Cytosorb Dialysis: An Adjunct for Survival in the Covid-19 Patient in Cytokine Storm? A Case Series

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to the biggest global health crisis of our lifetime. There is accumulating evidence that a substantial number of critically ill COVID-19 patients exhibit a dysregulated host response manifesting as cytokine storm or cytokine release syndrome which in turn contributes to the high observed rates of mortality. Just as in other hyperinflammatory conditions extracorporeal cytokine removal may have potential beneficial effects in this subgroup of COVID-19 patients. The CytoSorb blood purification device is the most extensively investigated cytokine removal platform with considerable evidence suggesting that early intervention can provide rapid hemodynamic stabilization and improvement in vital organ functions AIM OF THE STUDY Here we describe 4 cases of severely ill adult patients with coronavirus disease 2019 admitted to intensive care unit who were treated with CytoSorb therapy. METHOD(S) All 4 patients were admitted in the ICU with CT severity score of >15/25. During their clinical course, all patients were prescribed tocilizumab (an interleukin-6 receptor blocker) antivirals hydroxychloroquine azithromycin and other antibiotics and general antipyretic drugs. All patients received low-molecular-weight heparin thromboprophylaxis adjusted to baseline weight and renal function Patient A and C required invasive mechanical ventilation whereas Patients B D were on NIV The mean age of the patients was 67.7 years (range = 29-79) Patients received a median of 2 attempts of hemoperfusion. The median CytoSorb perfusion time was 20hrs. RESULT(S) The level of IL-6 significantly decreased after treatments. It reduced by 95% for Patient A, 70% for Patient B, 99% for Patient D Mean Arterial Pressure improved by 15 mmHg average for Patients A, B, D PaO2/FiO2 Ratio improved by 143 average for Patients A, B, D HsCRP levels fell by average of 39 mg/l for patients A, B, D Patient A expired 2 days after the cytosorb dialysis (Refractory Shock) Patient C expired following Dialysis Albumin mildly decreased after CytoSorb. No significant changes were found in red blood cell counts, white cell counts, and platelets. ICU and in-hospital mortality was 50%. CONCLUSION(S) In this case series, critically ill patients with COVID-19 with severe acute respiratory failure refractory to prone positioning and hypercytokinemia who received adjuvant treatment with cytokine hemoadsorption showed a significant reduction in IL-6 plasma levels and other inflammatory biomarkers. Improvements in oxygenation and MAP were also observed.