The Characteristics of Patients with Severe COVID-19 Pneumonia Treated with Direct Hemoperfusion Using Polymyxin B-Immobilized Fiber Column (PMX-DHP)

Overview

Journal Infect Drug Resist

Publisher Dove Medical Press

Date 2022 Aug 31

PMID 36043160

Authors

Tsukasa Kuwana

Kosaku Kinoshita

Shingo Ihara

Nami Sawada

Toru Hosokawa

Tomokazu Mutoh

Umefumi Iguchi

Katsuhiro Nakagawa

Junko Yamaguchi

Affiliations

Soon will be listed here.

Abstract

Purpose: The characteristics of patients with severe COVID-19 pneumonia who underwent direct hemoperfusion using polymyxin B-immobilized fiber column (PMX-DHP), in addition to steroids and immunomodulators, remain unclear.

Patients And Methods: We conducted a retrospective observational study on 31 patients with severe COVID-19 pneumonia treated with PMX-DHP in an intensive care unit (ICU) from December 2020 to September 2021.

Results: Outcomes 28 days after admission to the ICU were 20 in the survival group and 11 in the death group. Parameters significantly different between the survival and death group before PMX-DHP were percentage of invasive mechanical ventilation (25% vs 72.7%, P = 0.0209), PaO/FO (P/F) ratio (104.5 vs 75, P = 0.0317), and sequential organ failure assessment (SOFA) score (2 vs 3, P = 0.0356). Invasive mechanical ventilation avoidance rate was significantly different between the survival (100%) and death group (0%) (P = 0.0012). P/F ratio, respiratory ratio (RR), and lymphocyte counts improved significantly after PMX-DHP for all patients. The lymphocyte counts changed significantly in the survival (P < 0.0001), but not the death group (P = 0.7927).

Conclusion: PMX-DHP, in addition to steroids and immunomodulators, may improve oxygenation and alleviate tachypnea by modulating the lymphocyte numbers and levels of various mediator against severe COVID-19 pneumonia. It may be better to perform PMX-DHP before multi organ dysfunction and lung injury has progressed. Furthermore, the early increase in lymphocyte counts after PMX-DHP might be an indicate a positive outcome.

Citing Articles

Blood perfusion with polymyxin B immobilized columns in patients with COVID-19 requiring oxygen therapy.

Katagiri D, Tsukada A, Izumi S, Shimizu Y, Terada-Hirashima J, Uemura Y Sci Rep. 2024; 14(1):12550.

PMID: 38822071 PMC: 11143350. DOI: 10.1038/s41598-024-63330-2.

References

Gordon A, Mouncey P, Al-Beidh F, Rowan K, Nichol A, Arabi Y . Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med. 2021; 384(16):1491-1502. PMC: 7953461. DOI: 10.1056/NEJMoa2100433. View

Enomoto N, Mikamo M, Oyama Y, Kono M, Hashimoto D, Fujisawa T . Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival. BMC Pulm Med. 2015; 15:15. PMC: 4349669. DOI: 10.1186/s12890-015-0004-4. View

Nishibori M, Takahashi H, Katayama H, Mori S, Saito S, Iwagaki H . Specific Removal of Monocytes from Peripheral Blood of Septic Patients by Polymyxin B-immobilized Filter Column. Acta Med Okayama. 2009; 63(1):65-9. DOI: 10.18926/AMO/31855. View

Oishi K, Mimura-Kimura Y, Miyasho T, Aoe K, Ogata Y, Katayama H . Association between cytokine removal by polymyxin B hemoperfusion and improved pulmonary oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis. Cytokine. 2012; 61(1):84-9. DOI: 10.1016/j.cyto.2012.08.032. View

Liu Q, Wang R, Qu G, Wang Y, Liu P, Zhu Y . Gross examination report of a COVID-19 death autopsy. Fa Yi Xue Za Zhi. 2020; 36(1):21-23. DOI: 10.12116/j.issn.1004-5619.2020.01.005. View

Kalil A, Patterson T, Mehta A, Tomashek K, Wolfe C, Ghazaryan V . Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19. N Engl J Med. 2020; 384(9):795-807. PMC: 7745180. DOI: 10.1056/NEJMoa2031994. View

Vincent J, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter P . Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998; 26(11):1793-800. DOI: 10.1097/00003246-199811000-00016. View

Shekar K, Badulak J, Peek G, Boeken U, Dalton H, Arora L . Extracorporeal Life Support Organization Coronavirus Disease 2019 Interim Guidelines: A Consensus Document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers. ASAIO J. 2020; 66(7):707-721. PMC: 7228451. DOI: 10.1097/MAT.0000000000001193. View

Mehta P, McAuley D, Brown M, Sanchez E, Tattersall R, Manson J . COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395(10229):1033-1034. PMC: 7270045. DOI: 10.1016/S0140-6736(20)30628-0. View

10.

Izcovich A, Ragusa M, Tortosa F, Marzio M, Agnoletti C, Bengolea A . Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020; 15(11):e0241955. PMC: 7671522. DOI: 10.1371/journal.pone.0241955. View

11.

Horby P, Lim W, Emberson J, Mafham M, Bell J, Linsell L . Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2020; 384(8):693-704. PMC: 7383595. DOI: 10.1056/NEJMoa2021436. View

12.

Naik N, Puri G, Kajal K, Mahajan V, Bhalla A, Kataria S . High-Dose Dexamethasone Versus Tocilizumab in Moderate to Severe COVID-19 Pneumonia: A Randomized Controlled Trial. Cureus. 2022; 13(12):e20353. PMC: 8752381. DOI: 10.7759/cureus.20353. View

13.

Katagiri D, Ishikane M, Asai Y, Izumi S, Takasaki J, Katsuoka H . Direct hemoperfusion using a polymyxin B-immobilized polystyrene column for COVID-19. J Clin Apher. 2020; 36(3):313-321. PMC: 8246724. DOI: 10.1002/jca.21861. View

14.

Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G . Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020; 180(10):1345-1355. PMC: 7364371. DOI: 10.1001/jamainternmed.2020.3539. View

15.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A . Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16):1574-1581. PMC: 7136855. DOI: 10.1001/jama.2020.5394. View

16.

Yao X, Li T, He Z, Ping Y, Liu H, Yu S . [A pathological report of three COVID-19 cases by minimal invasive autopsies]. Zhonghua Bing Li Xue Za Zhi. 2020; 49(5):411-417. DOI: 10.3760/cma.j.cn112151-20200312-00193. View

17.

Lim Z, Subramaniam A, Ponnapa Reddy M, Blecher G, Kadam U, Afroz A . Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis. Am J Respir Crit Care Med. 2020; 203(1):54-66. PMC: 7781141. DOI: 10.1164/rccm.202006-2405OC. View

18.

Chauhan S . Comprehensive review of coronavirus disease 2019 (COVID-19). Biomed J. 2020; 43(4):334-340. PMC: 7263230. DOI: 10.1016/j.bj.2020.05.023. View

19.

Shimizu T, Miyake T, Kitamura N, Tani M, Endo Y . Endotoxin adsorption: Direct hemoperfusion with the polymyxin B-immobilized fiber column (PMX). Transfus Apher Sci. 2017; 56(5):682-688. DOI: 10.1016/j.transci.2017.08.015. View

20.

Spagnolo P, Balestro E, Aliberti S, Cocconcelli E, Biondini D, Casa G . Pulmonary fibrosis secondary to COVID-19: a call to arms?. Lancet Respir Med. 2020; 8(8):750-752. PMC: 7228737. DOI: 10.1016/S2213-2600(20)30222-8. View