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

Hashemian, Seyed Mohammadreza; Shafigh, Navid; Afzal, Golnaz; Jamaati, Hamidreza; Mortaz, Esmaeil; Tabarsi, Payam; Marjani, Majid; Malekmohammad, Majid; Dastan, Farzaneh; Mortazavi, Seyed Mehdi; Sadr, Makan; Idani, Esmaeil; Khoundabi, Batoul; Mohamadnia, Abdolreza; Abedini, Atefeh; Kiani, Arda; Moniri, Afshin; Nadji, Seyed Alireza; Yassari, Fatemeh; Mokhber Dezfuli, Mojtaba; Varahram, Mohammad; Eshaghi, Faezeh; Malekpour, Mahdi; Velayati, Aliakbar

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

Document Type : Review Article

Authors

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

Mohammad Varahram ¹⁰

Faezeh Eshaghi ¹

Mahdi Malekpour ¹¹

Aliakbar Velayati ¹

¹ Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

² Department of Anesthesiology and Critical Care Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

³ Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁴ Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁵ Tracheal Diseases Research Center (TDRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁶ Department of Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁷ Virology Research Center (VRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁸ Iran-Helal Institute of Applied-Science and Technology, Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran

⁹ Lung Transplantation Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

¹⁰ Mycobacteriology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

¹¹ Geisinger Medical Center, Danville, PA , USA

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

Coronavirus disease 2019

COVID-19

Acute respiratory distress syndrome

ARDS

Inflammatory marker

Hemoperfusion

Continuous renal replacement therapy

Cytokine

Oxygenation

Mortality