AIM: To investigate continuous renal replacement therapy (CRRT) with CytoSorb® cartridge for patients with life-threatening COVID-19 plus acute kidney injury (AKI), sepsis, acute respiratory distress syndrome (ARDS), and cytokine release syndrome (CRS). PATIENTS AND METHODS: Of 492 COVID-19 patients admitted to our intensive care unit (ICU), 50 had AKI necessitating CRRT (10.16%) and were enrolled in the study. Upon ICU admission, all had AKI, ARDS, septic shock, and CRS. In addition to CRRT with CytoSorb® , all received ARDS-net ventilation, prone positioning, plus empiric ribavirin, interferon beta-1b, antibiotics, hydrocortisone, and prophylactic anticoagulation. We retrospectively analyzed inflammatory biomarkers, oxygenation, organ function, duration of mechanical ventilation, ICU length-of-stay, and mortality on day-28 post-ICU admission. RESULTS: Patients were 49.64 ±8.90 years old (78% male) with body mass index of 26.70±2.76 kg/m2 . On ICU admission, mean Acute Physiology and Chronic Health Evaluation II, was 22.52±1.1. Sequential Organ Function Assessment (SOFA) score was 9.36±2.068 and the ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen (PaO2 /FiO2 ) was 117.46±36.92. Duration of mechanical ventilation was 17.38±7.39 days, ICU length-of-stay was 20.70±8.83 days, and mortality 28 days post-ICU admission was 30%. Non-survivors had higher levels of inflammatory biomarkers, and more unresolved shock, ARDS, AKI, and pulmonary emboli (8% vs. 4 %, p<0.05) compared to survivors. After 2±1 CRRT sessions with CytoSorb® , survivors had decreased SOFA scores, lactate dehydrogenase, ferritin, D-dimers, C-reactive protein, and interleukin-6; and increased PaO2 /FiO2 ratios, and lymphocyte counts (all p<0.05). Receiver-operator-curve analysis showed that post therapy values of interleukin-6 (cutoff point > 620 pg/ml) predicted in-hospital mortality for critically ill COVID-19 patients (area-under-the-curve: 0.87, 95% confidence-intervals: 0.81-0.93; p=0.001). No side effects of therapy were recorded. CONCLUSION: In this retrospective case-series, CRRT with the CytoSorb® cartridge provided a safe rescue therapy in life-threatening COVID-19 with associated AKI, ARDS, sepsis, and hyperinflammation.
Continuous renal replacement therapy with the addition of CytoSorb® cartridge in critically ill patients with COVID-19 plus acute kidney injury: a case-series