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Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series

INTRODUCTION: Severe coronavirus disease 2019 (COVID-19) is characterised by hyperinflammatory state, systemic coagulopathies, and multiorgan involvement, especially acute respiratory distress syndrome (ARDS). We here describe our preliminary clinical experience with COVID-19 patients treated via an...

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Autores principales: Ugurov, Petar, Popevski, Dijana, Gramosli, Tanja, Neziri, Dashurie, Vuckova, Dragica, Gjorgon, Marko, Stoicovski, Emil, Marinkovic, Sanja, Veljanovska-Kiridjievska, Lidija, Ignevska, Katerina, Mehandziska, Sanja, Ambarkova, Elena, Mitrev, Zan, Rosalia, Rodney Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Cirurgia Cardiovascular 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8973137/
https://www.ncbi.nlm.nih.gov/pubmed/33113325
http://dx.doi.org/10.21470/1678-9741-2020-0403
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author Ugurov, Petar
Popevski, Dijana
Gramosli, Tanja
Neziri, Dashurie
Vuckova, Dragica
Gjorgon, Marko
Stoicovski, Emil
Marinkovic, Sanja
Veljanovska-Kiridjievska, Lidija
Ignevska, Katerina
Mehandziska, Sanja
Ambarkova, Elena
Mitrev, Zan
Rosalia, Rodney Alexander
author_facet Ugurov, Petar
Popevski, Dijana
Gramosli, Tanja
Neziri, Dashurie
Vuckova, Dragica
Gjorgon, Marko
Stoicovski, Emil
Marinkovic, Sanja
Veljanovska-Kiridjievska, Lidija
Ignevska, Katerina
Mehandziska, Sanja
Ambarkova, Elena
Mitrev, Zan
Rosalia, Rodney Alexander
author_sort Ugurov, Petar
collection PubMed
description INTRODUCTION: Severe coronavirus disease 2019 (COVID-19) is characterised by hyperinflammatory state, systemic coagulopathies, and multiorgan involvement, especially acute respiratory distress syndrome (ARDS). We here describe our preliminary clinical experience with COVID-19 patients treated via an early initiation of extracorporeal blood purification combined with systemic heparinisation and respiratory support. METHODS: Fifteen patients were included; several biomarkers associated with COVID-19 severity were monitored. Personalised treatment was tailored according to the levels of interleukin (IL)-6, IL-8, tumour necrosis factor alpha, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, thrombocyte counts, D-dimers, and fibrinogen. Treatment consisted of respiratory support, extracorporeal blood purification using the AN69ST (oXiris®) hemofilter, and 300 U/kg heparin to maintain activation clotting time ≥ 180 seconds. RESULTS: Ten patients presented with severe to critical disease (dyspnoea, hypoxia, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). The median intensive care unit length of stay was 9.3 days (interquartile range 5.3-10.1); two patients developed ARDS and died after 5 and 26 days. Clinical improvement was associated with normalisation (increase) of thrombocytes and white blood cells, stable levels of IL-6 (< 50 ng/mL), and a decrease of CRP and fibrinogen. CONCLUSION: Continuous monitoring of COVID-19 severity biomarkers and radiological imaging is crucial to assess disease progression, uncontrolled inflammation, and to avert irreversible multiorgan failure. The combination of systemic heparin anticoagulation regimens and extracorporeal blood purification using cytokine-adsorbing hemofilters may reduce hyperinflammation, prevent coagulopathy, and support clinical recovery.
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spelling pubmed-89731372022-04-01 Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series Ugurov, Petar Popevski, Dijana Gramosli, Tanja Neziri, Dashurie Vuckova, Dragica Gjorgon, Marko Stoicovski, Emil Marinkovic, Sanja Veljanovska-Kiridjievska, Lidija Ignevska, Katerina Mehandziska, Sanja Ambarkova, Elena Mitrev, Zan Rosalia, Rodney Alexander Braz J Cardiovasc Surg Original Article INTRODUCTION: Severe coronavirus disease 2019 (COVID-19) is characterised by hyperinflammatory state, systemic coagulopathies, and multiorgan involvement, especially acute respiratory distress syndrome (ARDS). We here describe our preliminary clinical experience with COVID-19 patients treated via an early initiation of extracorporeal blood purification combined with systemic heparinisation and respiratory support. METHODS: Fifteen patients were included; several biomarkers associated with COVID-19 severity were monitored. Personalised treatment was tailored according to the levels of interleukin (IL)-6, IL-8, tumour necrosis factor alpha, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, thrombocyte counts, D-dimers, and fibrinogen. Treatment consisted of respiratory support, extracorporeal blood purification using the AN69ST (oXiris®) hemofilter, and 300 U/kg heparin to maintain activation clotting time ≥ 180 seconds. RESULTS: Ten patients presented with severe to critical disease (dyspnoea, hypoxia, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). The median intensive care unit length of stay was 9.3 days (interquartile range 5.3-10.1); two patients developed ARDS and died after 5 and 26 days. Clinical improvement was associated with normalisation (increase) of thrombocytes and white blood cells, stable levels of IL-6 (< 50 ng/mL), and a decrease of CRP and fibrinogen. CONCLUSION: Continuous monitoring of COVID-19 severity biomarkers and radiological imaging is crucial to assess disease progression, uncontrolled inflammation, and to avert irreversible multiorgan failure. The combination of systemic heparin anticoagulation regimens and extracorporeal blood purification using cytokine-adsorbing hemofilters may reduce hyperinflammation, prevent coagulopathy, and support clinical recovery. Sociedade Brasileira de Cirurgia Cardiovascular 2022 /pmc/articles/PMC8973137/ /pubmed/33113325 http://dx.doi.org/10.21470/1678-9741-2020-0403 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Ugurov, Petar
Popevski, Dijana
Gramosli, Tanja
Neziri, Dashurie
Vuckova, Dragica
Gjorgon, Marko
Stoicovski, Emil
Marinkovic, Sanja
Veljanovska-Kiridjievska, Lidija
Ignevska, Katerina
Mehandziska, Sanja
Ambarkova, Elena
Mitrev, Zan
Rosalia, Rodney Alexander
Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series
title Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series
title_full Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series
title_fullStr Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series
title_full_unstemmed Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series
title_short Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series
title_sort early initiation of extracorporeal blood purification using the an69st (oxiris®) hemofilter as a treatment modality for covid-19 patients: a single-centre case series
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8973137/
https://www.ncbi.nlm.nih.gov/pubmed/33113325
http://dx.doi.org/10.21470/1678-9741-2020-0403
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