Hemoadsorption in Patients with Various Types of Respiratory Support for Severe COVID-19

Abstract

Study aim. To evaluate the efficacy of hemoadsorption in patients with severe COVID-19 on mechanical lung ventilation (MLV) and noninvasive respiratory support.Material and methods. We retrospectively analysed longitudinal clinical and laboratory parameters of 49 patients with severe coronavirus infection who were treated in the First Intensive care unit of Grodno University Hospital from September 2020 to November 2021 and underwent hemoadsorption using the Hemo-Proteasosorb sorbent. All patients were divided into two groups: Hemo-Proteasosorb + MLV (22 patients who underwent hemoadsorption while being on MLV) and Hemo-Proteasosorb without MLV (27 patients who had hemoadsorption while receiving the low- and high-flow oxygen therapy or noninvasive lung ventilation).Results. In the Hemo-Proteasosorb + MLV group a decrease in procalcitonin (PCT) (from 0.27 [0.12–2.08] down to 0.14 [0.05–1.77], P=0.027), C-reactive protein (CRP) (from 135.4 [10.6–303.0] down to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7  [4.9–19.49] to 8.2  [3.7–14.7], P=0.00004), and D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) was seen on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also demonstrated a reduction in the levels of CRP (from 4 [10.6–303.0] to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7 [4.9–19.49] to 8.2 [3.7–14.7], P=0.00004), D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also showed a decrease in PCT (from 0.29 [0.14–21.25] to 0.14 [0.04–11.91], P=0.002), CRP (from 132.6 [30.7–183.0] to 28.55 [5.3–182.0], P=0.0002), fibrinogen (from 10.2 [4.41–15.5] to 6.5 [2.8–11.9], P=0.00005), D-dimer (from 1445.0 [365.0–4830.0] to 1049.0 [301.0–3302.0], P=0.005), while an increase in SpO₂/FiO₂ (from 238 [88–461] up to 320 [98–471], P=0.011) was registered. On days 5–7, positive changes in SpO₂/FiO₂ index (238 [88–461] vs 320 [96–471], P=0.0020) were observed in the Hemo-Proteasosorb without MLV group, as well as a trend toward further reduction in the levels of CRP (132.6 [30.7–183.0] vs 23.85 [2.2–200.0], P=0.0001) and fibrinogen (10.2 [4.41–15.5] to 5.11 [2.3–11.5], P=0.0017). The patients were assessed using the NEWS2 score at all the stages of the study. On days 2–3 of the study, a reduction in the mean NEWS2 score was noted in the Hemo-Proteasosorb + MLV group (8.0  [4.0–11.0] vs 6.0 [2.0–10.0], P=0.0002), whereas on days 5–7 its increase was seen vs stage 2 of the study with its values still lower than those prior to hemoadsorption (8.0 [4.0–11.0] vs 7.0 [2.0–9.0], P=0.011). On day 3 of treatment, in the Haemo-Proteasorb without MLV group we observed a decreased mean NEWS2 score (7.0 [3.0–9.0] vs 5.0 [1.0–9.0], P=0.00002), on days 5–7, this trend was still present (7.0 [3.0–9.0] vs 3.0 [1.0–8.0], P=0.00002).Conclusion. Hemoadsorption was beneficial for patients with severe COVID-19 during both oxygen therapy and mechanical ventilation due to decreased levels of inflammatory markers, hypercoagulation, and reduced NEWS2 scores.