Blood Purification Techniques, Inflammatory Mediators and Mortality in COVID-19 Patients

Hashemian, Seyed Mohammadreza; Shafigh, Navid; Afzal, Golnaz; Jamaati, Hamidreza; Mortaz, Esmaeil; Tabarsi, Payam; Marjani, Majid; Malekmohammad, Majid; Dastan, Farzaneh; Mortazavi, Seyed Mehdi; Sadr, Makan; Idani, Esmaeil; Khoundabi, Batoul; Mohamadnia, Abdolreza; Abedini, Atefeh; Kiani, Arda; Moniri, Afshin; Nadji, Seyed Alireza; Yassari, Fatemeh; Mokhber Dezfuli, Mojtaba; Pourabdollah, Mihan; Varahram, Mohammad; Eshaghi, Faezeh; Malekpour, Mahdi; Velayati, Aliakbar

BACKGROUND: Inflammatory mediators are an important component in the pathophysiology of the coronavirus disease 2019 (COVID-19). This study aimed to assess the effects of reducing inflammatory mediators using hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the mortality of patients with COVID-19. MATERIALS AND METHODS: Twelve patients with confirmed diagnosis of COVID-19 were included. All patients had acute respiratory distress syndrome (ARDS). Patients were divided into three groups, namely, HP, CRRT and HP+CRRT. The primary outcome was mortality and the secondary outcomes were oxygenation and reduction in inflammatory mediators at the end of the study. RESULTS: Patients were not different at baseline in demographics, inflammatory cytokine levels, and the level of acute phase reactants. Half of the patients (3 out of 6) in the HP+CRRT group survived along with the survival of one patient (1 out of 2) in the HP group. All four patients in the CRRT group died. Serum creatinine (SCr), Interleukin-1 (IL1), Interleukin-6 (IL6), Interleukin-8 (IL8), partial pressure of oxygen (PaO(2)), O(2) saturation (O(2) sat), and hemodynamic parameters improved over time in HP+CRRT and CRRT groups, but no significant difference was observed in the HP group (All Ps > 0.05). CONCLUSION: Combined HP and CRRT demonstrated the best result in terms of mortality, reduction of inflammatory mediators and oxygenation. Further investigations are needed to explore the role of HP+CRRT in COVID-19 patients.