Coupled Plasma Filtration and Adsorption treatment in COVID-19 patients with special health condition

• Published in: Journal of critical care 2024-06, Vol.81, p.154680, Article 154680
• Main Authors: Tuna, Verda, Tepe, Mehmet, Tek, Seyda, Naurzvai, Nurgul
• Format: Article
• Language: English
• Subjects: Coronaviruses; Coupled Plasma Filtration and Adsorption; COVID-19; CPFA; Critical care; Cytokine storm; Mortality; Patients; Pregnancy; Pregnant COVID-19; Sever COVID-19
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154680

A Severe Acute Respiratory Syndrome Coronavirus-2 causes Coronavirus Disease 2019 (COVID-19), which is a multi organ involving severe respiratory disease. In severe COVID-19, multi organ dysfunction due to cytokine storm is the main cause of mortality. The organ dysfunction is usually indicated by a high SOFA score. Extracorporeal blood cleansing therapy is an alternative treatment modality to modify cytokine storms if the patient is unresponsive to immunomodulators and anticytokine treatments. In this study, we aimed to evaluate the applicability of Coupled Plasma Filtration and Adsorption (CPFA), in COVID-19 patients with secondary organ failure because of cytokine storm when anti cytokine therapy cannot be utilized. This is a retrospective cohort study of six severe COVID-19 patients (including pregnant and immunosuppressive patients) suffering from secondary organ failure due to cytokine storm despite antiviral, anti-inflammatory and immunomodulatory therapy, supported with mechanical ventilation. These patients underwent CPFA therapy in 3 sessions. Before starting CPFA therapy and in 24th, 48th and 72nd hours of CPFA therapy SOFA score, vitals, Horowitz index, vasopressor use, laboratory parameters including organ function tests and inflammation markers were recorded from patient files. Two of 6 patients included in the study were males (33.3%) and four were females (66.7%). Mean age was 41.5 ± 7.61, mean BMI was 33.62 ± 2.28, mean APACHE II score was 19.33 ± 2.66, and mean length of stay at ICU was 13.5 ± 2.67. Three patients were pregnant and one patient had rheumatoid arthritis. Acute kidney injury (AKI) was seen in all patients. Secondary infection was present in half of the patients. Mortality was seen in only one patient. Kaletra was the choice of antiviral therapy for all three pregnant patients. Other 3 patients received favipiravir. Vasopressor requirements and mean SOFA score were decreased and vitals were normalized by CPFA therapy (p