1
|
Tanhehco YC, Alsammak M, Chhibber V, Ibeh N, Li Y, Stephens LD, Noland DK, Wu DW, Zantek ND, DeChristopher PJ, Martin MCS, Lu W, Wehrli G. Apheresis practice variation during the COVID-19 pandemic: Results of a survey. J Clin Apher 2024; 39:e22109. [PMID: 38634419 DOI: 10.1002/jca.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic affected healthcare delivery across all specialties including apheresis. To describe the changes in apheresis service practices that occurred during the pandemic, the American Society for Apheresis (ASFA) Apheresis Medicine Attending Physician Subcommittee conducted a survey study. STUDY DESIGN AND METHODS A 32-question survey was designed and distributed to 400 ASFA physician members on September 7, 2022. Attending physicians responded to questions about whether and how apheresis service practices changed during the COVID-19 pandemic compared with the time period prior to the pandemic in terms of: (1) procedure types and volumes, (2) patient consultation workflow, and (3) the use of telemedicine. Descriptive analyses were reported as number and frequency of responses. RESULTS The survey response rate was 13.8% (55/400). Of these respondents, 96.4% (53/55) were attending physicians. The majority of respondents (42/53, 79.2%) indicated that the types of procedures performed during COVID-19 compared to pre-pandemic did not change. Most frequently for apheresis procedure volume, respondents reported: no change in their monthly inpatient volume (21/47, 44.7%) and a decrease in their monthly outpatient volume (28/46, 60.9%). Prior to COVID-19, 75.0% (30/40) of respondents performed consultations at bedside for inpatients and 67.4% (29/43) performed consultations at bedside for outpatients. Bedside consultations decreased in both settings during the pandemic but were still most frequently performed by attending physicians. At the same time, the use of telemedicine increased for 15.4% of survey respondents during COVID-19. CONCLUSION Some, but not all, respondents observed or made changes to their apheresis service during the COVID-19 pandemic. A subset of changes, such as increased utilization of telemedicine, may persist.
Collapse
Affiliation(s)
- Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mohamed Alsammak
- Blood Bank/Transfusion Medicine, Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Vishesh Chhibber
- Department of Pathology and Laboratory Medicine, Northwell Health, Manhasset, New York, USA
| | - Nnaemeka Ibeh
- Department of Pathology and Laboratory Medicine, University of Texas Health Houston, Houston, Texas, USA
| | - Yanhua Li
- Transfusion Medicine, UMass Memorial Health and Departments of Medicine and Pathology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Daniel K Noland
- Department of Pathology, University of Texas Southwestern and Children's Health Dallas, Dallas, Texas, USA
| | - Ding Wen Wu
- Department of Pathology and Laboratories, New York University Langone Health, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Phillip J DeChristopher
- Loyola University Health System, Department of Pathology and Laboratory Medicine, Maywood, Illinois, USA
| | | | - Wen Lu
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Center for Regenerative Biotherapeutics, Rochester, Minnesota, USA
| | - Gay Wehrli
- University Hospitals Samaritan Medical Center and Case Western Reserve University, Ashland, Ohio, USA
| |
Collapse
|
2
|
Ioannou ADF, Tai C, Labato MA, Butty EM. Retrospective evaluation of 22 dogs with leptospirosis treated with extracorporeal renal replacement therapies (2018-2021). J Vet Intern Med 2024; 38:1051-1059. [PMID: 38334229 PMCID: PMC10937474 DOI: 10.1111/jvim.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Outcomes of dogs with acute kidney injury secondary to leptospirosis (AKI-L) treated using renal replacement therapies (RRT) are poorly characterized. HYPOTHESIS/OBJECTIVES Describe survival to discharge, short (≤30 days) and long-term (≥6 months) outcomes of AKI-L dogs receiving RRT and determine if there is a significant difference in maximum blood urea nitrogen (maxBUN), maximum creatinine (maxCr), maximum bilirubin (maxBili) and the number of body systems affected between survivors and non-survivors. ANIMALS Twenty-two client-owned dogs with AKI-L receiving RRT. METHODS Retrospective medical record review of dogs with AKI-L that received RRT between 2018 and 2021. RESULTS Sixteen of 22 (73%) dogs survived to discharge. Of the survivors, 13 (81%) were alive >30 days from discharge and 12 (75%) were alive at 6 months from discharge. Factors significantly higher in non-survivors included number of body systems affected (survivors: 1 (19%), 2 (50%), 3 (25%) and 4 (6%) vs non-survivors: 3 (33.3%), and 4 (66.7%); P = .01) and median maxBili (survivors: 1.9 mg/dL; range, 0.1-41.6 vs non-survivors: 21.0 mg/dL; range, 12.3-38.9; P = .02). There was no significant difference in median maxBUN (survivors: 153.0 mg/dL; range, 67-257 vs non-survivors: 185.5 mg/dL; range, 102-218; P = .44) and median maxCr (survivors: 9.8 mg/dL; range, 6.2-15.9 vs non-survivors: 9.8 mg/dL; range, 8.4-13.5; P = .69) between survivors and non-survivors. CONCLUSIONS AND CLINICAL IMPORTANCE Regardless of azotemia severity, dogs with AKI-L receiving RRT have a good survival rate to discharge. The number of body systems affected and hyperbilirubinemia might be associated with worse outcomes.
Collapse
Affiliation(s)
- Antonia Da Fonseca Ioannou
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Carolyn Tai
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Mary Anna Labato
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Emmanuelle M. Butty
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| |
Collapse
|
3
|
Yavuz T, Orhan S, Rollas K, Toksoy CK, Kazan ED, Bozkurt E, Cosgun İG, Yavasoglu F. Evaluation of clinical features and laboratory findings in critical intensive care unit patients with severe coronavirus disease-19 who underwent extracorporeal cytokine adsorption. Ther Apher Dial 2023; 27:890-897. [PMID: 37177852 DOI: 10.1111/1744-9987.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/03/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
AIM To evaluate the inflammatory parameters and oxygenation in severe coronavirus disease-19 patients who underwent extracorporeal cytokine adsorption (CA). METHODS Patients who underwent extracorporeal CA for cytokine storm were included in the study. The changes in oxygenation, laboratory parameters, and mortality rates were investigated. RESULTS Thirty-six patients were included in the study. The hemoglobin, thrombocyte, and C-reactive protein (CRP) decreased, and PaO2 /FiO2 ratio increased (p < 0.001; p < 0.01; p < 0.001; p = 0.04, respectively). Twelve (33.3%) patients received a single session, 24 (66.6%) received 2 or more sessions. CRP and fibrinogen levels decreased, and PaO2 /FIO2 ratio increased in the single session group (p = 0.04; p = 0.04; p = 0.01, respectively). In the multi-session group, the hemoglobin, platelet, procalcitonin, and CRP levels decreased, and PaO2 /FIO2 ratio increased (p < 0.01; p = 0.02; p = 0.02; p < 0.01; p = 0.01, respectively). Day 15, 30, and 90 mortality rates were 61.1%, 83.3%, and 88.9%. CONCLUSION CA with hemoperfusion reduced CRP and improved oxygenation; however, mortality rates were high.
Collapse
Affiliation(s)
- Tunzala Yavuz
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Semiha Orhan
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Kazim Rollas
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cansu Koseoglu Toksoy
- Department of Neurology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Elif Dizen Kazan
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Erhan Bozkurt
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - İbrahim Guven Cosgun
- Department of Chest Diseases, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Filiz Yavasoglu
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| |
Collapse
|
4
|
Chavda VP, Raval N, Sheta S, Vora LK, Elrashdy F, Redwan EM, Uversky VN, Ertas YN. Blood filtering system for COVID-19 management: novel modality of the cytokine storm therapeutics. Front Immunol 2023; 14:1064459. [PMID: 37153613 PMCID: PMC10160615 DOI: 10.3389/fimmu.2023.1064459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
The newly emerged coronavirus (SARS-CoV-2) is virulent, contagious, and has rapidly gained many mutations, which makes it highly infectious and swiftly transmissible around the world. SARS-CoV-2 infects people of all ages and targets all body organs and their cellular compartments, starting from the respiratory system, where it shows many deleterious effects, to other tissues and organs. Systemic infection can lead to severe cases that require intensive intervention. Multiple approaches were elaborated, approved, and successfully used in the intervention of the SARS-CoV-2 infection. These approaches range from the utilization of single and/or mixed medications to specialized supportive devices. For critically ill COVID-19 patients with acute respiratory distress syndrome, both extracorporeal membrane oxygenation (ECMO) and hemadsorption are utilized in combination or individually to support and release the etiological factors responsible for the "cytokine storm" underlying this condition. The current report discusses hemadsorption devices that can be used as part of supportive treatment for the COVID-19-associated cytokine storm.
Collapse
Affiliation(s)
- Vivek P. Chavda
- Department of Pharmaceutic and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad, India
| | - Nidhi Raval
- National Institute of Pharmaceutical Education and Research (NIPER) – Ahmedabad, Gandhinagar, Gujarat, India
| | - Soham Sheta
- Formulation and Development, Zydus Lifesciences Ltd., Ahmedabad, Gujrat, India
| | - Lalitkumar K. Vora
- School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
- *Correspondence: Lalitkumar K. Vora, ; Vladimir N. Uversky, ; Yavuz Nuri Ertas,
| | - Fatma Elrashdy
- Department of Endemic Medicine and Hepatogastroenterology, Cairo University, Cairo, Egypt
| | - Elrashdy M. Redwan
- Biological Science Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vladimir N. Uversky
- Department of Molecular Medicine and Byrd Alzheimer’s Research Institure, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- *Correspondence: Lalitkumar K. Vora, ; Vladimir N. Uversky, ; Yavuz Nuri Ertas,
| | - Yavuz Nuri Ertas
- ERNAM - Nanotechnology Research and Application Center, Erciyes University, Kayseri, Türkiye
- Department of Biomedical Engineering, Erciyes University, Kayseri, Türkiye
- *Correspondence: Lalitkumar K. Vora, ; Vladimir N. Uversky, ; Yavuz Nuri Ertas,
| |
Collapse
|
5
|
Ruiz-Rodríguez JC, Plata-Menchaca EP, Chiscano-Camón L, Ruiz-Sanmartin A, Ferrer R. Blood purification in sepsis and COVID-19: what´s new in cytokine and endotoxin hemoadsorption. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022. [PMCID: PMC8978509 DOI: 10.1186/s44158-022-00043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sepsis and COVID-19 are two clinical conditions that can lead to a dysregulated inflammatory state causing multiorgan dysfunction, hypercytokinemia, and a high risk of death. Specific subgroups of critically ill patients with particular characteristics could benefit from rescue treatment with hemoadsorption. There is a lack of adequately designed randomized controlled trials evaluating the potential benefits of cytokine or endotoxin hemoadsorption. Critically ill COVID-19 patients with severe acute respiratory failure poorly responsive to conventional treatment could be candidates to receive cytokine hemoadsorption in the presence of high levels of interleukin 6. This treatment can also be suitable for patients with refractory septic shock and hypercytokinemia. In the context of high endotoxin activity, hemoadsorption with polymyxin B could improve clinical parameters and the prognosis of patients with refractory septic shock. Predictive enrichment, using biomarkers or other individual features, identifies potential responders to cytokine, endotoxin, or sequential hemoadsorption. Besides, recognizing the particular subsets of patients likely to respond to one or both types of hemoadsorption will aid the design of future studies that accurately validate the effectiveness of these therapies.
Collapse
|
6
|
Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, is an unprecedented challenge for the global community. The pathogenesis of COVID-19, its complications and long term sequelae (so called Long/Post-COVID) include, in addition to the direct virus-induced tissues injury, multiple secondary processes, such as autoimmune response, impairment of microcirculation, and hyperinflammation. Similar pathological processes, but in the settings of neurological, cardiovascular, rheumatological, nephrological, and dermatological diseases can be successfully treated by powerful methods of Therapeutic Apheresis (TA). We describe here the rationale and the initial attempts of TA treatment in severe cases of acute COVID-19. We next review the evidence for the role of autoimmunity, microcirculatory changes and inflammation in pathogenesis of Long/Post COVID and the rationale for targeting those pathogenic processes by different methods of TA. Finally, we discuss the impact of COVID-19 pandemic on patients, who undergo regular TA treatments due to their underlying chronic conditions, with the specific focus on the patients with inherited lipid diseases being treated at the Dresden University Apheresis Center.
Collapse
Affiliation(s)
- Sergey Tselmin
- University Hospital Carl Gustav Carus, Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Julius
- University Hospital Carl Gustav Carus, Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- University Hospital Carl Gustav Carus, University Center for Vascular Medicine, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Roman N Rodionov
- University Hospital Carl Gustav Carus, Lipidology and Center for Extracorporeal Therapy, University Center for Vascular Medicine, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
7
|
Factors Associated with Length of Hospital Stay among COVID-19 Patients in Saudi Arabia: A Retrospective Study during the First Pandemic Wave. Healthcare (Basel) 2022; 10:healthcare10071201. [PMID: 35885728 PMCID: PMC9316254 DOI: 10.3390/healthcare10071201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic severely affected healthcare systems and tested their preparedness. To date, the length of hospital stay (LoHS) and its factors among COVID-19 patients has not been thoroughly studied. Moreover, it is essential to identify the features of these patients. Adult COVID-19 patients in Saudi Arabia with complete electronic medical records and who were hospitalised for >1 day between 1 May 2020 and 30 July 2020 at one of two hospitals were considered for this retrospective cohort study. Descriptive statistics and multivariate generalized linear models were performed using the data. Of the patients, 34% were ≥50 years old and 80.14% were female. More than 70% had mild-to-moderate symptoms; 45% had either diabetes or hypertension. The median LoHS was 7.00 days (IQR: 3−11). Patients who were females, had either critical or severe disease, were on mechanical ventilation, had diabetes, and administered ceftriaxone had significantly longer LoHS (p < 0.05). Patients administered zinc sulphate had significantly shorter LoHS (p = 0.0008). During the first pandemic wave, COVID-19 patients were hospitalised for 7 days. Healthcare professionals should pay more attention to women, patients with diabetes, and those with severe or critical symptoms. Unnecessary use of ceftriaxone should be minimised, and zinc sulphate can be administered.
Collapse
|
8
|
Application of Extracorporeal Apheresis in Treatment of COVID-19: a Rapid Review. BIONANOSCIENCE 2022; 12:979-993. [PMID: 35578681 PMCID: PMC9096332 DOI: 10.1007/s12668-022-00987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/08/2023]
Abstract
Spread of a novel coronavirus infection in 2019 caused by SARS-CoV-2 virus has become a real threat to public health all around the world. The new pandemic required the mobilization of all resources for effective treatment of COVID-19 patients. Extracorporeal apheresis methods were suggested as an addition to the therapy of severe COVID-19 patients, especially when there is a threat of cytokine storm. Cytokine storm has a complex and not fully understood mechanism, and it can result in the multiple organ failure syndrome, associated with high mortality. The main cytokines that play the key role in the cytokine storm are IL-6, IL-10, and TNF-alpha. Removal of the target pro-inflammatory cytokines from the bloodstream can be beneficial in reducing the risk of complications as well as the mortality rate. We describe and compare different methods of extracorporeal apheresis: hemoadsorption, selective plasma filtration, and plasma exchange therapy in the context of their potential use in COVID-19 treatment.
Collapse
|
9
|
2D MXenes for combatting COVID-19 Pandemic: A perspective on latest developments and innovations. FLATCHEM 2022; 33. [PMCID: PMC9055790 DOI: 10.1016/j.flatc.2022.100377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The COVID-19 pandemic has adversely affected the world, causing enormous loss of lives. A greater impact on the economy was also observed worldwide. During the pandemic, the antimicrobial aprons, face masks, sterilizers, sensor processed touch-free sanitizers, and highly effective diagnostic devices having greater sensitivity and selectivity helped to foster the healthcare facilities. Furthermore, the research and development sectors are tackling this emergency with the rapid invention of vaccines and medicines. In this regard, two-dimensional (2D) nanomaterials are greatly explored to combat the extreme severity of the pandemic. Among the nanomaterials, the 2D MXene is a prospective element due to its unique properties like greater surface functionalities, enhanced conductivity, superior hydrophilicity, and excellent photocatalytic and/or photothermal properties. These unique properties of MXene can be utilized to fabricate face masks, PPE kits, face shields, and biomedical instruments like efficient biosensors having greater antiviral activities. MXenes can also cure comorbidities in COVID-19 patients and have high drug loading as well as controlled drug release capacity. Moreover, the remarkable biocompatibility of MXene adds a feather in its cap for diverse biomedical applications. This review briefly explains the different synthesis processes of 2D MXenes, their biocompatibility, cytotoxicity and antiviral features. In addition, this review also discusses the viral cycle of SARS-CoV-2 and its inactivation mechanism using MXene. Finally, various applications of MXene for combatting the COVID-19 pandemic and their future perspectives are discussed.
Collapse
|
10
|
Abdullayev R, Gul F, Bilgili B, Seven S, Cinel I. Cytokine Adsorption in Critically Ill COVID-19 Patients, a Case-Control Study. J Intensive Care Med 2022; 37:1223-1228. [PMID: 35274999 PMCID: PMC8919098 DOI: 10.1177/08850666221085185] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aim: New coronavirus disease (COVID-19) has become an international
emergency. As many of the intensive care unit (ICU) patients with the disease
also present multiple organ failure, blood purification techniques might be a
good choice in their treatment. In this study we aimed to investigate the role
of cytokine removal in COVID-19 patients managed in ICUs. Methods:
For this case-control study we have investigated the role of the cytokine
removal by means of two resin membranes (HA330 and Mediasorb) in COVID-19
patients managed in ICUs. Particularly, we investigated the overtime variation
in clinical severity scores, laboratory variables, and effects on hospital and
ICU stay and mortality. Results: Seventy-two patients have been
evaluated, of which half constituted Cytokine Filtration (CF) Group, and other
half the Case-Control (CC) Group. Mortality was 55.6% and 50% in CF and CC
groups, respectively. In the CF Group, there was decrease in C-reactive protein
(CRP) and fibrinogen levels measured at the end of cytokine adsorption;
lymphocyte count and ratio were increased, whereas neutrophile ratio was
decreased. There were no differences between the groups regarding other
laboratory variables, SOFA scores and vasopressor uses.
Conclusions: We have demonstrated decrease in CRP, fibrinogen
and increase in lymphocyte count in the patients having cytokine adsorption, but
there was no clinical reflection of these benefits, and no decrease in mortality
as well. Even though there is physio-pathologic rationale to use cytokine
adsorption techniques for immunomodulation in critically ill COVID-19 patients,
it is early to make strong suggestions about their benefits.
Collapse
Affiliation(s)
- Ruslan Abdullayev
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| | - Fethi Gul
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| | - Beliz Bilgili
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| | - Seda Seven
- Department of Anesthesiology and Reanimation, Marmara University Training and Research Hospital, Istanbul, Turkey
| | - Ismail Cinel
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
11
|
A Case of COVID-19-Associated Pediatric Multisystem Inflammatory Syndrome in Shock Managed by Cytokine Filtration. Case Rep Pediatr 2022; 2022:3373289. [PMID: 35127192 PMCID: PMC8808292 DOI: 10.1155/2022/3373289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 has been recognized as a complication arising due to cytokine storm. Several management strategies including intravenous immunoglobulin and immunomodulators have been reported. This case report highlights the use of a cytokine filter (oXiris®) in the management of MIS-C. Cytokine filters eliminate cytokines and reduce the demand for vasopressors in patients with other inflammatory conditions. A 7-year-old child with prolonged fever, vomiting, hypotension, elevated inflammatory mediators, and dilatation of coronary arteries on echocardiography was found to have positive SARS-CoV-2 IgG and PCR. He was diagnosed as MIS-C and was managed in the pediatric intensive care unit. He required ventilatory support, vasopressors, and continuous renal replacement therapy (CRRT) with a cytokine filter. He showed marked improvement within 24 hours of initiating CRRT. Cytokine filters may have a potential role in the management of severely ill children due to MIS-C. To our knowledge, this is the first report of successful use of the oXiris® membrane in MIS-C. However, further case series and controlled trials are needed to establish its use in this condition.
Collapse
|
12
|
Premužić V, Babel J, Gardijan D, Lapić I, Gabelica R, Ostojić Z, Lozić M, Pavliša G, Hrabak M, Knežević J, Rogić D, Mihaljević S. Extracorporeal blood purification is associated with improvement in biochemical and clinical variables in the critically-ill COVID-19 patients. Ther Apher Dial 2021; 26:316-329. [PMID: 34486793 PMCID: PMC8652436 DOI: 10.1111/1744-9987.13730] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Abstract
This study tried to investigate the impact of oXiris filter on both clinical and laboratory parameters in critically-ill COVID-19 intensive care unit (ICU) patients receiving extracorporeal blood purification and the clinical setting for the initiation of therapy. A consecutive sample of 15 ICU patients with COVID-19 was treated with oXiris membrane for blood purification or for support of renal function due to acute kidney injury. We have included 19 non treated ICU COVID-19 patients as a control group. Two chest x-rays were analyzed for determining the chest x-ray severity score. We have found a significant decrease of SOFA score, respiratory status improved and the chest x-ray severity score was significantly decreased after 72 h of treatment. IL-6 significantly decreased after 72 h of treatment while other inflammatory markers did not. Respiratory status in the control group worsened as well as increase in SOFA score and chest x-ray severity score. Survived patients have shorter time from the onset of symptoms before starting with extracorporeal blood purification treatment and shorter time on vasoactive therapy and invasive respiratory support than deceased patients. Critically-ill patients with COVID-19 treated with extracorporeal blood purification survived significantly longer than other ICU COVID-19 patients. Treatment with oXiris membrane provides significant reduction of IL-6, leads to improvement in respiratory status, chest x-ray severity score, and reduction of SOFA score severity. Our results can suggest that ICU COVID-19 patients in an early course of a disease could be potentially a target group for earlier initiation of extracorporeal blood purification.
Collapse
Affiliation(s)
- Vedran Premužić
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb, Croatia
| | - Jakša Babel
- Department of Intensive Care Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Danilo Gardijan
- Department of Radiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ivana Lapić
- Clinical Institute for Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Rajka Gabelica
- Clinic of Anesthesiology Resuscitation and Intensive Care, University Hospital Center Zagreb, Zagreb, Croatia
| | - Zvonimir Ostojić
- Cardiology Clinic, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marin Lozić
- Clinic of Anesthesiology Resuscitation and Intensive Care, University Hospital Center Zagreb, Zagreb, Croatia
| | - Gordana Pavliša
- Department for Respiratory Diseases Jordanovac, Zagreb, Croatia
| | - Maja Hrabak
- Department of Radiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Josip Knežević
- Clinical Institute for Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Clinical Institute for Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Slobodan Mihaljević
- Clinic of Anesthesiology Resuscitation and Intensive Care, University Hospital Center Zagreb, Zagreb, Croatia
| |
Collapse
|
13
|
Shchekina AE, Galstyan GM, Gavrilina OA, Arapova NM, Bronyakina SI, Kotova ES, Troitskaya VV, Parovichnikova EN, Maschan MA, Savchenko VG. Extracorporeal cytokine removal in chimeric antigen receptor T-cell therapy associated cytokine release syndrome in patient with acute lymphoblastic leukemia. Case report. TERAPEVT ARKH 2021; 93:811-817. [DOI: 10.26442/00403660.2021.07.200931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022]
Abstract
Сytokine release syndrome is the common complication of CAR-T therapy. We report a case of patient with B-cell acute lymphoblastic leukemia developing сytokine release syndrome with shock and multiple organ failure and requiring cytokine removal and hemodiafiltration. Remission of the disease was achieved after CAR-T therapy.
Collapse
|
14
|
Rosalia RA, Ugurov P, Neziri D, Despotovska S, Kostoska E, Veljanovska-Kiridjievska L, Kuzmanov D, Trifunovski A, Popevski D, Villa G, Mitrev Z. Extracorporeal Blood Purification in Moderate and Severe COVID-19 Patients: A Prospective Cohort Study. Blood Purif 2021; 51:233-242. [PMID: 34126617 DOI: 10.1159/000515627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is characterized by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and with critical cases progressing to acute respiratory distress syndrome. Control of hyperinflammation has been proposed as a possible therapeutic avenue for COVID-19; extracorporeal blood purification (EBP) modalities offer an attractive mean to ameliorate maladaptive inflammation. With this work, we evaluated the longitudinal changes of systemic inflammatory markers in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) haemofilter. METHODS We performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing haemofilter (CAH) according to local practice; we visualize longitudinal results of biochemical, inflammatory, blood gas, and vital sign parameters focussing on systemic levels of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin. RESULTS All patients were treated with ≥1 cycle extracorporeal continuous venovenous haemofiltration (CVVH) with CAH; of these, 30 severe patients received CVVH-CAH within 4-12 h of admission after recognizing a hyper-inflammatory state. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and were placed on EBP during hospitalization. The treatment was associated with a reduction of ferritin, CRP, fibrinogen, several inflammatory markers, and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3%. CONCLUSION EBP with CAH was associated with a decrease in CRP, and control of IL-6 and procalcitonin.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
| | - Zan Mitrev
- Zan Mitrev Clinic, Skopje, North Macedonia
| |
Collapse
|
15
|
Albalawi O, Alharbi Y, Bakouri M, Alqahtani A, Alanazi T, Almutairi AZ, Alosaimi B, Mubarak A, Choudhary RK, Alturaiki W. Clinical characteristics and predictors of mortality among COVID-19 patients in Saudi Arabia. J Infect Public Health 2021; 14:994-1000. [PMID: 34153731 PMCID: PMC8192299 DOI: 10.1016/j.jiph.2021.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The new coronavirus disease (COVID-19) has caused more than 1.8 million deaths, with a fatality rate of 2.5% in more than 200 countries as of January 4, 2021. Analysis of COVID-19 clinical features can help predict disease severity and risk of mortality, early identification of high-risk patients, and provide knowledge to inform clinical interventions. OBJECTIVE The purpose of this study is to investigate the clinical characteristics and possible predictors associated with mortality in patients with COVID-19 admitted to King Fahad (KFH), Ohood, and Miqat hospitals in Madina, Saudi Arabia. METHODS This retrospective observational study to investigate the clinical characteristic and possible predictors associated with mortality for those 119 mild, moderate, or critically ill patients confirmed by laboratory results to have COVID-19 who were admitted to three hospitals in Madina, Saudi Arabia, from March 25, 2020, to July 30, 2020. Data were collected from December 1, 2020, to December 14, 2020. RESULTS Of the 119 patients included in the study, the mean age was 54.2 (±15.7) years, with 78.2% survivors and 21.8% non-survivors. The demographic analysis indicated that the likelihood of mortality for patients in the older age group (i.e., ≥65 years) was five times higher than those in the younger age group (OR = 5.34, 95% CI 1.71-16.68, p = 0.004). The results also indicated those patients who admitted to the intensive care unit (ICU) was approximately seven times higher odds of mortality compare with those who were not admitted (OR = 6.48, 95% CI 2.52-16.63, p < 0.001). In addition, six laboratory parameters were positively associated with the odds of mortality: white blood cell count (OR = 1.11, 95% CI 1.02-1.21, p = 0.018), neutrophil (OR = 1.11, 95% CI 1.02-1.22, p = 0.020), creatine kinase myocardial band (OR = 1.02, 95% CI 1.00-1.03, p = 0.030), C-reactive protein (OR = 1.01, 95% CI 1.00-1.01, p = 0.002), urea (OR = 1.06, 95% CI 1.01-1.11, p = 0.026), and lactate dehydrogenase (OR = 1.00, 95% CI 1.00-1.01, p = 0.020). CONCLUSIONS In this cohort, COVID-19 patients within the older age group (≥65 years) admitted to the ICU with increased C-reactive protein levels in particular, were associated with increased odds of mortality. Further clinical observations are warranted to support these findings and enhance the mapping and control of this pandemic.
Collapse
Affiliation(s)
- Olayan Albalawi
- Department of Statistic, Faculty of Science, University of Tabuk, Tabuk 47512, Saudi Arabia.
| | - Yousef Alharbi
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia.
| | - Mohsen Bakouri
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia; Department of Physics, College of Arts, Fezzan University, Traghen City 71340, Libya; Health and Basic Sciences Research Center, Majmaah University, Majmaah 11952, Saudi Arabia.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia.
| | - Thamer Alanazi
- Department of Pathology and Laboratory Medicine, King Abdullah Bin Abdulaziz University Hospital, PNU, Riyadh, Saudi Arabia.
| | | | - Bandar Alosaimi
- Department of Research Labs, Research Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia.
| | - Ayman Mubarak
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Ranjay K Choudhary
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia.
| | - Wael Alturaiki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia.
| |
Collapse
|
16
|
Ruiz-Rodríguez JC, Chiscano-Camón L, Palmada C, Ruiz-Sanmartin A, García-de-Acilu M, Plata-Menchaca E, Perurena-Prieto J, Hernandez-Gonzalez M, Pérez-Carrasco M, Soler-Palacin P, Ferrer R. Hemadsorption as a Treatment Option for Multisystem Inflammatory Syndrome in Children Associated With COVID-19. A Case Report. Front Immunol 2021; 12:665824. [PMID: 34140949 PMCID: PMC8204690 DOI: 10.3389/fimmu.2021.665824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/04/2021] [Indexed: 12/27/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is characterized by hypercytokinemia leading to overwhelming inflammation. We describe the use of a hemadsorption device as part of the supportive treatment for cytokine storm.
Collapse
Affiliation(s)
- Juan Carlos Ruiz-Rodríguez
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Luis Chiscano-Camón
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Clara Palmada
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Adolf Ruiz-Sanmartin
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marina García-de-Acilu
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Erika Plata-Menchaca
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Janire Perurena-Prieto
- Immunology Division, Vall d'Hebron University Hospital, Barcelona, Spain.,Diagnostic Immunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Manuel Hernandez-Gonzalez
- Immunology Division, Vall d'Hebron University Hospital, Barcelona, Spain.,Diagnostic Immunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marcos Pérez-Carrasco
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| |
Collapse
|
17
|
Matsushita Y, Kusaoi M, Hiki M, Murayama G, Abe Y, Nozawa K, Takahashi K, Yamaji K, Tamura N, Naito T. Combination therapy with plasma exchange and glucocorticoid may be effective for severe COVID-19 infection: A retrospective observational study. Ther Apher Dial 2021; 25:390-400. [PMID: 33887110 PMCID: PMC8250198 DOI: 10.1111/1744-9987.13656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 12/15/2022]
Abstract
We retrospectively analyzed the characteristics and outcomes of five patients with COVID-19 who were received glucocorticoid (with or without pulse therapy) and therapeutic plasma exchange. The efficacy of the treatment was determined by whether the patient was able to be transferred from the COVID-19 exclusive ICU to the general ward. In comparing patients who received prednisolone pulse therapy (three cases) with those who did not (two cases), 2/3 (66%) and 0/2 (0%) patients could be discharged from the COVID-19 dedicated ICU, respectively. Among five patients who was performed plasma exchange, two elderly male patients who underwent plasma exchange as early as within 8 days of disease exacerbation survived and were able to be transferred to the general ward. This observational study indicates that plasma exchange in conjunction with methylprednisolone pulse therapy at the appropriate time may be an effective treatment for elderly patients with severe COVID-19.
Collapse
Affiliation(s)
- Yasushi Matsushita
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Makio Kusaoi
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Makoto Hiki
- Department of Emergency Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan.,Department of Cardiovascular Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Goh Murayama
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshiyuki Abe
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Nozawa
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Ken Yamaji
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| |
Collapse
|
18
|
Alessandri F, Pistolesi V, Manganelli C, Ruberto F, Ceccarelli G, Morabito S, Pugliese F. Acute Kidney Injury and COVID-19: A Picture from an Intensive Care Unit. Blood Purif 2021; 50:767-771. [PMID: 33412548 DOI: 10.1159/000513153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care unit (ICU) for severe respiratory failure. The aim is to evaluate the rate of AKI, defined according to Kidney Disease: Improving Global Outcome guidelines, in a series of critical COVID-19 patients admitted to the ICU of a single tertiary teaching hospital. METHODS From April to May 2020, all consecutive critically ill COVID-19 patients admitted to the ICU who did not meet exclusion criteria (length of ICU stay <48 h, ESRD requiring dialysis, and patients still hospitalized in ICU at the time of data analysis) were enrolled in this study. Patients were stratified according to the highest AKI stage attained during ICU stay. RESULTS Sixty-one patients were included in the analysis. AKI was observed in 35/61 patients (57.4%): 25/35 episodes (71.4%) were observed within the first 7 days. AKI was classified as follows: 17.1% stage 1, 25.7% stage 2, and 57.2% stage 3. Fourteen out of 20 stage-3 patients required continuous renal replacement therapy (CRRT), mostly related to persistent oliguria. The overall ICU mortality was 68.9%, and it was higher in patients developing AKI if compared to no-AKI patients (p = 0.006). Renal function recovery of any grade was observed in 14 out of 35 AKI patients (40%). Among patients undergoing CRRT, 13 patients were still dialysis dependent at the time of death. CONCLUSION In critical COVID-19 patients, ICU mortality is particularly high, especially in patients developing AKI. An accurate monitoring of renal function in early phases of respiratory failure should be ensured in order to timely apply any strategy aimed at limiting renal complications during ICU stay.
Collapse
Affiliation(s)
- Francesco Alessandri
- Department of General and Specialist Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy,
| | - Valentina Pistolesi
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Chiara Manganelli
- Department of General and Specialist Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Franco Ruberto
- Department of General and Specialist Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Santo Morabito
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Pugliese
- Department of General and Specialist Surgery "Paride Stefanini", "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | | |
Collapse
|
19
|
Shadmanfar S, Jonaidi-Jafari N, Jafari R, Rastgar-Moqaddam Z, Saburi A. COVID-19 in rheumatoid arthritis cases: an Iranian referral center experience. Clin Rheumatol 2020; 40:2979-2984. [PMID: 33219453 PMCID: PMC7679060 DOI: 10.1007/s10067-020-05464-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022]
Abstract
Coronavirus infections, known as COVID-19, can induce a fatal respiratory system infection and also affect other organs, such as the kidney and heart. The mortality rate has been estimated between 1 and 5% in previous reports; however, the mortality and morbidity can be higher in patients with the immune-deficiency condition. Rheumatoid arthritis (RA) is one of the most rheumatoid disorders, and it is important to report their clinical and paraclinical data when affected with COVID-19. Evidence about their laboratory and radiologic findings is limited. In this case series, 10 cases of chronic and approved rheumatoid arthritis (RA) affected by COVID-19 are presented. Only 40% had dry cough, but myalgia and weakness as the general first presentation of infections was reported in most cases (80%). Gastrointestinal symptoms, including nausea/vomiting, diarrhea, anorexia, and abdominal pain, were reported in 50% of individuals. In blood cell count, 30% of cases had thrombocytopenia, and ESR in all cases was positive. Abnormal CRP and elevated LDH were seen in 90% of cases. In HRCT assessment, all cases had an abnormal parenchymal pattern, and 90% of cases presented the usual pattern of COVID-19 (bilateral multifocal GGO/consolidation). Although it is a limited report, these findings are helpful for comparison of clinical and paraclinical cases in RA cases with normal cases.
Collapse
Affiliation(s)
- Soraya Shadmanfar
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Rheumatology Department, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nematollah Jonaidi-Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramezan Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Radiology Department, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Amin Saburi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. .,Dr Saburi Radiology & Ultrasound Clinic, Mashhad, Iran.
| |
Collapse
|
20
|
Ramirez-Sandoval JC, Gaytan-Arocha JE, Xolalpa-Chávez P, Mejia-Vilet JM, Arvizu-Hernandez M, Rivero-Sigarroa E, Torruco-Sotelo C, Correa-Rotter R, Vega-Vega O. Prolonged Intermittent Renal Replacement Therapy for Acute Kidney Injury in COVID-19 Patients with Acute Respiratory Distress Syndrome. Blood Purif 2020; 50:355-363. [PMID: 33105136 DOI: 10.1159/000510996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/16/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 frequently develop severe acute kidney injury (AKI). Although continuous renal replacement therapy is the standard of care for critically ill patients, prolonged intermittent renal replacement therapy (PIRRT) may be a feasible option. We aimed to describe the tolerability and security of PIRRT treatments in COVID-19 patients with ARDS who required mechanical ventilation and developed severe AKI. METHODS We prospectively analyzed patients who underwent PIRRT treatments at a COVID-19 reference hospital in Mexico City. Intradialytic hypotension was defined as a systolic blood pressure decrease of ≥20 mm Hg or an increase of 100% in vasopressor dose. RESULTS We identified 136 AKI cases (60.7%) in 224 patients admitted to the intensive care unit. Among them, 21 (15%) underwent PIRRT (130 sessions) due to stage 3 AKI. The median age of the cohort was 49 (range 36-73) years, 17 (81%) were male, 7 (33%) had diabetes, and the median time between symptoms onset and PIRRT initiation was 12 (interquartile range [IQR] 7-14) days. The median of PIRRT procedures for each patient was 5 (IQR 4-9) sessions. In 108 (83%) PIRRT sessions, the total ultrafiltration goal was achieved. In 84 (65%) PIRRT procedures, there was a median increase in norepinephrine dose of +0.031 mcg/kg/min during PIRRT (IQR 0.00 to +0.07). Intradialytic hypotensive events occurred in 56 (43%) procedures. Fifteen (12%) PIRRT treatments were discontinued due to severe hypotension. Vasopressor treatment at PIRRT session onset (OR 6.2, 95% CI 1.4-28.0, p: 0.02) and a pre-PIRRT lactate ≥3.0 mmol/L (OR 4.63, 95% CI 1.3-12.8, p: 0.003) were independently and significantly associated with the risk of hypotension during PIRRT. During follow-up, 11 patients (52%) recovered from AKI and respiratory failure and 9 (43%) died. Several adaptations to our PIRRT protocol during the COVID-19 outbreak are presented. CONCLUSIONS PIRRT was feasible in the majority of COVID-19 patients with ARDS and severe AKI, despite frequent transitory intradialytic hypotensive episodes. PIRRT may represent an acceptable alternative of renal replacement therapy during the COVID-19 outbreak.
Collapse
Affiliation(s)
- Juan C Ramirez-Sandoval
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jorge E Gaytan-Arocha
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pedro Xolalpa-Chávez
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan M Mejia-Vilet
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mauricio Arvizu-Hernandez
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eduardo Rivero-Sigarroa
- Department of Intensive Care, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Torruco-Sotelo
- Department of Intensive Care, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Olynka Vega-Vega
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico,
| |
Collapse
|
21
|
Mahajan RK, Paul G, Mahajan R, Gautam PL, Paul B. Systemic manifestations of COVID-19. J Anaesthesiol Clin Pharmacol 2020; 36:435-442. [PMID: 33840920 PMCID: PMC8022059 DOI: 10.4103/joacp.joacp_359_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused due to a novel coronavirus SARS-CoV-2, has swept across the planet and has become a public health emergency of international concern. Like other coronaviruses, it predominantly involves the respiratory system. However, several atypical manifestations of the disease have been reported worldwide in a short span of time. Almost all organ systems (cardiovascular, gastrointestinal, renal, hepatic, endocrine, and nervous system) have been reported to be involved. This review concisely summarizes the systemic effects of COVID-19, thus emphasizing that the disease can present in various forms and the healthcare workers need to be extra vigilant, approaching all patients with a high index of suspicion.
Collapse
Affiliation(s)
- Rubina K. Mahajan
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gunchan Paul
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Parshotam L. Gautam
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Birinder Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
22
|
Pisani A, Pompa PP, Bardi G. Potential Applications of Nanomaterials to Quench the Cytokine Storm in Coronavirus Disease 19. Front Bioeng Biotechnol 2020; 8:906. [PMID: 32974295 PMCID: PMC7466734 DOI: 10.3389/fbioe.2020.00906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/14/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Anissa Pisani
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Chemistry and Industrial Chemistry, University of Genova, Genoa, Italy
| | - Pier Paolo Pompa
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Giuseppe Bardi
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia, Genoa, Italy
| |
Collapse
|
23
|
Pranata R, Supriyadi R, Huang I, Permana H, Lim MA, Yonas E, Soetedjo NNM, Lukito AA. The Association Between Chronic Kidney Disease and New Onset Renal Replacement Therapy on the Outcome of COVID-19 Patients: A Meta-analysis. Clin Med Insights Circ Respir Pulm Med 2020; 14:1179548420959165. [PMID: 32994700 PMCID: PMC7502996 DOI: 10.1177/1179548420959165] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the association between chronic kidney disease (CKD) and new onset renal replacement therapy (RRT) with the outcome of Coronavirus Disease 2019 (COVID-19) in patients. METHODOLOGY A systematic literature search from several databases was performed on studies that assessed CKD, use of RRT, and the outcome of COVID-19. The composite of poor outcome consisted of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care, and use of mechanical ventilator. RESULTS Nineteen studies with a total of 7216 patients were included. CKD was associated with increased composite poor outcome (RR 2.63 [1.33, 5.17], P = .03; I 2 = 51%, P = .01) and its subgroup, consisting of mortality (RR 3.47 [1.36, 8.86], P = .009; I 2 = 14%, P = .32) and severe COVID-19 (RR 2.89 [0.98, 8.46], P = .05; I 2 = 57%, P = .04). RRT was associated with increased composite poor outcome (RR 18.04 [4.44, 73.25], P < .001; I 2 = 87%, P < .001), including mortality (RR 26.02 [5.01, 135.13], P < .001; I 2 = 60%, P = .06), severe COVID-19 (RR 12.95 [1.93, 86.82], P = .008; I 2 = 81%, P < .001), intensive care (IC) (RR 14.22 [1.76, 114.62], P < .01; I 2 = 0%, P < .98), and use of mechanical ventilator (RR 34.39 [4.63, 255.51], P < .0005). CONCLUSION CKD and new-onset RRT were associated with poor outcome in patients with COVID-19.
Collapse
Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Rudi Supriyadi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Hikmat Permana
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of
Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Nanny Natalia M Soetedjo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of
Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Antonia Anna Lukito
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| |
Collapse
|
24
|
Epidemiological Modeling of COVID-19 in Saudi Arabia: Spread Projection, Awareness, and Impact of Treatment. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10175895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The first case of COVID-19 originated in Wuhan, China, after which it spread across more than 200 countries. By 21 July 2020, the rapid global spread of this disease had led to more than 15 million cases of infection, with a mortality rate of more than 4.0% of the total number of confirmed cases. This study aimed to predict the prevalence of COVID-19 and to investigate the effect of awareness and the impact of treatment in Saudi Arabia. In this paper, COVID-19 data were sourced from the Saudi Ministry of Health, covering the period from 31 March 2020 to 21 July 2020. The spread of COVID-19 was predicted using four different epidemiological models, namely the susceptible–infectious–recovered (SIR), generalized logistic, Richards, and Gompertz models. The assessment of models’ fit was performed and compared using four statistical indices (root-mean-square error (RMSE), R squared (R2), adjusted R2 ( Radj2), and Akaike’s information criterion (AIC)) in order to select the most appropriate model. Modified versions of the SIR model were utilized to assess the influence of awareness and treatment on the prevalence of COVID-19. Based on the statistical indices, the SIR model showed a good fit to reported data compared with the other models (RMSE = 2790.69, R2 = 99.88%, Radj2 = 99.98%, and AIC = 1796.05). The SIR model predicted that the cumulative number of infected cases would reach 359,794 and that the pandemic would end by early September 2020. Additionally, the modified version of the SIR model with social distancing revealed that there would be a reduction in the final cumulative epidemic size by 9.1% and 168.2% if social distancing were applied over the short and long term, respectively. Furthermore, different treatment scenarios were simulated, starting on 8 July 2020, using another modified version of the SIR model. Epidemiological modeling can help to predict the cumulative number of cases of infection and to understand the impact of social distancing and pharmaceutical intervention on the prevalence of COVID-19. The findings from this study can provide valuable information for governmental policymakers trying to control the spread of this pandemic.
Collapse
|
25
|
Barati F, Pouresmaieli M, Ekrami E, Asghari S, Ziarani FR, Mamoudifard M. Potential Drugs and Remedies for the Treatment of COVID-19: a Critical Review. Biol Proced Online 2020; 22:15. [PMID: 32754003 PMCID: PMC7377207 DOI: 10.1186/s12575-020-00129-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT COVID-19 disease with a high rate of contagious and highly nonspecific symptoms, is an infectious disease caused by a newly discovered coronavirus. Most people who fall sick with COVID-19 will experience mild to moderate symptoms such as respiratory symptoms, cough, dyspnea, fever, and viral pneumonia and recover without any special cure. However, some others need special and emergency treatment to get rid of this widespread disease. Till now, there are numbers of proposed novel compounds as well as standards therapeutics agent existed for other conditions seems to have efficacy against the 2019-nCoV. Some which are being tested for MERS-CoV and SARS-CoV are validated that could be also efficient against this new coronavirus. However, there are currently no effective specific antivirals or drug combinations introduced for 2019-nCoV specifically that be supported by high-level evidence. The main purpose of this paper is to review typical and ongoing treatments for coronavirus disease including home remedies, herbal medicine, chemical drugs, plasma therapy, and also vaccinies. In this regards, famous herbal medicines and common chemical drugs which are routinely to be prescribed for patients are introduced. Moreover, a section is assigned to the drug interactions and some outdated drugs which have been proved to be inefficient. We hope that this work could pave the way for researchers to develop faster and more reliable methods for earlier treatment of patients and rescue more people. GRAPHICAL ABSTRACT
Collapse
Affiliation(s)
- Fatemeh Barati
- Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Mahdi Pouresmaieli
- Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Elena Ekrami
- Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Sahar Asghari
- Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Farzad Ramezani Ziarani
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Matin Mamoudifard
- Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| |
Collapse
|