Effect of Hemoperfusion on the Clinical Outcome of Severe and Critical Covid-19 Patients Admitted at the University of Santo Tomas Hospital: An Analytical Cohort Study

ABSTRACT

Introduction: Severe sepsis is a life-threatening end organ dysfunction resulting from dysregulated host response to infection and poses a significant burden to healthcare systems worldwide. Since the advent of CoVID-19, cytokine release syndrome has also been attributed to clinical deterioration presenting as acute respiratory distress syndrome and acute kidney injury of infected individuals. Objective(s) To determine the clinical outcome of Severe and Critical COVID-19 patients who underwent hemoperfusion compared with patients who did not undergo hemoperfusion. Method(s) This study entailed a retrospective cohort analysis of patients aged >= 18 and < 90 years old admitted at University of Santo Tomas Hospital who were diagnosed with Severe or Critical COVID-19. Subjects were grouped between those who underwent hemoperfusion (HP group) using HA 330 cartridge and those who did not undergo the procedure (non-HP). Demographic and clinical data collected for both groups included age, sex, comorbidities present, time to initiation of hemoperfusion, total hemoperfusion time, use of other medications specifically immunomodulator and anti-viral drugs, antibiotics and steroid, length of hospital stay and in-hospital mortality. Mean arterial pressure, cardiac rate, oxygen saturation, arterial blood gas, complete blood count, oxygen requirement, inotropic score, serum creatinine, urine output, lactate dehydrogenase (LDH), ferritin, high sensitivity C-reactive protein (HsCRP), Interleukin-6 values and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were compared from baseline and after 4 sessions of hemoperfusion for the HP group. The clinical outcomes: length of hospital stay, in-hospital mortality and time to off high flow nasal cannula (HFNC) between two groups were also compared. Result(s) A total of 98 cases were included, 49 subjects underwent hemoperfusion using HA 330 and 49 patients did not undergo hemoperfusion. Demographic data is similar between both groups. Baseline clinical data between Hemoperfusion and non-Hemoperfusion group did not show statistical difference. However, Baseline LDH, HsCRP, Ferritin, IL-6, PF ratio and APACHE II score were statistically different between two groups. Effect on Disease Severity Length of hospital stay and time to off HFNC was shorter in the non-HP group vs the HP group, median of 13 days vs 18 days (p-value 0.003) and 107 hours vs 222 hours (p- value <0.001), respectively. There is also no significant difference in in-hospital mortality between two groups. [Formula presented] [Formula presented] [Formula presented] Conclusion(s) This retrospective study did not show survival benefit with the use of hemoperfusion. Undergoing hemoperfusion did not show a significant effect on changes in disease severity as represented by no significant difference seen in APACHE II score, PF ratio, acute kidney injury, length of hospital stay and in-hospital mortality. Hemoperfusion also has no significant effect in terms of decreasing the values of inflammatory markers LDH, ferritin, and IL-6. A large, multi-center, randomized clinical trial is warranted to truly determine the clinical benefit of hemoperfusion not only in severe to critical COVID-19 but also in severe sepsis and conditions that trigger systemic inflammatory response and cytokine storm. *This abstract was also submitted for the ISN FrontiersInfections and the Kidneys congress. No conflict of interestCopyright © 2023