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Abstract: PO0158

CRRT with the oXiris Filter Attenuates IL-6 in a Patient with Severe COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Tang, Jennifer Chiwing, Keck Hospital of USC, Los Angeles, California, United States
  • Cao, Thanh, Keck Hospital of USC, Los Angeles, California, United States
Introduction

SARS-CoV-2 infection can result in ARDS and multiorgan dysfunction. The pathophysiology underlying Covid-19 includes a hypercoagulable state and a cytokine release storm with upregulation of IL-6, IL-10, and TNF-alpha, which are associated with ICU admission, ARDS, AKI, and increased mortality. While there are no proven treatments for this cytokine storm, tocilizumab, has shown promise in studies against severe Covid-19, suggesting that cytokine removal via blood purification products like oXiris may help achieve immune homeostasis.

Case Description

A 70-year-old male status post DDRT in 2016 presented with fevers, malaise, and dyspnea. He tested positive for SARS-CoV-2 and was admitted requiring high-flow nasal cannula with a rate of 50L/min and FiO2 of 90%.
Urinalysis revealed pyuria, hematuria, and proteinuria. Labs revealed a creatinine of 2.4 and a BUN of 61 as well as a CRP of 130, ESR of 65, D-dimer of 1048, LDH of 325, ferritin of 3891, and IL-6 of 5.6 consistent with severe Covid-19. An ultrasound of his allograft kidney was normal.
The patient then went into PEA arrest and was intubated with decreasing urine output, therefore was initiated on CRRT with an oXiris filter for 48 hours followed by a M150 filter. His P/F ratio increased and his IL-6 and SOFA score decreased while on the oXiris filter, however both CRP and LDH increased. After switching filters, the patient’s P/F ratio quickly declined with a rapid increase of IL-6. Ultimately, the family decided to withdraw care.

Discussion

The oXiris filter could potentially manage the cytokine storm seen in Covid-19 as it is the only filter shown to remove cytokine and endotoxins, improve renal function, and have antithrombogenic properties as it is grafted with heparin. It is an AN69-based oXiris membrane treated on the inside with a high concentration of polyethyleneimine (PEI) binding cytokines and endotoxins. Given the impact of Covid-19, more studies must be done to assess if oXiris may serve as an effective treatment.

Graph demonstrating Day of Admission vs IL-6, CRP, and LDH.