rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2024-4-30-38rmt-2507Research ArticleПРАКТИКУЮЩЕМУ ВРАЧУFOR PRACTIONERЭффект гемосорбции с помощью адсорбера CytoSorb при тяжелых осложнениях COVID-19The Effect of Hemoadsorption with CytoSorb on Severe COVID-19 ComplicationsРыбалкоА. С.RybalkoA. S.

Александр Сергеевич Рыбалко

108811, г. Москва, поселение Вороновское, квартал № 10;109263, г. Москва, ул. Шкулева, д. 4

Andrey S. Rybalko

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow

rybalko_a@internet.ruГалкинаС. Н.GalkinaS. N.

108811, г. Москва, поселение Вороновское, квартал № 10;109263, г. Москва, ул. Шкулева, д. 4

Svetlana N. Galkina

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow

СарыгларА. С.SaryglarA. S.

108811, г. Москва, поселение Вороновское, квартал № 10;109263, г. Москва, ул. Шкулева, д. 4

Aydys S. Saryglar

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow

ВоронинА. В.VoroninA. V.

108811, г. Москва, поселение Вороновское, квартал № 10;109263, г. Москва, ул. Шкулева, д. 4

Alexander V. Voronin

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow

РезяповаМ. И.RezyapovaM. I.

108811, г. Москва, поселение Вороновское, квартал № 10;109263, г. Москва, ул. Шкулева, д. 4

Marina I. Rezyapova

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow

ЧаусН. И.ChausN. I.

108811, г. Москва, поселение Вороновское, квартал № 10; 109263, г. Москва, ул. Шкулева, д. 4; 107031, г. Москва, ул. Петровка, д. 25, стр. 2

Nikolay I. Chaus

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow; 25 Petrovka Str., Bldg. 2, 107031 Moscow

ПереходовС. Н.PerekhodovS. N.

108811, г. Москва, поселение Вороновское, квартал № 10; 109263, г. Москва, ул. Шкулева, д. 4

Sergey N. Perekhodov

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow

КарпунН. А.KarpunN. A.

108811, г. Москва, поселение Вороновское, квартал № 10; 109263, г. Москва, ул. Шкулева, д. 4; 107031, г. Москва, ул. Петровка, д. 25, стр. 2

Nikolay A. Karpun

10 block Voronovskoye settlement, 108811 Moscow; 4 Shkulev Str., 109263 Moscow; 25 Petrovka Str., Bldg. 2, 107031 Moscow

Московский клинический центр инфекционных болезней «Вороновское»; Городская клиническая больница им. В. П. Демихова Департамента здравоохранения г. МосквыРоссияMoscow Clinical Center for Infectious Diseases «Voronovskoye»; Demikhov City Clinical Hospital, Moscow City Health DepartmentRussian FederationМосковский клинический центр инфекционных болезней «Вороновское»; Городская клиническая больница им. В. П. Демихова Департамента здравоохранения г. Москвы; Федеральный научно-клинический центр реаниматологии и реабилитологииРоссияMoscow Clinical Center for Infectious Diseases «Voronovskoye»; Demikhov City Clinical Hospital, Moscow City Health Department; Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian FederationМосковский клинический центр инфекционных болезней «Вороновское»; Городская клиническая больница им. В. П. Демихова Департамента здравоохранения г. Москвы; Федеральный научно-клинический центр реаниматологии и реабилитологииРоссияMoscow Clinical Center for Infectious Diseases «Voronovskoye»; Demikhov City Clinical Hospital, Moscow City Health Department;Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation2024060920242043038Copyright © Рыбалко А.С., Галкина С.Н., Сарыглар А.С., Воронин А.В., Резяпова М.И., Чаус Н.И., Переходов С.Н., Карпун Н.А., 20242024Рыбалко А.С., Галкина С.Н., Сарыглар А.С., Воронин А.В., Резяпова М.И., Чаус Н.И., Переходов С.Н., Карпун Н.А.Rybalko A.S., Galkina S.N., Saryglar A.S., Voronin A.V., Rezyapova M.I., Chaus N.I., Perekhodov S.N., Karpun N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2507Цель исследования

Цель исследования. Определение влияния гемосорбции с помощью адсорбера CytoSorb на течение воспалительного ответа, дыхательной недостаточности и летальность у пациентов с тяжелым течением новой коронавирусной инфекции.

Материалы и методы

Материалы и методы. В ретроспективное одноцентровое когортное сравнительное исследование включили данные 124 госпитализированных пациентов с диагнозом COVID-19, находившихся в отделении реанимации и интенсивной терапии (ОРИТ). Пациентов включали в одну из 2-х групп: основную группу с проведением гемосорбции (группа 1, n=93), или группу сравнения, где гемосорбцию не проводили (группа 2, n= 31). В группе 1 тяжесть дыхательной недостаточности до начала гемосорбции была значимо выше, по остальным клиническим и демографическим параметрам группы были сопоставимы.

Результаты

Результаты. У больных группы 1 наблюдали значимые изменения 9 клинико-инструментальных и лабораторных параметров из 13 отслеживаемых: снижение температуры тела (p=0,005), концентрации лактатдегидрогеназы (ЛДГ) (p<0,001), С-реактивного белка (СРБ) (p<0,001) и IL-6 (p<0,001), а также рост отношения SpO₂/FiO₂ (p=0,041), числа лимфоцитов (p=0,003) и лейкоцитов (p<0,001), отсутствие динамики по шкале SOFA (p=0,068) по сравнению с данными до начала гемосорбции. У больных группы 2 значимый положительный тренд выявили только для температуры тела (p=0,003). Остальные значимые изменения были неблагоприятными: снижение отношения SpO₂/FiO₂ (p=0,002), рост фракции кислорода во вдыхаемой смеси FiO₂ (p=0,001), рост числа лейкоцитов (p<0,05), концентрации ЛДГ (p=0,038), ПКТ (p<0,001) и IL-6 (p=0,005), рост баллов по шкале SOFA с 3,0 до 7,0 (ДИ 3,0; 9,0) (p=0,001). Госпитальная летальность от любых причин в группе 1 составила 37,63%, в группе 2 — 74,20%.. Применение гемосорбции, как патогенетического метода лечения гипервоспалительной реакции в рамках алгоритма ведения больных с тяжелыми осложнениями COVID-19, находящихся в ОРИТ, ассоциировалось с регрессом воспалительной реакции и дыхательной недостаточности, а также значимо снизило летальность.

The aim of the study was to assess the effect of hemoadsorption with CytoSorb on the inflammatory response, respiratory failure, and mortality in patients with severe novel coronavirus infection.

Materials and methods

Materials and methods. A retrospective single-center cohort comparative study of hemoadsorbtion using the CytoSorb therapy included data from 124 COVID-19 ICU patients. Patients were divided into two groups: the study arm with hemoadsorption (group 1, N=93) and the control arm without hemoadsorption (group 2, N=31). Patients in group 1 had more severe respiratory failure at baseline, but were otherwise comparable to patients in group 2 in terms of clinical and demographic parameters.

Results

Results. After hemoadsorption, group 1 patients showed significant improvement in 9 of 13 monitored clinical, instrumental, and laboratory parameters: fever (P=0.005), lactate dehydrogenase (LDH) (P<0.001), C-reactive protein (CRP) (P<0.001), and IL-6 (P<0.001) levels, as well as an increase in SpO₂/FiO₂ ratio (P=0.041), leukocyte count (P<0.001) and lymphocyte count (P=0.003), as well as no significant changes in SOFA score (P=0.068). The only improvement seen in group 2 patients was a reduction in fever (P=0.003). Other significant changes in group 2 were unfavorable, such as a decrease in SpO₂/FiO₂ ratio (P=0.002), an increase in inspiratory oxygen fraction FiO₂ (P=0.001), leukocyte count (P<0.05), LDH (P=0.038), procalcitonin (P<0.001), and IL-6 (P=0.005), as well as an increase in SOFA score from 3.0 to 7.0 (95%CI, 3.0–9.0) (P=0.001). The all-cause hospital mortality rate was 37,63% in group 1 and 74.20% in group 2.

Conclusion

Conclusion. The use of hemoadsorption with CytoSorb as a pathogenetic therapy targeting the hyperinflammatory response in the management algorithm of ICU patients with severe COVID-19 complications resulted in resolution of the inflammatory response and respiratory failure, as well as a significant reduction in mortality.

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The authors declare that there are no conflicts of interest present.