MO373EXPERIENCE OF EXTRACORPOREAL BLOOD PURIFICATION METHODS APPLICATION TO PATIENTS WITH SEVERE COVID - 19

Abstract

Background and AimsIn the rapidly changing conditions of life due to the COVID - 19 pandemic, the medical society around the world have faced with the question of treatment previously unknown, multi-faceted and insidious infection. The coronavirus infection has forced doctors to reconsider the tactics of intensive care patients in critical condition. To date, overall mortality rate from COVID – 19 varied from 8.11 to 120.85 per 100.000 population (Johns Hopkins University mortality analyses). Mortality rate in extremely severe cases exceeds 60% - 78% (Yang et al., Lancet Respiratory Medicine, 2020. Zhou et al., Lancet, 2020).We would like to share our clinical experience of extracorporeal blood purification methods application to patients in ICU with various clinical manifestations, as well as the presence of comorbid pathology.MethodWe conducted a retrospective analysis of 239 medical records of patients hospitalized in the ICU of JSC NRCSC Nur-Sultan, Kazakhstan because of severe course of COVID 19. Period of hospitalization from 16.06.2020 to 29.09.2020, the total number of beds - 97, in the ICU - 25.ResultsThe total number of patients with COVID -19 - 239 patients. In ICU -67 patients. Patients required in renal replacement therapy (RRT) – 31 patients.Among patients on RRT males-28 (90.3%) - female-3 (9.67%).Mean age-60 years.Distribution of the comorbid pathology.NOComorbid pathologyN = 31Diabetes insipidus10 (32,2%)Sepsis5 (16.1%)MODS6 (19.3%)Acute kidney damage 2 (KDIGO 2018)9 (29%)Acute kidney damage 3 (KDIGO 2018)5 (16.1%)Anuria11 (35.48%)Acute respiratory failure 324 (77.4%)ARDS19 (61.29%)Artificial lung ventilation28 (90.32%)COPD3 (9.67%)Hypertension9 (29%)Ischemic heart disease6 (19.3%)Obesity9 (29%)Cytokine storm19 (61.29%)ECMO15 (48.38%)LVAD1 (3.22%)Gastric ulcer1 (3.22%)Indications for RRT: acute respiratory failure in the absence of heart failure or fluid overload; presence of diffuse alveolar damage (DAD) (detected by high-resolution CT); PaO2 / FiO2 ≤ 300 mm Hg Duration:> 6-24 hours per column with a blood flow rate of 80-120 ml/min. In addition, indications for the urgent start of extracorporeal treatment are:signs of severe coronavirus infection (respiratory rate ≥ 30 per minute and / or blood oxygen saturation ≤ 93% and / or PO2/FiO2 index ≤ 200 mmHg;detection of lung lesion progression using one of the imaging methods ≥10% per day;progressive increase in the level of inflammatory markers (CRP, IL-6, etc.).The duration of hospitalization in the ICU – 12.54 days.Combinations and duration of the procedures.Name of the procedure(n)Duration (in hour)HP HA330 + CVVHF/CVVHDF 2+1+1 (n=33)> 1224 чHP Cytosorb© + CVVHF/CVVHDF 1+1+1(n=5)> 24 чHP HA330II+ CVVHF/CVVHDF 2+1+1 (n=31)> 1224 чPE + CVVHF/CVVHDF 2+1+1(n=7)> 624 чHP2+1+1(n=14)> 3-6 чFootnote: combinations and duration of use are in accordance with the recommendations of Ronco C. et al. (2020).Laboratory data - Leukocyte, CRP, Interleukine, procalcitonin, Creatinin, presepsin in dynamics.Laboratory dataBefore blood purificationAfter the 1st procedureAfter the 2nd procedureAfter the 3d procedurep valueLeukocyte15.3013.3110.688.230.01CRP17.9116.1214.1013.020.02Il - 6260.77205.82201.188188.90.027PCT26.5812.134.345.560.01Creat2.331.771.891.340.01Presepsin2420.242788.811783.562063.410.18General Mortality – 37 from 239 (15.5%)Mortality in ICU – 37 from 67 (55.2%)According to literature review, the mortality rate of patients with severe COVID - 19 in the ICU (Fawad Rahim et al, Cureus . 2020 Oct 12;12(10):e10906. doi: 10.7759/cureus.10906.) without the use of CRRT exceeds 70-77%.)ConclusionOur analysis had showed a positive effect of early use (1 day of hospitalization) of extracorporeal methods of blood purification, on a decreasing of inflammation indicators, as well as positive survival rate of patients with severe COVID-19 course in ICU conditions.