Abstract
In this study, we aimed to determine whether continuous renal replacement therapy (CRRT) with oXiris filter may alleviate cytokine release syndrome (CRS) in non-AKI patients with severe and critical coronavirus disease 2019 (COVID-19). A total of 17 non-AKI patients with severe and critical COVID-19 treated between February 14 and March 26, 2020 were included and randomly divided into intervention group and control group according to the random number table. Patients in the intervention group immediately received CRRT with oXiris filter plus conventional treatment, while those in the control group only received conventional treatment. Demographic data were collected and collated at admission. During ICU hospitalization, the concentrations of circulating cytokines and inflammatory chemokines, including IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ, were quantitatively measured daily to reflect the degree of CRS induced by SARS-CoV-2 infection. Clinical data, including the severity of COVID-19 white blood cell count (WBC), neutrophil proportion (NEUT%), lymphocyte count (LYMPH), lymphocyte percentage (LYM%), platelet (PLT), C-reaction protein (CRP), high sensitivity C-reactive protein (hs-CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), albumin (ALB), serum creatinine (SCr), D-Dimer, fibrinogen (FIB), IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, number of hospital days and sequential organ failure assessment (SOFA) score were obtained and collated from medical records, and then compared between the two groups. Age, and SCr significantly differed between the two groups. Besides the IL-2 concentration that was significantly lower on day 2 than that on day 1 in the intervention group, and the IL-6 concentrations that were significantly higher on day 1, and day 2 in the intervention group compared to the control group, similar to the IL-10 concentration on day 5, there were no significant differences between the two groups. To sum up, CRRT with oXiris filter may not effectively alleviate CRS in non-AKI patients with severe and critical COVID-19. Thus, its application in these patients should be considered with caution to avoid increasing the unnecessary burden on society and individuals and making the already overwhelmed medical system even more strained (IRB number: IRB-AF/SC-04).
Highlights
Excessive and uncontrolled systemic immune responses are the real culprit of disease deterioration and death in patients with Coronavirus disease 2019 (COVID-19), and not fatal virus infection (Gao et al, 2021)
The therapeutic purpose of continuous renal replacement therapy (CRRT) has evolved from the single replacement of kidney function to support of multiple organ systems via the removal of circulating cytokines and inflammatory mediators. It can be considered for use in acute respiratory distress syndrome (ARDS) induced by current SARS-CoV-2 infection, especially for severe and critical COVID-19 patients with cytokine release syndrome (CRS), regardless of the presence of acute kidney injury (AKI) complications (Gao et al, 2019; Zhang et al, 2020; Xiang et al, 2021). oXiris filter is a highly biocompatible modified hemodiafilter with a special heparin-coated design, which can be combined with CRRT in clinical practice
CRRT with oXiris filter can further enhance the clearance of circulating cytokines and inflammatory chemokines, improve clinical symptoms and laboratory indicators, reduce disease severity, and prolong the survival time in critically ill patients with COVID-19 (Cascarano et al, 2021; Premužić et al, 2021; Rosalia et al, 2021)
Summary
Excessive and uncontrolled systemic immune responses are the real culprit of disease deterioration and death in patients with Coronavirus disease 2019 (COVID-19), and not fatal virus infection (Gao et al, 2021). The therapeutic purpose of continuous renal replacement therapy (CRRT) has evolved from the single replacement of kidney function to support of multiple organ systems via the removal of circulating cytokines and inflammatory mediators. It can be considered for use in acute respiratory distress syndrome (ARDS) induced by current SARS-CoV-2 infection, especially for severe and critical COVID-19 patients with CRS, regardless of the presence of acute kidney injury (AKI) complications (Gao et al, 2019; Zhang et al, 2020; Xiang et al, 2021). The relevant studies mainly focused on acute or chronic renal failure in patients with COVID-19, which is one of the potential indications for CRRT initiation
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