Expert recommendations for blood purification protocol in patients with severe COVID-19

Abstract

The new coronavirus pneumonia (COVID-19) occurred in Wuhan in December 2019. Subsequent outbreak of COVID-19 worldwide is defined by the World Health Organization (WHO) as a public health emergency of international concern. Epidemiological data showed that the severe COVID-19 patients accounted for as high as 20% or more. In addition to the impairment of respiratory system, acute kidney injury (AKI) remains one of the main complications. Immune damage mediated by cytokine storms and concomitant AKI contribute a key factor of poor prognosis. Based on the previous experience of blood purification in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) combined with clinical front-line practice, we have developed a blood purification protocol for severe COVID-19 patients. This protocol is divided into four major steps: The first step is to assess whether patients with severe COVID-19 need blood purification; the second step is to prescribe a blood purification treatment for COVID-19 patients; the third step is to monitor and adjust the parameters of blood purification; the fourth step is to evaluate the timing of discontinue the blood purification. It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implementation of the present protocol.