Decreased CRRT Filter Lifespan in COVID-19 ICU Patients.

David Legouis,Céline Binvignat,Maria F Montalbano,Pierre Emmanuel Marti,Nils Siegenthaler,Jérôme Pugin,Benjamin Assouline,Claudia Heidegger,Camille Thieffry,Claudio Andreetta,Sebastian D Sgardello,Frédéric Sangla

doi:10.3390/jcm10091873

David Legouis, Céline Binvignat + Show 10 more

Open Access

https://doi.org/10.3390/jcm10091873

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Abstract

(1) Background: Increased thromboembolic events and an increased need for continuous renal replacement therapy (CRRT) have been frequently reported in COVID-19 patients. Our aim was to investigate CRRT filter lifespan in intensive care unit (ICU) COVID-19 patients. (2) Methods: We compared CRRT adjusted circuit lifespan in COVID-19 patients admitted for SARS-CoV-2 infection to a control group of patients admitted for septic shock of pulmonary origin other than COVID-19. Both groups underwent at least one session of CRRT for AKI. (3) Results: Twenty-six patients (13 in each group) were included. We analysed 117 CRRT circuits (80 in the COVID-19 group and 37 in the control group). The adjusted filter lifespan was shorter in the COVID-19 group (17 vs. 39 h, p < 0.001). This trend persisted after adjustment for confounding factors (−14 h, p = 0.037). Before CRRT circuit clotting, the COVID-19 group had a more procoagulant profile despite higher heparin infusion rates. Furthermore, we reported a decreased relation between activated partial thromboplastin time (aPTT) and cumulative heparin dose in COVID-19 patients when compared to historical data of 23,058 patients, suggesting a heparin resistance. (4) Conclusion: COVID-19 patients displayed a shorter CRRT filter lifespan that could be related to a procoagulant profile and heparin resistance.

Highlights

Introduction published maps and institutional affilAcute kidney injury (AKI) is frequently associated with critically ill coronavirus disease (COVID-19) patients and occurs in a third of intensive care unit (ICU) patients, of whom 10 to 20% require continuous renal replacement therapy (CRRT) [1,2,3]
Among the 129 COVID-19 ICU patients screened, 13 patients requiring CRRT were included in the COVID-19 group (Figure 1)
We found a decrease in filter lifespan in these patients compared to ICU patients admitted for septic shock of pulmonary origin other than COVID-19

Summary

Introduction

Introduction published maps and institutional affilAcute kidney injury (AKI) is frequently associated with critically ill coronavirus disease (COVID-19) patients and occurs in a third of intensive care unit (ICU) patients, of whom 10 to 20% require continuous renal replacement therapy (CRRT) [1,2,3]. The main limitation of CRRT is the premature clotting of the filters leading to blood loss, decreased effectiveness and a longer duration of treatment which in turn increases costs [4,5]. Numerous factors pertaining to CRRT modalities, clinical features, biological parameters and coagulation parameters have been identified [6]. Due to their highly inflammatory state, patients with COVID-19 express hypercoagulability [7], and have a higher risk of vascular thromboembolisms [8,9,10,11,12,13]. The alteration of coagulation in COVID-19 patients may affect the lifespan of the CRRT circuit due to early clotting of filters [14]

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