Early and Timely Use of Hemofiltration Therapy with Poly Methyl Meth Acrylate (PMMA) Filters in Severe COVID-19 Adult Respiratory Distress Syndrome Patients: A Single Centre Study in India

Abstract

A high Interleukin-6 (IL-6) level in COVID-19 plays a major role in the pathophysiology and is considered a reliable parameter in predicting the adversity of the disease. In COVID-19. Extracorporeal blood purification has been proposed as an adjuvant therapy and it aims at controlling the dysregulation in the immune system. Essentially, it lowers the upregulated levels of several mediators and therefore controls the cytokine storm, instead of actively targeting individual pathways of inflammation. Positive IL-6 balance post-Polymethyl methacrylate (PMMA) filter used for Cytokine storm in COVID-19 patients with dialysis has shown to be an independent predictor of mortality. A retrospective analysis of seventeen patients wherein hemofiltration was used for cytokine storm with dialysis, sepsis, and septic shock. The inflammatory markers post-hemofiltration sessions were supervised to understand hemofiltration's efficacy. The average age of the patients was 70.2 (18.2) years. They were classified as responders or non-responder groups based on the decrease or no change/ increase respectively between the pre-and post-filtration IL-6 levels. A 3.6-fold increase was noticed in non-responders (N=11) for IL-6 levels post hemofiltration. Responders demonstrated a 21.4% (p<0.05) reduction in IL-6 levels post hemofiltration. Of these, 4 who survived demonstrated a decrease in IL-6 levels of 66.2%. Of 10 non-responders, none survived. However, the survival rate was 71.43 percent among the responders. There was a significant statistical difference in the mortality rate between the two groups (p= 0.003).Cytokine storm, an overwhelming immunological response in COVID-19 patients, can be controlled successfully by the early and timely use of hemofiltration therapy with PMMA filters like Hemofeel. However, patients with higher positive IL-6 balance post-hemofiltration may be associated with limited outcomes.