Continuous renal replacement therapy with the addition of CytoSorb(®) cartridge in critically ill patients with COVID‐19 plus acute kidney injury: a case‐series

Alharthy, Abdulrahman; Faqihi, Fahad; Memish, Ziad A; Balhamar, Abdullah; Nasim, Nasir; Shahzad, Ahmad; Tamim, Hani; Alqahtani, Saleh A; Brindley, Peter G; Karakitsos, Dimitrios

AIM: To investigate continuous renal replacement therapy (CRRT) with CytoSorb(®) cartridge for patients with life‐threatening COVID‐19 plus acute kidney injury (AKI), sepsis, acute respiratory distress syndrome (ARDS), and cytokine release syndrome (CRS). PATIENTS AND METHODS: Of 492 COVID‐19 patients admitted to our intensive care unit (ICU), 50 had AKI necessitating CRRT (10.16%) and were enrolled in the study. Upon ICU admission, all had AKI, ARDS, septic shock, and CRS. In addition to CRRT with CytoSorb(®), all received ARDS‐net ventilation, prone positioning, plus empiric ribavirin, interferon beta‐1b, antibiotics, hydrocortisone, and prophylactic anticoagulation. We retrospectively analyzed inflammatory biomarkers, oxygenation, organ function, duration of mechanical ventilation, ICU length‐of‐stay, and mortality on day‐28 post‐ICU admission. RESULTS: Patients were 49.64 ±8.90 years old (78% male) with body mass index of 26.70±2.76 kg/m(2). On ICU admission, mean Acute Physiology and Chronic Health Evaluation II, was 22.52±1.1. Sequential Organ Function Assessment (SOFA) score was 9.36±2.068 and the ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen (PaO(2)/FiO(2)) was 117.46±36.92. Duration of mechanical ventilation was 17.38±7.39 days, ICU length‐of‐stay was 20.70±8.83 days, and mortality 28 days post‐ICU admission was 30%. Non‐survivors had higher levels of inflammatory biomarkers, and more unresolved shock, ARDS, AKI, and pulmonary emboli (8% vs. 4 %, p<0.05) compared to survivors. After 2±1 CRRT sessions with CytoSorb(®), survivors had decreased SOFA scores, lactate dehydrogenase, ferritin, D‐dimers, C‐reactive protein, and interleukin‐6; and increased PaO(2)/FiO(2) ratios, and lymphocyte counts (all p<0.05). Receiver‐operator‐curve analysis showed that post therapy values of interleukin‐6 (cutoff point > 620 pg/ml) predicted in‐hospital mortality for critically ill COVID‐19 patients (area‐under‐the‐curve: 0.87, 95% confidence‐intervals: 0.81‐0.93; p=0.001). No side effects of therapy were recorded. CONCLUSION: In this retrospective case‐series, CRRT with the CytoSorb(®) cartridge provided a safe rescue therapy in life‐threatening COVID‐19 with associated AKI, ARDS, sepsis, and hyperinflammation.