Şiddetli Covid–19 Hastasında Erken Hemoperfüzyon Uygulanması ile Akut Solunum Yetmezliğinin Başarılı İyileşmesi: Vaka Sunumu

Özet

Sitokin fırtınası, konağın virüslere, bakterilere veya diğer dış uyaranlara karşı aşırı bağışıklık tepkisidir ve bu, inflamatuar faktörlerin kontrolsüz salınımı ile kendini gösterir. Hemoperfüzyon, hiper inflamasyon sürecini azaltmak için sitokinleri, endotoksinleri ve diğer dolaşımdaki inflamatuar aracıları kaldırabilir ve belirli iyileştirici etkiler elde edilmiştir. Ancak kritik hastalığı olan COVID-19 hastalarının tedavisinde işlevine dair kanıtlar hala sınırlıdır. Burada 62 yaşında SARS-CoV-2 pozitif   pnomonisi olan ve akut solunum yetmezliği ile yoğun bakım ünitesine kabul edilen, erken dönemde HA 330 ile hemoadsorbsiyon uygulanması sonucunda  entübasyona gerek olmadan iyileşerek hastaneden taburcu olan bir vakayı sunuyoruz.

Referanslar

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497–506.

Fajgenbaum DC, June CH. Cytokine Storm. The New England journal of medicine, 2020 Dec 3;383(23):2255-2273. doi: 10.1056/NEJMra2026131.

RECOVERY Collaborative Group; Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19. The New England journal of medicine. 2021 Feb 25;384(8):693-704. doi: 10.1056/NEJMoa2021436.

Clark EG, Hiremath S, McIntyre L, et al. Haemoperfu-sion should only be used for COVID-19 in the context of randomized trials. Nature reviews. Nephrology. 2020; 16(12): 697–699. https://doi.org/10.1038/s41581-020-00352-9

Nkawi G, Fan W, Pomarè Montin D, et al. A new series of sorbent devices for multiple clinical pur-poses: current evidence and future directions. Blood purificationood . 2019; 47(1–3): 94–100.

FDA Emergency Use Authorization approval documents. 2020. Available from: https: //www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization# covidothermedde.other

Shadvar K, Tagizadiyeh A, Gamari AA, et al. Hemoperfusion as a potential treatment for critically ill COVID-19 patients with cytokine storm. Blood purification, 2021;50(3), 405–407. https://doi.org/10.1159/000511391 .

Surasit K, Srisawat N. The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study. Blood purification 2022 51(11):879-888.doi: 10.1159/000521713.

Abbasi S, Naderi Z, Amra B, et al. Hemoperfusion in patients with severe COVID-19 respiratory failure, lifesaving or not? Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2021;26(1):34. doi:10.4103/jrms.JRMS_1122_20

Esmaeili Vardanjani A, Ronco C, Rafiei H,et al. Early hemoperfusion for cytokine removal may contribute to prevention of intubation in patients infected with COVID-19. Blood purification 2021;50(2):257–260 doi:10.1159/000509107

Sette A, Crotty S. Adaptive immunity to SARS-CoV-2 and COVID-19. Cell .2021; 184(4):861–880. doi: 10.1016/j.cell.2021.01.007

Karki R, Kanneganti TD. Innate immunity, cytokine storm, and inflammatory cell death in COVID-19. Journal of translational medicine 2022; 20(1):542. doi: 10.1186/s12967-022-03767-z

Kasuga Y, Zhu B, Jang KJ, et al. Innate immune sensing of coronavirus and viral evasion strategies. Experimental & molecular medicine. 2021; 53(5):723–736. doi: 10.1038/s12276-021-00602-1

Mathew D, Giles JR, Baxter AE, et al. Deep immune profiling of COVID-19 patients reveals distinct immunotypes with therapeutic implications. Science(New York NY). 2020; 369(6508): eabc8511 doi: 10.1126/science.abc8511.

Ramasamy S, Subbian S. Critical determinants of cytokine storm and type I interferon response in COVID-19 pathogenesis. Clinical microbiology reviews, 2021; 34(3): e00299-20. doi: 10.1128/CMR.00299-20

Alam MS, Czajkowsky DM. SARS-CoV-2 infection and oxidative stress:Pathophysiological insight into thrombosis and therapeutic opportunities. Cytokine & growth factor reviews, 2022; 63:44–57. doi: 10.1016/j.cytogfr.2021.11.001

Prasad M, Leon M, Lerman LO, et al. Viral endothelial dysfunction: A unifying mechanism for COVID-19. Mayo Clinic proceedings, 2021; 96(12):3099–3108. doi: 10.1016/j.mayocp.2021.06.027

Merad M, Martin JC. Pathological inflammation in patients with COVID-19: A key role for monocytes and macrophages. Nature reviews. Immunology, 2020; 20(6):355–62. doi: 10.1038/s41577-020-0331-4

Mehta Y, Dixit SB, Zirpe KG, et al. Cytokine storm in novel coronavirus disease (COVID-19): Expert management considerations. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2020; 24(6):429–434. doi: 10.5005/jp-journals-10071-23415

Mahdavi M, Hejri GM, Pouraliakbar H,et al. Cytokine storm after heart transplantation in COVID-19-related haemophagocytic lymphohistiocytosis (HLH). ESC Heart failure 2022; 9(1):219–223. doi: 10.1002/ehf2.13728

Lalwani P, Baskaran S, Uribe DA, , et al. A case of COVID-19-Associated pediatric multisystem inflammatory syndrome in shock managed by cytokine filtration. Case reports in pediatrics. 2022; 3373289. doi: 10.1155/2022/3373289

Tay MZ, Poh CM, Renia L, et al. The trinity of COVID-19: immunity, inflammation and intervention. Nature reviews. Immunology 2020; 20(6):363–374. doi: 10.1038/s41577-020-0311-8

Wolley M, Jardine M, Hutchison CA. Exploring the clinical relevance of providing increased removal of Large middle molecules. Clinical journal of the American Society of Nephrology : CJASN. 2018; 13(5):805–814. doi: 10.2215/CJN.10110917

Ronco C, Bellomo R. Hemoperfusion: technical aspects and state of the art. Critical care (London, England). 2022; 26(1):135. doi: 10.1186/s13054-022-04009-w

Ronco C, Bellomo R. Acute renal failure and multiple organ dysfunction in the ICU: from renal replacement therapy (RRT) to multiple organ support therapy (MOST). The International journal of artificial organs. 2002; 25(8):733–747. doi: 10.1177/039139880202500801

Supady A, Weber E, Rieder M, et al. Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): A single centre, open-label, randomised, controlled trial. The Lancet. Respiratory medicine. 2021; 9(7):755–762. doi: 10.1016/S2213-2600(21)00177-6

Guo J, Xia H, Wang S, et al. The artificial-liver blood-purification system can effectively improve hypercytokinemia for COVID-19. Frontiers in immunology 2020; 11:586073. doi: 10.3389/fimmu.2020.586073

Peng Z, Singbartl K, Simon P, et al. Blood purification in sepsis: A new paradigm. Contributions to nephrology. 2010; 165:322–8. doi: 10.1159/000313773

Lancman G, Mascarenhas J, Bar-Natan M. Severe COVID-19 virus reactivation following treatment for b cell acute lymphoblastic leukemia. Journal of hematology & oncology. 2020; 13(1):131. doi: 10.1186/s13045-020-00968-1

Yessayan LT, Neyra JA, Westover AJ, et al. Extracorporeal immunomodulation treatment and clinical outcomes in ICU COVID-19 patients. Critical care explorations. 2022; 4(5):e0694. doi: 10.1097/CCE.0000000000000694

Tampe D, Korsten P, Bremer SCB, et al. Kinetics of bilirubin and ammonia elimination during hemadsorption therapy in secondary sclerosing cholangitis following ECMO therapy and severe COVID-19. Biomedicines . 2021; 9(12): 1841. doi: 10.3390/biomedicines9121841

Holubek WJ, Hoffman RS, Goldfarb DS et al. Use of hemodialysis and hemoperfusion in poisoned patients. Kidney international.2028; 74:1327–1334. https://doi.org/10.1038/ki.2008.462

Shalkham AS, Kirrane BM, Hoffman RS et al. The availability and use of charcoal hemoperfusion in the treatment of poisoned patients. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2006;48:239–241. https://doi.org/10.1053/j.ajkd.2006.04.080

Winchester JF, Kellum JA, Ronco C et al. Sorbents in acute renal failure and the systemic inflammatory response syndrome. Blood purification. 2003;21:79–84. https://doi.org/10.1159/000067860

Peng, Z., Singbartl, K., Simon, P., et al. Blood purification in sepsis: a new paradigm. Contributions to nephrology. 2010;165,322–328.

Ricci Z, Romagnoli S, Reis T, et al. Hemoperfusion in the intensive care unit. Intensive care medicine. 2022; 48(10), 1397–1408.https://doi.org/10.1007/ s00134-022-06810-1

Ankawi G, Fan W, Pomarè Montin D, et al. A new series of sorbent devices for multiple clinical purposes: Current evidence and future directions. Blood Purification .2019; 47(1-3):94–100. doi: 10.1159/000493523

Pomarè Montin D, Ankawi G, Lorenzin A,et al. Biocompatibility and cytotoxic evaluation of new sorbent cartridges for blood hemoperfusion. Blood Purification. 2018; 46(3):187–195. doi: 10.1159/000489921

Lezhnina A, Lem V, Blatt N. Application of extracorporeal apheresis in treatment of COVID-19: A rapid review. BioNanoScience .2022; 12(3):979–93. doi: 10.1007/s12668- 022-00987-x

Chang K, Li Y, Qin Z, Zhang Z, et al. Effect of extracorporeal hemoadsorption in critically ill patients with COVID-19: A narrative review. Frontiers in immunology. 2023; Feb 3;14:1074465. doi: 10.3389/fimmu.2023.1074465.

Alavi Darazam I, Kazempour M, Pourhoseingholi MA, et al. Efficacy of hemoperfusion in severe and critical cases of COVID-19. Blood purification. 2023; 52(1), 8–16. doi:10.1159/000524606

Abdullayev R, Gul F, Bilgili B,et al. Cytokine adsorption in critically ill COVID-19 patients, a case-control study. Journal of intensive care medicine. 2022; 37(9):1223–1228. doi:10.1177/08850666221085185

Li Y, Han M, Yang M et al. Hemoperfusion with the HA330/HA380 cartridge in intensive care settings: a state-of-the-art review. Blood purification. 2024; 54(2), 122–137. https://doi.org/10.1159/000542469

He Z, Lu H, Jian X et al. The efficacy of resin hemoperfusion cartridge on inflammatory responses during adult cardiopulmonary bypass. Blood purification.2022; 51:31–37. https://doi.org/10.1159/000514149

Waalders NJB, Kox M, Pickkers P. Haemoadsorption to remove inflammatory mediators in sepsis: past, present, and future. Intensive care medicine experimental. 2025; 21;13(1):38. doi: 10.1186/s40635-025-00740-0.

Köhler T, Schwier E, Praxenthaler J, et al. Therapeutic modulation of the host defense by hemoadsorption with CytoSorb®)-basics, indications and perspectives-a scoping review. International journal of molecular sciences. 2021; 22(23):12786. doi: 10.3390/ijms222312786

Sekandarzad A, Weber E, Prager EP, et al. Cytokine adsorption in patients with acute-on-chronic liver failure (CYTOHEP)-a single center, open-label, three-arm, randomized, controlled intervention trial. Trials.2022; 23 (1):222. doi: 10.1186/s13063-022-06139-6

Eichhorn T, Rauscher S, Hammer C, et al. Polystyrene-Divinylbenzene-Based adsorbents reduce endothelial activation and monocyte adhesion under septic conditions in a pore size-dependent manner. Inflammation. 2016; 39(5):1737–1746. doi: 10.1007/s10753-016-0408-1

Gruda MC, Ruggeberg KG, O'Sullivan P, et al. Broad adsorption of sepsis-related PAMP and DAMP molecules, mycotoxins, and cytokines from whole blood using CytoSorb sorbent porous polymer beads. PloS One. 2018; 13(1):e0191676. doi: 10.1371/journal.pone.0191676

Song T, Hayanga J, Durham L, et al. CytoSorb therapy in COVID-19 (CTC) patients requiring extracorporeal membrane oxygenation: A multicenter, retrospective registry. Frontiers in medicine. 2021;8:773461. doi: 10.3389/fmed.2021.773461

Stockmann H, Thelen P, Stroben F, et al. CytoSorb rescue for COVID-19 patients with vasoplegic shock and multiple organ failure: A prospective, open-label, randomized controlled pilot study. Critical care medicine. 2022; 50 (6):964–976. doi: 10.1097/CCM.0000000000005493

Diab M, Lehmann T, Bothe W, et al. Cytokine hemoadsorption during cardiac surgery versus standard surgical care for infective endocarditis (REMOVE): Results from a multicenter randomized controlled trial. Circulation. 2022; 145(13):959–968. doi: 10.1161/CIRCULATIONAHA.121.056940

Holme’n A, Corderfeldt A, Lannemyr L,et al. Whole blood adsorber during CPB and need for vasoactive treatment after valve surgery in acute endocarditis: A randomized controlled study. Journal of cardiothoracic and vascular anesthesia. 2022; 36(8 Pt B):3015–3020. doi: 10.1053/j.jvca.2022.02.028

Rasch S, Sancak S, Erber J, et al. Influence of extracorporeal cytokine adsorption on hemodynamics in severe acute pancreatitis: Results of the matched cohort pancreatitis cytosorbents inflammatory cytokine removal (PACIFIC) study. Artificial organs. 2022; 46(6):1019–1026. doi: 10.1111/aor.14195

Supady A, Zahn T, Kuhl M, et al. Cytokine adsorption in patients with post-cardiac arrest syndrome after extracorporeal cardiopulmonary resuscitation (CYTER) - a single-centre, open-label, randomised, controlled trial. Resuscitation. 2022; 173:169–178. doi: 10.1016/j.resuscitation.2022.02.001

Brouwer WP, Duran S, Kuijper M, et al. Hemoadsorption with CytoSorb shows a decreased observed versus expected 28-day all-cause mortality in ICU patients withseptic shock: A propensity-score-weighted retrospective study. Critical care. 2019;23(1):317. doi: 10.1186/s13054-019-2588-1

Pieri M, Fominskiy E, Nardelli P, et al. CytoSorb purification in critically ill SARS-CoV-2 patients. The International journal of artificial organs .2022; 45(2):216–220. doi: 10.1177/03913988211052572

Ruiz-Rodrı guez JC, Chiscano-Camo’n L, Ruiz-Sanmartin A, et al. Cytokine hemoadsorption as rescue therapy for critically ill patients with SARS-CoV-2 pneumonia with severe respiratory failure and hypercytokinemia. Frontiers in medicine. 2021; 8:779038. doi: 10.3389/ fmed.2021.779038

Nassiri AA, Hakemi MS, Miri MM, et al. Blood purification with CytoSorb in critically ill COVID-19 patients: A case series of 26 patients. Artificial organs. 2021; 45(11):1338–47. doi: 10.1111/aor.14024

Wunderlich-Sperl F, Kautzky S, Pickem C, et al. Adjuvant hemoadsorption therapy in patients with severe COVID-19 and related organ failure requiring CRRT or ECMO therapy: A case series. The International journal of artificial organs. 2021; 44(10):694–702. doi: 10.1177/03913988211030517

Vira’g M, Rottler M, Ocskay K, et al. Extracorporeal cytokine removal in critically ill COVID-19 patients: A case series. Frontiers in medicine. 2021; 8:760435. doi: 10.3389/fmed.2021.760435

Jarczak D, Roedl K, Fischer M, et al. Effect of hemadsorption therapy in critically ill patients with COVID-19 (CYTOCOV-19): A prospective randomized controlled pilot trial. Blood Purification. 2022; 1–10. doi: 10.1159/000526446

Kellum JA, Kong L, Fink MP, et al. Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the genetic and inflammatory markers of sepsis (GenIMS) study. Archives of internal medicine. 2007; 167(15):1655–1663. doi: 10.1001/archinte.167.15.1655

Friesecke S, Träger K, Schittek GA, et al. International registry on the use of the CytoSorb adsorber in ICU patients : Study protocol and preliminary results. Medizinische Klinik Intensivmedizin und Notfallmedizin . 2019; 114(8):699–707. doi: 10.1007/s00063-017-0342-5

Ronco C, Bellomo R. Hemoperfusion: technical aspects and state of the art. Critical care (London, England). 2022; 26(1):135. doi: 10.1186/s13054-022-04009-w

Lu C, Hou N. Skin hyperpigmentation in coronavirus disease 2019 patients: Is polymyxin b the culprit? Frontiers in pharmacology. 2020; 11:01304–. doi: 10.3389/fphar.2020.01304

Ronco C, Reis T, De Rosa S. Coronavirus epidemic and extracorporeal therapies in intensive care: si vis pacem para bellum. Blood Purification. 2020; 49(3):255–8. doi:10.1159/000507039

Srisawat N, Tungsanga S, Lumlertgul N, et al. The effect of polymyxin b hemoperfusion on modulation of human leukocyte antigen DR in severe sepsis patients. Critical care (London, England). 2018; 22(1):279. doi: 10.1186/s13054-018-2077-y

Johansson PI, Windelov NA, Rasmussen LS, et al. Blood levels of histone-complexed DNA fragments are associated with coagulopathy, inflammation and endothelial damage early after trauma. Journal of emergencies, trauma, and shock . 2013; 6(3):171–175. doi: 10.4103/0974-2700.115327

Nishibori M, Takahashi HK, Katayama H, et al. Specific removal of monocytes from peripheral blood of septic patients by polymyxin b- immobilized filter column. Acta medica Okayama. 2009; 63(1):65–9. doi: 10.18926/AMO/31855

Abe S, Seo Y, Hayashi H, et al. Neutrophil adsorption by polymyxin b-immobilized fiber column for acute exacerbation in patients with interstitial pneumonia: A pilot study. Blood Purification. 2010; 29(4):321–326. doi: 10.1159/000287232

Ishiwari M, Togashi Y, Takoi H, et al. Polymyxin b haemoperfusion treatment for respiratory failure and hyperferritinaemia due to COVID- 19. Respirology case reports. 2020; 8(9):e00679. doi: 10.1002/rcr2.679

Katagiri D, Ishikane M, Asai Y, et al. Direct hemoperfusion using a polymyxin b-immobilized polystyrene column for COVID-19. Journal of clinical apheresis. 2021; 36(3):313–321. doi: 10.1002/jca.21861

De Rosa S, Cutuli SL, Ferrer Ret al. Polymyxin b hemoperfusion in coronavirus disease 2019 patients with endotoxic shock: Case series from EUPHAS2 registry. Artificial organs. 2021; 45(6):E187–E194. doi: 10.1111/ aor.13900

Guan M, Wang H, Tang X, et al. Continuous renal replacement therapy with adsorbing filter oXiris in acute kidney injury with septic shock: A retrospective observational study. Frontiers in medicine. 2022; 9:789623. doi: 10.3389/fmed.2022.789623

Niazi NS, Nassar TI, Stewart IJ, et al. A review of extracorporeal blood purification techniques for the treatment of critically ill coronavirus disease 2019 patients. ASAIO journal (American Society for Artificial Internal Organs . 1992; 68(10):1219–1227 doi: 10.1097/MAT.0000000000001761.

Zang S, Chen Q, Zhang Y, Xu L, Chen J. Comparison of the clinical effectiveness of AN69-oXiris versus AN69-ST filter in septic patients: A single-centre study. Blood Purification. 2021; 51(7):617–629. doi: 10.1159/000519166

Padala SA, Vakiti A, White JJ, et al. First reported use of highly adsorptive hemofilter in critically ill COVID-19 patients in the USA. Journal of clinical medicine research. 2020; 12(7):454–457. doi: 10.14740/jocmr4228

Zhang H, Zhu G, Yan L, et al. The absorbing filter oxiris in severe coronavirus disease 2019 patients: A case series. Artificial organs. 2020; 44(12):1296–1302. doi:10.1111/aor.13786

Premuzić V, Babel J, Gardijan D, et al. Extracorporeal blood purification is associated with improvement in biochemical and clinical variables in the critically-ill COVID-19 patients. Ther Apheresis Dialysis. 2022; 26(2):316–329. doi: 10.1111/1744-9987.13730

Rosalia RA, Ugurov P, Neziri D, et al. Extracorporeal blood purification in moderate and severe COVID-19 patients: A prospective cohort study. Blood Purification. 2022; 51(3):233–242. doi:10.1159/000515627

Villa G, Romagnoli S, De Rosa S, et al. Blood purification therapy with a hemodiafilter featuring enhanced adsorptive properties for cytokine removal in patients presenting COVID-19: A pilot study. Critical care (London, England). 2020; 24(1):605. doi: 10.1186/s13054-020-03322-6

Kang K, Luo Y, Gao Y, et al. Continuous renal replacement therapy with oXiris filter may not be an effective resolution to alleviate cytokine release syndrome in non-AKI patients with severe and critical COVID-19. Frontiers in pharmacology. 2022; 13:817793. doi: 10.3389/fphar.2022.817793

Khadzhynov D, von dem Berge U, Muench F, et al. Efficacy and complications of regional citrate anticoagulation during continuous renal replacement therapy in critically ill patients with COVID-19. Journal of critical care. 2022;67:126–131. doi: 10.1016/j.jcrc.2021.10.010

Chiao C, Faust H, Singh T. Regional citrate and systemic heparin are adequate to maintain filter half-life for COVID-19 patients on continuous renal replacement therapy. Seminars in dialysis. 2022; 35(4):325‐329. doi: 10.1111/sdi.13061

Siew LY, Lee ZY, Yunos NM et al. Outcomes of extracorporeal blood purification with oXiris® membrane in critically ill patients: a systematic review and meta-analysis. Journal of critical care. 2024; 83:154844. https://doi. org/10.1016/j.jcrc.2024.154844

Monard C, Rimmele’ T, Ronco C. Extracorporeal blood purification therapies for sepsis. Blood Purification. 2019; 47(Suppl 3):1–14. doi: 10.1159/000499520

Bermejo-Martin JF, Gonza’lez-Rivera M, Almansa R, et al. Viral RNA load in plasma is associated with critical illness and dysregulated host response in COVID-19. Critical care (London, England. 2020; 24(1):691.doi: 10.1186/s13054-020-03398-0

Kielstein JT, Borchina DN, Fühner T, et al. Hemofiltration with the seraph(®) 100 microbind(®) affinity filter decreases SARS-CoV-2 nucleocapsid protein in critically ill COVID-19 patients. Critical care (London, England). 2021; 25(1):190. doi: 10.1186/s13054-021-03597-3

Kelly MM, Wilkinson JD, Rastegar M, et al. Two patients with severe COVID pneumonia treated with the seraph-100 microbind affinity blood filter. Journal of intensive care medicine. 2021; 36(10):1228–1232. doi: 10.1177/08850666211039744

Pape A, Kielstein JT, Krüger T, et al. Treatment of a critically ill COVID-19 patient with the seraph 100 microbind affinity filter. TH open : companion journal to thrombosis and haemostasis. 2021; 5(2):e134–e138. doi: 10.1055/s-0041-1727121

Rifkin BS, Stewart IJ. Seraph-100 hemoperfusion in SARS-CoV-2-Infected patients early in critical illness: A case series. Blood Purification. 2022; 51(4):317–320. doi: 10.1159/ 000517430

Sayfalar

161-170

Gelecek

31 Mart 2026

Lisans

Lisans