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Abstract: PO0672

Effect of Early Initiation of Blood Purification in ICU Adults with Severe COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Qian, Jing, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Wang, Mengjing, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Ni, Li, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Zhang, Weichen, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Wang, Kangjie, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Yuan, Li, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Chen, Jing, Huashan Hospital Fudan University, Shanghai, Shanghai, China
Background

Cytokine storm induced by SARS-CoV-2 was considered as one of the main mechanisms of multiple organs dysfunction in Covid-19. Blood purification could remove excess cytokines or other harmful substances and then attenuate target organs injury. In this prospective single-center cohort study, we aimed to assess the efficacy of early initiation of blood purification in ICU adults with severe Covid-19.

Methods

Sixty-two patients in early stage of severe Covid-19 in ICU(Tongji Hospital, Wuhan, China) from Feb.9.2020 to Mar.24.2020 were recruited and divided into two subgroups: 20 patients initiated blood purification including CVVH(/HP) after ICU admission, and the other 42 patients who had not received RRT unless reached traditional RRT indication, were served as control. The primary outcome was in-hospital all-cause mortality.

Results

The 20 patients initiated early RRT after 6.4±3.6 days from ICU admission. The mean cumulative treatment time was 50.0±42.2 hours, the net ultrafiltration rate was 65.5±65.2ml/h. One patient in control group also received RRT after ICU admission due to AKI. No statistic difference was found in the two subgroups in baseline. 61.3% patients died during hospitalization. The median survival time was 12 days and the average observation time was 19 days. Kaplan-Meier analysis showed that the in-hospital all-cause mortality of early RRT patients was lower than control group(50.5% vs 66.7%, p=0.040). Univariate analysis and Cox proportional hazard regression also confirmed that early initiation of RRT was an independent protective factor(HR 0.21, 95%CI 0.06-0.74, p=0.014) for in-hospital all-cause death of severe Covid-19 after adjusting by SpO2, lymphocyte proportion, albumin, LogNT-proBNP, LogInterleukin-6, mechanical ventilation and use of glucocorticoid. A figure that shows the course of disease indicates that early initiation of blood purification may decrease the death without multiple organs injuries(39% vs 0%, p=0.037).

Conclusion

Early initiation of blood purification could probably reduce the mortality of severe Covid-19 . It was implied that it could delay occurs and reduce degrees of target organs injuries by cutting the peak load of cytokine storm. Further research in basic and clinical were needed to clarify the mechanism of blood purification in cytokine storm-related diseases.