#4837 CLINICAL OUTCOMES OF HEMOPERFUSION WITH MG350 AMONG RT-PCR-CONFIRMED SEVERE AND CRITICAL COVID-19 PATIENTS IN A TERTIARY HOSPITAL IN LA UNION

Abstract

Abstract Background and Aims Hemoperfusion (HP) refers to the circulation of anticoagulated blood through an extracorporeal circuit with a disposable, adsorbent-containing cartridge. Earlier studies showed that HP stabilizes the plasma levels of cytokines in sepsis and septic shock. Case reports demonstrated the benefit of HP among COVID-19 patients with severe and critical illness but local data on the outcome of HP in COVID is still lacking. This study aimed to determine the clinical outcomes of HP with MG 350 cartridge among RT-PCR confirmed severe and critical COVID-19 patients admitted in a tertiary hospital in La Union in terms of the trend of clinical parameters before and after HP, mean duration of ventilatory support, mean duration of hospital stay and patient's disposition. Method This is a descriptive, correlational, retrospective cohort single-center study that reviewed the in-patient medical records of 89 RT-PCR confirmed severe and critical COVID-19 patients who underwent at least two HP treatments. We determined their clinical profile and described the trend of clinical parameters before and after HP. Outcome of HP in terms of mean duration of ventilatory support, mean duration of hospital stay and patient's disposition were determined. The possible significant influence of HP to the clinical profile and outcomes as well as clinical parameters to outcomes were also correlated. Results There was a significant decrease in the levels of inflammatory markers such as C-Reactive Protein (CRP), D-dimer, ferritin and Lactate dehydrogenase (LDH) as well as improved respiratory and perfusion parameters such as oxygen saturation and Partial pressure of Oxygen (PaO2) after HP. Patients with higher oxygen saturation, PaO2 and lower fraction of inspired oxygen (FiO2) had shorter duration of ventilatory support. Increased FiO2, CRP, D-dimer, ferritin, white blood cell (WBC) count and Neutrophil Lymphocyte Ratio (NLR) are highly correlated with increased mortality. Early hemoperfusion correlated with shorter duration of ventilatory support, shorter hospital stay and decreased mortality. Interestingly, those with higher oxygen saturation, Pao2, ferritin and procalcitonin correlated with longer duration of hospital stay after HP. Patients with critical illness and late HP had longer duration of ventilatory support. Patients with bilateral infiltrates on chest X-ray and those on mechanical ventilator had longer duration of hospital stay. Increased COVID severity and decreased mean arterial pressure (MAP) had higher likelihood of death even after HP. Conclusion Hemoperfusion significantly decreased the level of inflammatory markers thereby lowering the risk for cytokine storm for COVID-19 patients. Early HP is recommended as it is correlated with shorter duration of ventilatory support, shorter hospital stay and decreased mortality.