Continuous Renal Replacement Therapy with oXiris Filter May Not Be an Effective Resolution to Alleviate Cytokine Release Syndrome in non-AKI Patients with Severe and Critical COVID-19 (preprint)

Background: 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). Methods: 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 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 serum levels of cytokine and inflammatory chemokines, including IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ, were measured daily to reflect the degree of CRS induced by SARS-CoV-2 infection. Clinical data, including 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 during hospitalization, and then compared between the two groups. Results: Age, and SCr significantly differed between the two groups. Besides the IL-2 level that was significantly lower on day 2 than that on day 1 in the intervention group, and the IL-6 levels that were significantly higher on day 1, and day 2 in the intervention group compared to the control group, similar to the IL-10 level on day 5, there were no significant differences between the groups. Conclusion: 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).

Pulmonary Function of 449 Hospitalized COVID-19 Patients Which Including 141 Asymptomatic Carriers and 308 Mild and Moderate Cases (preprint)

Background: Since the COVID-19 outbreak, there has been a few articles on pulmonary function studies in COVID-19 patients discharged one month later or three month later. However, there is no literature mentioned about the pulmonary function of hospitalized COVID-19 patients so far.Methods: In this study, we firstly performed a retrospective study to identify the pulmonary function changes with 449 COVID-19 inpatients including 141 asymptomatic carriers compared with 228 non-COVID-19 outpatients which accepted pulmonary function test in health examine center.Results: We found that COVID-19 patients included asymptomatic carriers had worse pulmonary function compared to non-COVID-19 patients even when they were hospitalized. In addition, age may be an important factor which contributes to pulmonary dysfunction in COVID-19 patients. Besides, the IL-6 level in the blood may affect the evaluation of lung function results and may be used to predict the pulmonary function of COVID-19 patients.Conclusion: Early rehabilitation training for COVID-19 patients is critical to their recovery.Funding Information: Supported by Novel coronavirus pneumonia emergency treatment and diagnosis technology research project of Heilongjiang provincial science and Technology Department, the National Natural Science Foundation of China (No.81571871, 81770276), Harbin Medical University Cancer Hospital Haiyan Fund (JJMS2021-10), Heilongjiang Postdoctoral Fund (LBH-Z20070).Declaration of Interests: All the authors have no conflict of interest to declare.Ethics Approval Statement: A written informed consent was regularly obtained from all patients upon admission into the 1st affiliated hospital of Harbin Medical University (the intensive care center for severe COVID-19 patients in Harbin, Heilongjiang province). The study was approved by the Ethics Committee of 1st affiliated hospital of Harbin Medical University.

Pulmonary Dysfunction in Patients Recovered from COVID-19 Pneumonia: A 6-Month Follow-up Study (preprint)

Objectives: This study investigates the clinical features and pulmonary functions of COVID-19 pneumonia survivors at 3 or 6 months after diagnosis in the Heilongjiang Province, China.Methods: Forty-six patients with COVID-19 pneumonia diagnosed since February 2020 were enrolled in this study for follow-up in July 2020. These patients were categorized into three groups: Group A (n=24) and Group B (n=11) who were diagnosed with moderate or severe pneumonia and followed up at three months after diagnosis; Group C (n=11) who were diagnosed with severe pneumonia and followed up at six months after diagnosis. Data on pulmonary function, arterial blood gas analysis, chest CT, blood test, antibody test, and health-related quality of life during hospitalization and at the follow-up visits were collected and analyzed. Results: Abnormal PO2 (A-a) was more prevalent in severe cases (Group B and C) than in moderate cases (Group A). Pulmonary dysfunction was common in this cohort. Abnormal CT scores of severe cases (Group B and C) were significantly higher than that of moderate cases (Group A). During the follow-up, lung abnormalities gradually resolved in the first 3 months (Group A and B), however, further resolution was not significant from 3 months to 6 months (Group B and C). Conclusion: Although pulmonary interstitial changes due to COVID-19 pneumonia gradually reverse over time, pulmonary dysfunction is common and appears to persist at least up to 6 months in patients recovered from COVID-19 pneumonia.

Decreased T Cell Levels in Critically Ill Coronavirus Patients: single-center, prospective and observational study (preprint)

Background: Since Dec. 2019, COVID-19 pandemic has been outbreak. T cells play an important role in dealing with various disease-causing pathogens. However, the role of T cells played in COVID-19 patients is still unknown. Our study aimed to describe immunologic state of the critical ill COVID-19 patients. Methods: 63 patients with confirmed COVID-19 pneumonia admitted Department of Intensive Care Unit of the First Affiliated Hospital of Harbin Medical University. The immunologic characteristics（lymphocyte apoptosis, the expression of PD-1 and HLA-DR in T cells, T cell subset levels, redistribution and the production of inflammatory factors）as well as their laboratory parameters were compared between severe group and critical group.Results: The level of T cells in peripheral blood was decreased in critical patients compared with that in severe patients, but the expression levels of PD-1 (CD4+: 24.71% VS 30.56%; CD8+: 33.05% VS 32.38%) and HLA-DR (T cells: 36.28% VS 27.44%; monocytes: 20.58% VS 23.83%) in T cells were not significantly changed, and apoptosis and necrosis were not different in lymphocytes (apoptosis: 1.04% VS 1.27%; necrosis: 0.67% VS 1.11%), granulocytes, or monocytes between those two groups.Conclusions: There is severe immunosuppression in critical ill COVID-19 patients. Redistribution of T cells might be the main reason for lymphocytic decline. Decreasing the infiltration of T lymphocytes in the lung may be beneficial for the treatment of COVID-19. Trial registration: The study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University. Code number: kyk2020003.