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Aim of the study. To evaluate the value of predictors of hemoadsorption clinical efficacy in patients with COVID-19. Materials and methods. This study analyzed the results of treatment of 62 patients with severe COVID-19 in the intensive care unit using selective hemoadsorption of cytokines. All patients with severe COVID-19 were admitted to the intensive care unit within 14 days from the disease onset were subdivided into two groups. Group 1 patients (n=32) received on a top of standard treatment the hemoperfusion (HP) procedure for 4 hours, for 2-3 days in a row, using a cytokine sorption column composed of mesoporous styrene-divinilbenzen copolymer matrix. Group 2 patients were not subjected to extracorporeal blood purification. All patients received IL-6 inhibitors at a baseline in accordance to the temporary guidelines. We evaluated factors of unfavorable outcomes by analyzing changes in biochemical markers of systemic inflammatory response and mortality rates in patients of both groups. Results. Initiation of HP later than 10 days from NCI onset (P < 0.001), length of stay in the ICU, extent of lung damage (P = 0.036) and the SOFA (Sequential Organ Failure Assessment) score (P = 0.009) were the most powerful predictors of unfavorable outcome. Levels of systemic inflammatory response markers (in-terleukin-6, CRP, D-dimer) in both groups did not significantly affect the survival rates and length of hospital stay (P > 0.05). HP group demonstrated better survival (P < 0.05). Mean hospital stay was 31 and 27 days, ICU stay - 11 and 8 days for Groups 1 and 2, respectively (P < 0.05). Conclusion. Treatment of severe COVID-19 patients with HP using novel domestic hemosorbent composed of styrene-divinilbenzen copolymer matrix resulted in decrease in CRP levels on the first day after application and, with early onset, contributed to a significant increase in survival and decreased hospital and ICU stay. Additional studies are warranted to clarify the optimal timing of the initiation of HP in severe COVID-19 patients.Copyright © 2023, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
RESUMEN
Aim of the study. To evaluate the value of predictors of hemoadsorption clinical efficacy in patients with COVID-19. Materials and methods. This study analyzed the results of treatment of 62 patients with severe COVID-19 in the intensive care unit using selective hemoadsorption of cytokines. All patients with severe COVID-19 were admitted to the intensive care unit within 14 days from the disease onset were subdivided into two groups. Group 1 patients (n=32) received on a top of standard treatment the hemoperfusion (HP) procedure for 4 hours, for 2-3 days in a row, using a cytokine sorption column composed of mesoporous styrene-divinilbenzen copolymer matrix. Group 2 patients were not subjected to extracorporeal blood purification. All patients received IL-6 inhibitors at a baseline in accordance to the temporary guidelines. We evaluated factors of unfavorable outcomes by analyzing changes in biochemical markers of systemic inflammatory response and mortality rates in patients of both groups. Results. Initiation of HP later than 10 days from NCI onset (P < 0.001), length of stay in the ICU, extent of lung damage (P = 0.036) and the SOFA (Sequential Organ Failure Assessment) score (P = 0.009) were the most powerful predictors of unfavorable outcome. Levels of systemic inflammatory response markers (in-terleukin-6, CRP, D-dimer) in both groups did not significantly affect the survival rates and length of hospital stay (P > 0.05). HP group demonstrated better survival (P < 0.05). Mean hospital stay was 31 and 27 days, ICU stay - 11 and 8 days for Groups 1 and 2, respectively (P < 0.05). Conclusion. Treatment of severe COVID-19 patients with HP using novel domestic hemosorbent composed of styrene-divinilbenzen copolymer matrix resulted in decrease in CRP levels on the first day after application and, with early onset, contributed to a significant increase in survival and decreased hospital and ICU stay. Additional studies are warranted to clarify the optimal timing of the initiation of HP in severe COVID-19 patients.Copyright © 2023, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
RESUMEN
Objective. To evaluate the effect of succinate-containing crystalloid solution (sodium meglumin succinate) on the severity of endothelial dysfunction in patients with severe COVID-19. Material and methods. The study included 53 patients with severe form of COVID-19 complicated by bilateral polysegmental pneumonia. All patients are initially, by the method of envelopes, randomized into two groups. In the study group (27 patients), the intensive care complex includes daily infusion of Reamberin (1.5% solution of meglumin sodium succinate), in a daily dose of 10 ml/kg for 4 hours for up to 11 days (or time spent in the intensive care unit). Patients of the control group (26 patients) received Ringer's solution in the same volume. Endotheliocytosis, homocysteine concentration, platelet levels and coagulation tests were studied in dynamics. Results and discussion. Assessment of the severity of endothelial dysfunction showed that the study group determined a more significant (p<0.05) decrease in initially elevated levels of endothelial cytosis and homocysteine concentration at all stages of the study. Significant intergroup differences have manifested since the second day of observation. Infusion correction of the severity of endothelial dysfunction led to a decrease in the frequency of thrombotic complications, the probability of conversion to an invasive ventilator and mortality compared to the traditional approach. Conclusion. The use of a succinate-containing crystalloid solution (sodium meglumin succinate) in the complex therapy of severe forms of NCI is justified by a more significant and persistent correction of the initially pronounced endothelial dysfunction, leading to a decrease in the number of thrombotic complications, transfers to invasive ventilator and mortality. © 2022, Media Sphera Publishing Group. All rights reserved.
RESUMEN
Objective. Aim of the study: to analyze the short-term treatment outcomes for patients with COVID-19 and hematomas of different localizations. Material and methods. The profile of hospital admissions of Sokolov North-West Regional Scientific and Clinical Center changed at November 6th, 2020. 1.878 patients with COVID-19 were admitted in the hospital from November 6th, 2020 and March 2nd, 2021. 25 people (1.1%) of admitted patients developed hematomas. The average age was 70±5.6 years. They were no mild forms of the disease. Anticoagulants were used in all cases from the 1st day of hospitalization. The volume of lung damage correspond-ed to CT-4 in 48% of patients, CT-3 in 2 (8%) patients and CT-2 — in 11 (44%) patients. The methods of diagnostic imaging of he-matomas were CT, ultrasound, and laparoscopy. Results. Hematomas were represented by deep intramuscular hematomas in 96% (24 patients). The typical localization of the he-matomas was rectus muscle of the anterior abdominal wall (12 patients). Chest wall hematoma was detected less often (5 pa-tients) and limb hematomas (3 patients). Retroperitoneal hematoma was observed in 2 patients, gluteal hematoma — in 1 patient. There was a combination of hematomas of various anatomical areas in 2 patients: in one patient — in the anterior abdominal wall and hip, in the second — in the anterior abdominal wall and pelvis. Blood transfusion was performed in 12 patients (48%). Risk factors of hematomas formation were: initially critical or fast progression of lung lesion volume in patients with COVID-19, co-morbidity of patients, the presence of obesity and an increased level of D-dimer. These risk factors were associated with intensified anticoagulant therapy. Out of 25 patients, 8 (32%) people underwent surgical procedures, hematoma punctures were performed in 6 (24%) patients, and 11 (44%) patients received conservative therapy. The mortality rate was 40% (10 patients). The cause of death was progressive pneumonia (9 patients) and disseminated intravascular coagulation syndrome (1 patient). Conclusion. Hematomas of different sites can occur in COVID-19 patients upon anticoagulation treatment. The decision making process in such cases should be determined by the severity of the patient’s condition and lung damage, the localization of the he-matoma, the amount of blood loss, the dynamics of the volume of the hematoma, and the proportion of the fluid component in it according to ultrasound or CT. The development of hematomas in COVID-19 patients is associated with poor prognosis. © 2021, Media Sphera Publishing Group. All rights reserved.