Blood purification methods in complex treatment of patients with a new coronavirus infection

Yaroustovsky M.B.; Shukevich D.L.; Ushakova N.D.; Sokolov A.A.; Rey S.I.

doi:https://doi.org/10.17116/anaesthesiology202005147

Close metadata

Recommended articles:

Neurometabolic therapy with Cerebrolysin in patients with sepsis-associated encephalopathy. Russian Journal of Anesthesiology and Reanimatology. 2024;(6):46-54

Heart failure with preserved ejection fraction: morphofunctional state of the heart throughout 2 years after COVID-19 pneumonia. Russian Cardiology Bulletin. 2024;(3):53-61

ALDH1, CD133, CD34-positive cancer stem cells in lung adenocarcinoma in patients who had a new coronavirus infection and retained the persistence of viral proteins in the lung tissue. Russian Journal of Archive of Pathology. 2024;(5):5-14

Factors affecting the quality of life of patients with neurological manifestations of post-COVID syndrome. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(9):44-50

The use of alginate plates with a complex of antimicrobial peptides and cytokines after surgical interventions on periodontal tissues as a prevention of early postoperative complications. Stomatology. 2024;(5):19-23

«Cytokine storm» as an immunopathologic reaction in pregnant women in the first trimester. Russian Bulletin of Obstetrician-Gynecologist. 2024;(5):19-24

Incidence of sudden cardiac death among diseases of the circulatory system during the COVID-19 pandemic in the Penza region. Forensic Medical Expertise. 2024;(5):10-14

Morphofunctional and biochemical determinants of endothelial function in patients with a new coronavirus infection COVID-19. Russian Journal of Preventive Medicine. 2024;(10):90-96

Local cytokine profile of the endometrium in patients with repeated implantation failures and its pharmacological correction by the secretome of peripheral blood mononuclear cells. Russian Journal of Human Reproduction. 2024;(5):46-54

The relationship between inflammatory markers, fatigue, and effort-based decision-making in patients at clinical high risk for psychosis. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(10):85-91

Abstract:

Blood purification methods are widely used for sepsis, systemic inflammatory response and multiple organ failure. The new coronavirus infection followed by sepsis or septic shock in severe cases is characterized by imbalance in concentrations of pro- and anti-inflammatory mediators (the so-called cytokine storm). These processes result the development and progression of multiple organ failure. Special attention is paid to impaired renal function, since acute renal damage in COVID-19 is a predictor of an adverse outcome. In this situation, blood purification methods are advisable for discontinuation of cytokine storm on the one hand and treatment/prevention of acute kidney injury on the other one. The authors describe blood purification methods which are currently used in the treatment of sepsis and septic shock and can be used for COVID-19. Effectiveness of some of these techniques have been already confirmed. The issues of acute renal injury and options for renal replacement therapy are also considered.

Keywords:

COVID-19

cytokine storm

sepsis

acute renal injury

renal replacement therapy

lipopolysaccharide

cytokines

plasma exchange

plasma filtration

Authors:

Yaroustovsky M.B.

Bakulev National Medical Research Center for Cardiovascular Surgery

Shukevich D.L.

Research Institute for Complex Issues of Cardiovascular Diseases

RSCI AuthorID: 484246
Scopus AuthorID: 55588843000
ORCID: 0000-0001-5708-2463

Ushakova N.D.

National Oncology Research Center

Sokolov A.A.

Mechnikov North-Western State Medical University

Rey S.I.

Sklifosovsky Research Institute of Emergency Care

Received:

05.04.2020

Accepted:

12.07.2020

Close metadata

References:

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine. 2020;46(5):846-848. https://doi.org/10.1007/s00134-020-05991-x
Ronco C, Ricci Z, Husain-Syed F. From Multiple Organ Support Therapy to Extracorporeal Organ Support in Critically Ill Patients. Blood Purification. 2019;48(2):99-105.
Fanelli V, Fiorentino M, Cantaluppi V, Gesualdo L, Stallone G, Ronco C, Castellano G. Acute kidney injury in SARS-CoV-2 infected patients. Critical Care. 2020;24(1):155. https://doi.org/10.1186/s13054-020-02872-z
Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, Li J, Yao Y, Ge S, Xu G. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International. 2020;97(5):829-838. https://doi.org/10.1016/j.kint.2020.03.005
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW; the Northwell COVID-19 Research Consortium, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(2):2052-2059. https://doi.org/10.1001/jama.2020.6775
Durvasula R, Wellington T, McNamara E, Watnick S. COVID-19 and Kidney Failure in the Acute Care Setting: Our Experience from Seattle. American Journal of Kidney Diseases. 2020;8:S0272-6386(20)30618-1. https://doi.org/10.1053/j.ajkd.2020.04.001
Teixeira C, Garzotto F, Piccinni P, Brienza N, Iannuzzi M, Gramaticopolo S, Forfori F, Pelaia P, Rocco M, Ronco C, Anello CB, Bove T, Carlini M, Michetti V, Cruz DN; NEFROlogia e Cura INTensiva (NEFROINT) investigators. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Critical Care. 2013;17(1):14. https://doi.org/10.1186/cc12484
Gibney N, Hoste E, Burdmann EA, Bunchman T, Kher V, Viswanathan R, Mehta RL, Ronco C. Timing of initiation and discontinuation of renal replacement therapy in AKI: unanswered key questions. Clinical Journal of the American Society of Nephrology. 2008;3(3):876-880. https://doi.org/10.2215/CJN.04871107
Friedrich JO, Wald R, Bagshaw SM, Burns KE, Adhikari NK. Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis. Critical Care. 2012;16(4):R146. https://doi.org/10.1186/cc11458
Ronco C, Ricci Z, De Backer D, Kellum JA, Taccone FS, Joannidis M, Pickkers P, Cantaluppi V, Turani F, Saudan P, Bellomo R, Joannes-Boyau O, Antonelli M, Payen D, Prowle JR, Vincent JL. Renal replacement therapy in acute kidney injury: controversy and consensus. Critical Care. 2015;19(1):146. https://doi.org/10.1186/s13054-015-0850-8
Fayad AI, Buamscha DG, Ciapponi A. Intensity of continuous renal replacement therapy for acute kidney injury. The Cochrane Database of Systematic Reviews. 2016(10):CD010613. https://doi.org/10.1002/14651858.CD010613.pub2
Wang Y, Gallagher M, Li Q, Lo S, Cass A, Finfer S, Myburgh J, Bouman C, Faulhaber-Walter R, Kellum JA, Palevsky PM, Ronco C, Saudan P, Tolwani A, Bellomo R. Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: a systematic review and individual patient data meta-analysis. Nephrology Dialysis Transplantation. 2018;33(6):1017-1024. https://doi.org/10.1093/ndt/gfx308
Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nature Reviews. Nephrology. 2020;16(6):308-310. https://doi.org/10.1038/s41581-020-0284-7
Malard B, Lambert C, Kellum J. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices. Intensive Care Medicine Experimental. 2018;6(1):12. https://doi.org/10.1186/s40635-018-0177-2
Zhang C. Usage of oXiris hemofilter for septic shock patients a single-center experience 2019. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(12):1531-1534. https://doi.org/10.3760/cma.j.issn.2095-4352.2019.12.019
Zhang L. Hemofilter with Adsorptive Capacities Case Report Series 2019. Blood Purification. 2019;47(Suppl 3):1-6. https://doi.org/10.1159/000499357
Broman ME, Hansson F, Vincent JL, Bodelsson M. Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: A randomized crossover double-blind study. PLoS One. 2019; 14(8):e0220444.
Sakai Y. Polymethylmethacrylate membrane with a series of serendipity. Contributions to Nephrology. 2011;173:137-147. https://doi.org/10.1159/000329052
Memoli B, Postiglione L, Cianciaruso B, Bisesti V, Cimmaruta C, Marzano L, Minutolo R, Cuomo V, Guida B, Andreucci M, Rossi G. Role of different dialysis membranes in the release of interleukin-6-soluble receptor in uremic patients. Kidney International. 2000;58(1):417-424. https://doi.org/10.1046/j.1523-1755.2000.00181.x
Nakada T, Oda S, Matsuda K, Sadahiro T. In: High-Performance Membrane Dialyzers. Saito A, Kawanishi H, Yamashita AC, Mineshima M, eds. Contributions to Nephrology. Basel, Karger, 2011;173:137-147.
Hirasawa H, Sugai T, Ohtake Y, Oda S, Matsuda K, Kitamura N. Blood purification for prevention and treatment of multiple organ failure. World Journal of Surgery. 1996;20(4):482-486. https://doi.org/10.1007/s002689900076
Sakai M. Efficacy of continuous haemodiafiltration using a polymethylmethacrylate membrane haemofilter in the treatment of sepsis and acute respiratory distress syndrome. Critical Care. 2012;16(Suppl 1):378. https://doi.org/10.1186/cc10985
Nishida O, Ogura H, Egi M, Fujishima S, Hayashi Y, Iba T, Imaizumi H, Inoue S, Kakihana Y, Kotani J, Kushimoto S, Masuda Y, Matsuda N, Matsushima A, Nakada TA, Nakagawa S, Nunomiya S, Sadahiro T, Shime N, Yatabe T, Hara Y, Hayashida K, Kondo Y, Sumi Y, Yasuda H, Aoyama K, Azuhata T, Doi K, Doi M, Fujimura N, Fuke R, Fukuda T, Goto K, Hasegawa R, Hashimoto S, Hatakeyama J, Hayakawa M, Hifumi T, Higashibeppu N, Hirai K, Hirose T, Ide K, Kaizuka Y, Kan’o T, Kawasaki T, Kuroda H, Matsuda A, Matsumoto S, Nagae M, Onodera M, Ohnuma T, Oshima K, Saito N, Sakamoto S, Sakuraya M, Sasano M, Sato N, Sawamura A, Shimizu K, Shirai K, Takei T, Takeuchi M, Takimoto K, Taniguchi T, Tatsumi H, Tsuruta R, Yama N, Yamakawa K, Yamashita C, Yamashita K, Yoshida T, Tanaka H, Oda S. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016). Journal of Intensive Care. 2018;6:7. https://doi.org/10.1186/s40560-017-0270-8
Novaya koronavirusnaya infektsiya COVID-19. Accessed July 18, 2020. (In Russ.). https://www.mhlw.go.jp/content/000609467.pdf
Ronco C, Reis T, De Rosa S. Coronavirus Epidemic and Extracorporeal Therapies in Intensive Care: si vis pacem para bellum. Blood Purification. 2020;49(3):255-258. https://doi.org/10.1159/000507039
Yaroustovsky M, Abramyan M, Popok Z, Nazarova E, Stupchenko O, Popov D, Plushch M, Samsonova N. Preliminary report regarding the use of selective sorbents in complex cardiac surgery patients with extensive sepsis and prolonged intensive care stay. Blood Purification. 2009,28(3):227-233. https://doi.org/10.1159/000231988
Boschetti-de-Fierro A, Voigt M, Storr M, Krause B. Extended characterization of a new class of membranes for blood purification: the high cut-off membranes. The International Journal of Artificial Organs. 2013;36(7):455-463. https://doi.org/10.5301/ijao.5000220
Villa G, Chelazzi C, Morettini E, Zamidei L, Valente S, Caldini A.L, Zagli G, De Gaudio A.R, Romagnoli S. Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study. PLoS One. 2017;12(2):e0172039. https://doi.org/10.1371/journal.pone.0172039
Asociación Panameña de Medicina Critica y Terapia Intensiva, GUÍAS nacionales de atención de pacientes adultos Covid-19. Version 2.0. Accessed July 18, 2020. https://medcriticapanama.com
Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y, Sub R, Tian Z, Xu X, Wei H. Pathogenic T cells and inflammatory monocytes incite inflammatory storm in severe COVID-19 patients. Proceedings of the National Academy of Sciences of the United States of America. 2020;117(20):10970-10975. https://doi.org/10.1093/nsr/nwaa041
Xu XL, Han MF, Li TT, Sun W, Wang DS, Fu BQ, Zhou YG, Zheng XH, Yang Y, Li XY, Zhang XH, Pan AJ, Wei HM. Effective treatment of severe COVID-19 patients with tocilizumab. China Xiv. Journal of Translational Medicine. 2020;18:164. https://doi.org/10.1186/s12967-020-02339-3
Rahmati M, Moosavi M. Cytokine-targeted therapy in severely ill COVID-19 patients: Options and cautions. Eurasian Journal of Medicine and Oncology. 2020;4(2):179-181. https://doi.org/10.14744/ejmo.2020.72142
Zhang Y, Yu L, Tang L, Zhu M, Jin Y, Wang Z, Li L. A Promising Anti-Cytokine-Storm Targeted Therapy for COVID-19: The Artiﬁcial-Liver Blood-Puriﬁcation System. Engineering (Beijing, China). 2020. Online ahead of print. https://doi.org/10.1016/j.eng.2020.03.006
Organ Crosstalk in Critical Illness. Accessed July 18, 2020. https://www.youtube.com/watch?v=9AjiFYVfuUA
COVID-19 Experience from Italy and China — Strategy of Extracorporeal Organ Support. Accessed July 18, 2020. https://youtu.be/Xs9g0kfxhE8
National Health Commission of the People’s Republic of China, National Administration of Traditional Chinese Medcine. Guideline for Diagnosis. Engineering 6 (2020) and treatment of COVID-19 (7th version) [Internet]. Accessed July 18, 2020. https://www.nhc.gov.cn/yzygj/s7653p/202003
Bein B, Bachmann M, Huggett S, Wegermann P. SARS-CoV-2/COVID-19: Empfehlungen zu Diagnostik und Therapie. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS. 2020;55(4):257-265. https://doi.org/10.1055/a-1146-8674
Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, Maffei C, Possenti S, Piva S, Latronico N, Focà E, Castelli F, Gaggia P, Movilli E, Bove S, Malberti F, Farina M, Bracchi M, Costantino EM, Bossini N, Gaggiotti M, Scolari F; Brescia Renal COVID Task Force. Managment of patients on dialysis and with kidney transplant during COVIN-19 coronavorus infection. Kidney International Reports. 2020;5(5):580-585. https://doi.org/10.1016/j.ekir.2020.04.001
Jarczak D, Nierhaus A. University Clinic Hamburg-Eppendorf, Hamburg, Germany NCT 04344080 U1111-1250-2078 (Registry Identifier: UTN) DRKS00021199 (Registry Identifier: DRKS).
Zhang Y, Yu L, Tang LL, Zhu M, Jin Y, Wang Z, Li L. A Promising Anti-Cytokine-Storm Targeted Therapy for COVID-19: The Artificial-Liver Blood-Purification System. Engineering (Beijing, China). 2020. Online ahead of print. https://doi.org/10.1016/j.eng.2020.03.006
Yaroustovsky M, Abramyan M, Komardina E, Nazarova H, Popov D, Plyushch M, Soldatkina A, Rogalskaya E. Selective LPS Adsorption using Polymyxin B-immobilized Fibers Cartridges in Sepsis Patients Following Cardiac Surgery. Shock. 2018;49(6):658-666. https://doi.org/10.1097/SHK.0000000000001016
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respiratory Medicine. 2020;8(5):475-481. https://doi.org/10.1016/S2213-2600(20)30079-5
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. https://doi.org/10.1016/S0140-6736(20)30211-7
Ushakova ND, Kit OI, Maslov AA, Men’shenina AP. Extracorporeal detoxification for abdominal sepsis in cancer patients. Obshchaya reanimatologiya. 2018;14(2):25-34. (In Russ.). https://doi.org/10.15360/1813-9779-2018-2-25-34
Lee CT, Tu YK, Yeh YC, Chang T, Shih PY, Chao A, Huang HH, Cheng YJ, Yeh YC; Behalf of the NTUH Center of Microcirculation Medical Research (NCMMR). Effects of polymyxin B hemoperfusion on hemodynamics and prognosis in septic shock patients. Journal of Critical Care. 2018;43:202-206. https://doi.org/10.1016/j.jcrc.2017.04.035
Loginov SP, Gromova EG, Kiselevsky MV, Krotenko NP, Dolzhikova YuI, Vlasenko RYa, Kuznetsova LS. Application of lipopolysaccharide adsorber in patients with septic shock. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2018;3:46-52. (In Russ.). https://doi.org/10.21320/1818-474X-2018-3-46-52
Gendel LL, Sokolov AA, Gubanova SN, Adamova IYu, Levashov PA.The first clinical experience of using columns for LPS-adsorption «Toxipak» for the treatment of patients with sepsis. Vestnik anesteziologii i reanimatologii. 2017;14(5):42-50. (In Russ.). https://doi.org/10.21292/2078-5658-2017-14-5-42-50
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, Shi J, Zhou M, Wu B, Yang Z, Zhang C, Yue J, Zhang Z, Renz H, Liu X, Xie J, Xie M, Zhao J. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. The Journal of Allergy and Clinical Immunology. 2020;146(1):110-118.
EVMS Critical Care COVID-19 Management Protocol. Eastern Virginia Medical School, Norfolk, VA. Accessed July 18, 2020. https://www.evms.edu/covid-19/medical_information_resources/#covidcare
Zhang Y, Xiao M, Zhang S. Coagulopathy and Antiphospholipid Antibodies in Patients with COVID-19. New England Journal of Medicine. 2020;382(17):e38.
Li T, Lu H, Zhang W. Clinical observation and management of COVID-19 patients. Emerging Microbes and Infections. 2020;9(1):687-690.
Chen W, Lan Y, Yuan X, Deng X, Li Y, Cai X, Li L, He R, Tan Y, Deng X, Gao M, Tang G, Zhao L, Wang J, Fan Q, Wen C, Tong Y, Tang Y, Hu F, Li F, Tang X. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerging Microbes and Infections. 2020; 9(1):469-473. https://doi.org/10.1080/22221751.2020.1732837
NHCP RC. Diagnosis and Treatment Scheme for Novel Coronavirus Pneumonia. Edition VI. National Health Commission of the People’s Republic of China, February 18, 2020. Accessed July 18, 2020.
Shi H, Zhou C, He P, Huang S, Duan Y, Wang X, Lin K, Zhou C, Zhang X, Zha Y. Successful treatment of plasma exchange followed by intravenous immunogloblin in a critically ill patient with 2019 novel coronavirus infection. International Journal of Antimicrobial Agents. 2020;105974. https://doi.org/10.1016/j.ijantimicag.2020.105974
Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, Li T, Yan X, Chen L, Zhang S, Qin Y, Li X. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clinical Immunology. 2020;214:108408. https://doi.org/10.1016/j.clim.2020.108408
Keith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A. A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19. Critical Care. 2020;24(1):128. https://doi.org/10.1186/s13054-020-2836-4
Aoyagi J, Kanai T, Maru T. Efficacy of plasma exchange with a high dose of acyclovir for disseminated varicella infection. CEN Case Reports. 2020; 9(1):15-18.
Fujiwara K, Kaneko S, Kakumu S, Sata M, Hige S, Tomita E, Mochida S; Virus Reduction Therapy Study Group. Double filtration plasmapheresis and interferon combination therapy for chronic hepatitis C patients with genotype 1 and high viral load. Hepatology Research. 2007;37(9):701-710.
Büttner S, Koch B, Dolnik O, Eickmann M, Freiwald T, Rudolf S, Engel J, Becker S, Ronco C, Geiger H. Extracorporeal Virus Elimination for the Treatment of Severe Ebola Virus Disease — First Experience with Lectin Affinity Plasmapheresis. Blood Purification. 2014;38(3-4):286-291.
Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, Wang F, Li D, Yang M, Xing L, Wei J, Xiao H, Yang Y, Qu J, Qing L, Chen L, Xu Z, Peng L, Li Y, Zheng H, Chen F, Huang K, Jiang Y, Liu D, Zhang Z, Liu Y, Liu L. Treatment of 5 Critically Ill Patients With COVID-19 with Convalescent Plasma. JAMA. 2020;323(16):1582-1589. https://doi.org/10.1001/jama.2020.4783