Hemoperfusion with CytoSorb® in Critically Ill COVID-19 Patients

Abstract

<b><i>Introduction:</i></b> Systematic inflammatory response occurred in some critically ill patients with COVID-19. Cytokine reduction by hemadsorption is a mechanism of treatment. However, whether CytoSorb hemoperfusion works for critically ill COVID-19 patients remains unknown. <b><i>Materials and Methods:</i></b> We observed case series of critically ill COVID-19 patients receiving CytoSorb hemoperfusion as rescue therapy from 3 hospitals in Hubei, China from February 28, 2020, to April 7, 2020. Their demographic, laboratory, and clinical data were collected. The parameters for organ function and IL-6 levels were compared before and after treatments. <b><i>Results:</i></b> A total of 10 cases were included. The median age of the patients was 67.7 years (range = 50–85) with APACHE II (23.5) and SOFA (11.4). Patients received a median of 3 attempts of hemoperfusion (range = 1–6). The median CytoSorb perfusion time was 47 h (12–92 h). The level of IL-6 significantly decreased after treatments (712.6 [145–5,000] vs. 136.7 [46.3–1,054] pg/mL, <i>p</i> = 0.005). Significant improvement was found in PaO₂/FiO₂ (118 [81–220] vs. 163 [41–340] mm Hg, <i>p</i> = 0.04) and lactate levels (2.5 [1–18] vs. 1.7 [1.1–10] mmol/L, <i>p</i> = 0.009). The hemodynamics measured by norepinephrine/MAP slightly improved after treatment (17 [0–68] vs. 8 [0–39], <i>p</i> = 0.09). Albumin mildly decreased after CytoSorb. No significant changes were found in red blood cell counts, white cell counts, and platelets. <b><i>Conclusion:</i></b> Treatment with CytoSorb in critically ill COVID-19 patients was associated with decreased IL-6 improvement in oxygenation. However, these effects cannot be confirmed as the direct effects of CytoSorb owing to lack of controls. Establishing causality requires large-scale randomized clinical trials.