#3317 THE EFFECT OF HEMOPERFUSION ON SURVIVAL AMONG COVID-19 CRITICALLY ILL PATIENTS IN A TERTIARY HOSPITAL IN DAVAO CITY, PHILIPPINES

Abstract

Abstract Background and Aims Cytokine storm in COVID-19 is an excessive immune response through the overproduction of inflammatory cytokines which significantly increases mortality. Hemoperfusion has been granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) in an effort to eliminate circulating inflammatory mediators among COVID-19 critical patients to improve clinical outcomes and survival. This study aims to determine the 8 – day survival of critical COVID-19 patients who received hemoperfusion. Method This is a descriptive study conducted among critically ill COVID-19 patients who completed hemoperfusion treatment admitted from October 2020 to October 2021 in a tertiary hospital in Davao City, Philippines. The inclusion criteria were adult patients greater than 18 years of age with RT-PCR confirmed SARS-CoV-2 infection who underwent and completed hemoperfusion during hospitalization for COVID-19. While those patients who did not complete the hemoperfusion treatment because of hemodynamic instability or death were excluded. All of the patients classified as COVID-19 critical received the standard treatment for COVID-19 such as steroids (dexamethasone) and antiviral (Remdesevir). Among the 1,037 COVID-19 adult patients admitted from October 2020 to October 2021, 28 of them were classified as critical and received hemoperfusion, but only 19 patients completed the treatment. Results Majority of patients in the study were males (14/19, 73.68%) with a mean age of 59 years (SD 12.90). Hypertension (n = 15, 78.95%) and Diabetes Mellitus (n = 14, 73.68%) were the most common comorbid illnesses. Cough (n = 15, 78.95%), fever (n = 11, 57.90%), and dyspnea (n = 7, 36.84%) were the frequent symptoms. The laboratory parameters (median hemoglobin, leukocytes, thrombocytes, creatinine, and ALT were within normal range except for an elevated median AST (54 U/L). Forty-two percent (8/19) of patients survived at day 8 (Figure 1). Survivors had higher baseline oxygen saturation compared to non-survivors (89% vs 78%), but in both groups, the oxygen saturation increased after hemoperfusion (Figure 2). All inflammatory markers (CRP, ferritin, LDH, and procalcitonin) decreased among survivors post-hemoperfusion. However, the ferritin, LDH, and procalcitonin remained elevated among non-survivors (Figure 3A, B, C D). The median time from symptoms onset to hemoperfusion initiation was longer in non-survivors compared to survivors (10 days vs 8 days) (Figure 4). Conclusion Close to half (42.11%) of the critical COVID-19 patients who underwent hemoperfusion survived at day 8. Therefore, hemoperfusion remains to be a beneficial adjunct treatment for critical COVID-19 patients especially if initiated early.