ABSTRACT
Abstract
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.