Mohammadreza Hashemian et al. Tanaffos. 2020 Dec.

Abstract

Background: Inflammatory mediators are an important component in the pathophysiology of the coronavirus disease 2019 (COVID-19). This study aimed to assess the effects of reducing inflammatory mediators using hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the mortality of patients with COVID-19.

Materials and methods: Twelve patients with confirmed diagnosis of COVID-19 were included. All patients had acute respiratory distress syndrome (ARDS). Patients were divided into three groups, namely, HP, CRRT and HP+CRRT. The primary outcome was mortality and the secondary outcomes were oxygenation and reduction in inflammatory mediators at the end of the study.

Results: Patients were not different at baseline in demographics, inflammatory cytokine levels, and the level of acute phase reactants. Half of the patients (3 out of 6) in the HP+CRRT group survived along with the survival of one patient (1 out of 2) in the HP group. All four patients in the CRRT group died. Serum creatinine (SCr), Interleukin-1 (IL1), Interleukin-6 (IL6), Interleukin-8 (IL8), partial pressure of oxygen (PaO2), O2 saturation (O2 sat), and hemodynamic parameters improved over time in HP+CRRT and CRRT groups, but no significant difference was observed in the HP group (All Ps > 0.05).

Conclusion: Combined HP and CRRT demonstrated the best result in terms of mortality, reduction of inflammatory mediators and oxygenation. Further investigations are needed to explore the role of HP+CRRT in COVID-19 patients.

Keywords: ARDS; Acute respiratory distress syndrome; COVID-19; Continuous renal replacement therapy; Coronavirus disease 2019; Cytokine; Hemoperfusion; Inflammatory marker; Mortality; Oxygenation.

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Conflict of interest statement

Competing interests Not applicable.

Figures

Figure 1.
Figure 1.
Laboratory parameters at baseline and after treatment in each study group. There was no difference (All Ps > 0.05) in the HP group. In the CRRT group, only norepinephrine dose did not show a significant difference (Ps > 0.05). In the HP+CRRT group, all parameters, except BUN, showed a significant increase after treatment (All Ps < 0.05).
Figure 2.
Figure 2.
Overall survival using Cox proportional model.
See this image and copyright information in PMC

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