Case of the Week
Literature Database
Use of CytoSorb in a patient with COVID-19 pneumonia
Dr. Krishna Prabhakar | Department of Internal Medicine and Critical Care, Citi Neuro Centre, Hyderabad, India
01/05/2022
New!Case of the week
Download documentDownload document
Summary
CoW 01/2022 – This case reports on a 60-year-old male diagnosed with COVID-19 following a positive RT-PCR test, who was hospitalized with complaints of cough with mild expectoration, and worsening shortness of breath for 2 days.
Case Presentation
On arrival, vital parameters were as follows: respiratory rate 24/min, heart rate 90/min, blood pressure 130/80 mmHg, oxygen saturation 90%
Previous medical history included diabetes mellitus, hypertension, coronary artery disease, partial percutaneous transluminal coronary angioplasty, and chronic obstructive pulmonary disease. Furthermore, the patient was a known smoker
Antiviral therapy with remdesivir (100 mg i.v.) and glucocorticoid therapy with methylprednisolone were initiated
Subsequent arterial blood gas analysis revealed hyperlactatemia (5.72 mmol/l) accompanied by severe respiratory insufficiency
Due to progressing respiratory distress over the following day, the patient was transferred to the intensive care unit (ICU) and was put on high-flow nasal cannula (HFNC) therapy (day 6). As the patient’s oxygenation deteriorated further, he was finally intubated and mechanically ventilated
Subsequently, the hemodynamic status started to worsen (Mean Arterial Pressure – MAP 58 mmHg) necessitating initiation of a norepinephrine infusion (0.2 µg/kg/min), which had to be increased to 0.4 µg/kg/min over the next 4 hours
At this time, the patient also showed increased D-Dimer (2132 ng/mL) and ferritin (5.73 ng/mL) levels as well as signs of systemic hyperinflammation with significantly elevated inflammatory marker plasma concentrations (interleukin – IL-6 1230 pg/ml, C-Reactive Protein [CRP] 329 mg/dL)
Given the progressive deterioration of his clinical condition under standard care and in the context of a further increase in IL-6 and CRP plasma levels, the patient was started on combined continuous renal replacement therapy (CRRT) and CytoSorb hemoadsorption on day 9 of his hospital stay
Treatment
One CytoSorb treatment was performed for 8 hours
CytoSorb was used in conjunction with CRRT (Fresenius 3008S) run in veno-venous hemodialysis (CVVHD) mode
Anticoagulation: heparin
Blood Flow Rate: 150 ml/min
Measurements
Hemodynamics and norepinephrine requirements
Inflammatory parameters
Metabolic status
Lung function and oxygenation
Results
Following use of CytoSorb treatment, the patient showed improvements in his hemodynamic condition. MAP increased to 68 mmHg while norepinephrine could be completely weaned off over the following hours
Combined treatment was further associated with a significant decrease in inflammatory markers. Post-CytoSorb therapy, IL-6 levels reduced from 1230 to 177 pg/ml while CRP levels could be lowered from 329 mg/dl to 207 mg/dl
Therapy also resulted in an improvement in oxygenation further improving until extubation of the patient was possible
His metabolic status improved as evidenced by a decrease in plasma lactate levels to 2.7 mmol/l
Finally, there was also a marked improvement in the patient’s overall condition during and after the treatment session
Patient Follow-Up
Follow-up on day 14 revealed that his IL-6 levels had further reduced (5.7 pg/ml), indicating complete recovery from his hyperinflammatory phase
Furthermore, oxygenation and lung function had also completely recovered 14 days after his hospital admission
Following completion of CytoSorb therapy, the patient was continued on antibiotics, dexamethasone as well as multivitamin therapy
He was transferred from the ICU to the normal ward on day 25 of his hospital stay and could be discharged home on day 27 in a clinically stable condition
Conclusions
In this case of a patient with moderate COVID-19 pneumonia, combined treatment with standard of care and CytoSorb hemoadsorption therapy was associated with control of the hyperinflammatory response, an improvement in lung function and of his overall clinical condition
According to the authors, this report highlights the potential use of CytoSorb hemoadsorption therapy in severely ill COVID-19 patients with significant hyperinflammation to stabilize patients in a critical condition giving the body time for recovery and protection of organ functions
There were no adverse effects, and the device was easily integrated into the circuit.
