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Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase
BACKGROUND: Plasma levels of C-reactive protein (CRP), induced by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) triggering COVID-19, can rise surprisingly high. The increase of the CRP concentration as well as a certain threshold concentration of CRP are indicative of clinical deterio...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366396/ https://www.ncbi.nlm.nih.gov/pubmed/34408751 http://dx.doi.org/10.3389/fimmu.2021.708101 |
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author | Ringel, Jens Ramlow, Anja Bock, Christopher Sheriff, Ahmed |
author_facet | Ringel, Jens Ramlow, Anja Bock, Christopher Sheriff, Ahmed |
author_sort | Ringel, Jens |
collection | PubMed |
description | BACKGROUND: Plasma levels of C-reactive protein (CRP), induced by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) triggering COVID-19, can rise surprisingly high. The increase of the CRP concentration as well as a certain threshold concentration of CRP are indicative of clinical deterioration to artificial ventilation. In COVID-19, virus-induced lung injury and the subsequent massive onset of inflammation often drives pulmonary fibrosis. Fibrosis of the lung usually proceeds as sequela to a severe course of COVID-19 and its consequences only show months later. CRP-mediated complement- and macrophage activation is suspected to be the main driver of pulmonary fibrosis and subsequent organ failure in COVID-19. Recently, CRP apheresis was introduced to selectively remove CRP from human blood plasma. CASE REPORT: A 53-year-old, SARS-CoV-2 positive, male patient with the risk factor diabetes type 2 was referred with dyspnea, fever and fulminant increase of CRP. The patient’s lungs already showed a pattern enhancement as an early sign of incipient pneumonia. The oxygen saturation of the blood was ≤ 89%. CRP apheresis using the selective CRP adsorber (PentraSorb(®) CRP) was started immediately. CRP apheresis was performed via peripheral venous access on 4 successive days. CRP concentrations before CRP apheresis ranged from 47 to 133 mg/l. The removal of CRP was very effective with up to 79% depletion within one apheresis session and 1.2 to 2.14 plasma volumes were processed in each session. No apheresis-associated side effects were observed. It was at no point necessary to transfer the patient to the Intensive Care Unit or to intubate him due to respiratory failure. 10 days after the first positive SARS-CoV-2 test, CRP levels stayed below 20 mg/l and the patient no longer exhibited fever. Fourteen days after the first positive SARS-CoV-2 test, the lungs showed no sign of pneumonia on X-ray. CONCLUSION: This is the first report on CRP apheresis in an early COVID-19 patient with fulminant CRP increase. Despite a poor prognosis due to his diabetes and biomarker profile, the patient was not ventilated, and the onset of pneumonia was reverted. |
format | Online Article Text |
id | pubmed-8366396 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83663962021-08-17 Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase Ringel, Jens Ramlow, Anja Bock, Christopher Sheriff, Ahmed Front Immunol Immunology BACKGROUND: Plasma levels of C-reactive protein (CRP), induced by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) triggering COVID-19, can rise surprisingly high. The increase of the CRP concentration as well as a certain threshold concentration of CRP are indicative of clinical deterioration to artificial ventilation. In COVID-19, virus-induced lung injury and the subsequent massive onset of inflammation often drives pulmonary fibrosis. Fibrosis of the lung usually proceeds as sequela to a severe course of COVID-19 and its consequences only show months later. CRP-mediated complement- and macrophage activation is suspected to be the main driver of pulmonary fibrosis and subsequent organ failure in COVID-19. Recently, CRP apheresis was introduced to selectively remove CRP from human blood plasma. CASE REPORT: A 53-year-old, SARS-CoV-2 positive, male patient with the risk factor diabetes type 2 was referred with dyspnea, fever and fulminant increase of CRP. The patient’s lungs already showed a pattern enhancement as an early sign of incipient pneumonia. The oxygen saturation of the blood was ≤ 89%. CRP apheresis using the selective CRP adsorber (PentraSorb(®) CRP) was started immediately. CRP apheresis was performed via peripheral venous access on 4 successive days. CRP concentrations before CRP apheresis ranged from 47 to 133 mg/l. The removal of CRP was very effective with up to 79% depletion within one apheresis session and 1.2 to 2.14 plasma volumes were processed in each session. No apheresis-associated side effects were observed. It was at no point necessary to transfer the patient to the Intensive Care Unit or to intubate him due to respiratory failure. 10 days after the first positive SARS-CoV-2 test, CRP levels stayed below 20 mg/l and the patient no longer exhibited fever. Fourteen days after the first positive SARS-CoV-2 test, the lungs showed no sign of pneumonia on X-ray. CONCLUSION: This is the first report on CRP apheresis in an early COVID-19 patient with fulminant CRP increase. Despite a poor prognosis due to his diabetes and biomarker profile, the patient was not ventilated, and the onset of pneumonia was reverted. Frontiers Media S.A. 2021-08-02 /pmc/articles/PMC8366396/ /pubmed/34408751 http://dx.doi.org/10.3389/fimmu.2021.708101 Text en Copyright © 2021 Ringel, Ramlow, Bock and Sheriff https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Immunology Ringel, Jens Ramlow, Anja Bock, Christopher Sheriff, Ahmed Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase |
title | Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase |
title_full | Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase |
title_fullStr | Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase |
title_full_unstemmed | Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase |
title_short | Case Report: C-Reactive Protein Apheresis in a Patient With COVID-19 and Fulminant CRP Increase |
title_sort | case report: c-reactive protein apheresis in a patient with covid-19 and fulminant crp increase |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366396/ https://www.ncbi.nlm.nih.gov/pubmed/34408751 http://dx.doi.org/10.3389/fimmu.2021.708101 |
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