LAUSR

Abstract Background and Aims In the rapidly changing conditions of life due to the COVID - 19 pandemic, the medical society around the world have faced with the question of treatment previously unknown, multi-faceted and insidious infection. The coronavirus infection has forced doctors to reconsider the tactics of intensive care patients in critical condition. To date, overall mortality rate from COVID – 19 varied from 8.11 to 120.85 per 100.000 population (Johns Hopkins University mortality analyses). Mortality rate in extremely severe cases exceeds 60% - 78% (Yang et al., Lancet Respiratory Medicine, 2020. Zhou et al., Lancet, 2020). We would like to share our clinical experience of extracorporeal blood purification methods application to patients in ICU with various clinical manifestations, as well as the presence of comorbid pathology. Method We conducted a retrospective analysis of 239 medical records of patients hospitalized in the ICU of JSC NRCSC Nur-Sultan, Kazakhstan because of severe course of COVID 19. Period of hospitalization from 16.06.2020 to 29.09.2020, the total number of beds - 97, in the ICU - 25. Results The total number of patients with COVID -19 - 239 patients. In ICU -67 patients. Patients required in renal replacement therapy (RRT) – 31 patients. Among patients on RRT males-28 (90.3%) - female-3 (9.67%). Mean age-60 years. Distribution of the comorbid pathology. NO Comorbid pathology N = 31 Diabetes insipidus 10 (32,2%) Sepsis 5 (16.1%) MODS 6 (19.3%) Acute kidney damage 2 (KDIGO 2018) 9 (29%) Acute kidney damage 3 (KDIGO 2018) 5 (16.1%) Anuria 11 (35.48%) Acute respiratory failure 3 24 (77.4%) ARDS 19 (61.29%) Artificial lung ventilation 28 (90.32%) COPD 3 (9.67%) Hypertension 9 (29%) Ischemic heart disease 6 (19.3%) Obesity 9 (29%) Cytokine storm 19 (61.29%) ECMO 15 (48.38%) LVAD 1 (3.22%) Gastric ulcer 1 (3.22%) Indications for RRT: acute respiratory failure in the absence of heart failure or fluid overload; presence of diffuse alveolar damage (DAD) (detected by high-resolution CT); PaO2 / FiO2 ≤ 300 mm Hg Duration:> 6-24 hours per column with a blood flow rate of 80-120 ml/min. In addition, indications for the urgent start of extracorporeal treatment are: signs of severe coronavirus infection (respiratory rate ≥ 30 per minute and / or blood oxygen saturation ≤ 93% and / or PO2/FiO2 index ≤ 200 mmHg; detection of lung lesion progression using one of the imaging methods ≥10% per day; progressive increase in the level of inflammatory markers (CRP, IL-6, etc.). The duration of hospitalization in the ICU – 12.54 days. Combinations and duration of the procedures. Name of the procedure (n) Duration (in hour) HP HA330 + CVVHF/CVVHDF 2+1+1 (n=33) > 1224 ч HP Cytosorb© + CVVHF/CVVHDF 1+1+1(n=5) > 24 ч HP HA330II+ CVVHF/CVVHDF 2+1+1 (n=31) > 1224 ч PE + CVVHF/CVVHDF 2+1+1(n=7) > 624 ч HP 2+1+1(n=14) > 3-6 ч Footnote: combinations and duration of use are in accordance with the recommendations of Ronco C. et al. (2020). Laboratory data - Leukocyte, CRP, Interleukine, procalcitonin, Creatinin, presepsin in dynamics. Laboratory data Before blood purification After the 1st procedure After the 2nd procedure After the 3d procedure p value Leukocyte 15.30 13.31 10.68 8.23 0.01 CRP 17.91 16.12 14.10 13.02 0.02 Il - 6 260.77 205.82 201.188 188.9 0.027 PCT 26.58 12.13 4.34 5.56 0.01 Creat 2.33 1.77 1.89 1.34 0.01 Presepsin 2420.24 2788.81 1783.56 2063.41 0.18 General Mortality – 37 from 239 (15.5%) Mortality in ICU – 37 from 67 (55.2%) According to literature review, the mortality rate of patients with severe COVID - 19 in the ICU (Fawad Rahim et al, Cureus . 2020 Oct 12;12(10):e10906. doi: 10.7759/cureus.10906.) without the use of CRRT exceeds 70-77%.) Conclusion Our analysis had showed a positive effect of early use (1 day of hospitalization) of extracorporeal methods of blood purification, on a decreasing of inflammation indicators, as well as positive survival rate of patients with severe COVID-19 course in ICU conditions.