Treatment of AKI With Continuous Renal Replacement Therapy and CytoSorb in Critically Ill Hospitalised Patients With COVID-19

ABSTRACT

Background: AKI is common in critically ill patients with COVID-19. The aim of this study was to evaluate the 30-and 60-day survival of patients with COVID-19 and AKI, treated in the ICU. We analysed two groups of patients patients in the first group were treated with CRRT only, and patients in the second group were treated with CRRT plus hemoadsorption with Cytosorb cartridge. Method(s) This is a retrospective study of patients admitted with COVID-19 between March, 2020 and April, 2022 in all COVID ICUs of our hospital. Inflammatory and biochemical biomarkers at admission, length of ICU stay, and mortality at day 30 and day 60 after ICU admission were analysed. Result(s) One hundred two patients (mean age 68.1+/-8.1 years, 74.5% male) had AKI requiring CRRT, and 44 (43.1%) out of these patients were treated concomitantly with CRRT and Cytosorb. Of the prior concomitant diseases, 39 (38.2%) patients had diabetes, 75 (73.5%) had hypertension, 22 (21.6%) had heart failure, and 26 (25.5%) had chronic kidney disease. Patients treated with CRRT and Cytosorb were younger (64.7 vs. 70.6 years;p<0.001), had lower serum creatinine levels (294 vs. 405 mumol/L;p<0.001), urea levels (29 vs. 48 mmol/L;p < 0.001), higher levels of IL-6 (1754 vs. 385 pg/mL;p<0.001) and lactate dehydrogenase (8.8 vs.7.1;p=0.038). We found no statistically significant difference between the two groups for serum lactate, ferritin, D-dimer, C-reactive protein, and procalcitonin. Onset of treatment was earlier in patients treated with CRRT and Cytosorb than in patients treated with CRRT alone (11.4 vs. 18.2 days;p=0.005). Mean length of stay in ICU was 27.4+/-20.2 days, with no differences between the two groups. Mortality 30 and 60 days after ICU admission was in all patients 58.8% and 76.5%. In patients treated with CRRT alone, mortality at 30 and 60 days was 65.5% and 84.5%, and in patients treated with CRRT and Cytosorb, 50% and 65.9%. The number of patients who died 60 days after ICU admission was statistically significantly higher in the group of patients treated with CRRT alone (x2, p=0.029). The most common causes of death were sepsis and multiple organ failure (55.1%), acute respiratory failure (24.4%), and cardiac arrest (19.2%). Conclusion(s) CRRT and CytoSorb cartridge treatment results in improved 60-day survival in COVID-19 ICU patients with AKI.