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Treatment of COVID-19-Releated Hyperinflammatory Response In Intensive Care Unit: Pulse Steroid, Anticytokines, IVIG, Plasmapheresis.

Year 2022, Volume 12, Issue 2, 228 - 232, 15.03.2022
https://doi.org/10.16899/jcm.1030022

Abstract

ABSTRACT AIM: In our study, we aimed to see whether there is a difference in the survival effects of the treatments in 144 covid-19 patients who developed HIS. MATERIAL and METHODS: Between Nov 2020 and Jan 2021; we retrospectively evaluated 323 patients who were admitted in to intensive care unit (ICU). Among these patients, we analyzed 144 patients whom recieved pulse steroid, anticytokine, plasmapheresis and IVIG treatment alone or in combination (1). The demographic characteristics of the patients are demonstrated in table 1. The treatment planning of Covid-19 in our hospital is organized and implemented by a multidisciplinary treatment board. Accordingly, pulse was administered to patients whom had shown HIS findings after the day 7 of the initial diagnosis. If there is no contraindication; transition to anticytokine treatment and then plasmapheresis and / or IVIG was applied (2,3). RESULTS: When all the treatments were examined, no difference was found between the survival rates according to the application. While the mortality rate was %68 in all patients hospitalized in our ICU’s with Covid-19, this rate was found to be %81 in our patients with HIS. CONCLUSION: There is an obvious condition that an amount of time is needed for supposed positive results of our admitted treatments. While our mortality rate was lower in all patients we followed up; in accordance with our expectations, we can say that the mortality rate is high in patients with HIS. The fact that no superiority of treatment modalities was observed in our study; we can still attribute the fact that the clinics of Covid-19 patients are not homogeneous and that there is no definite standardization regarding treatment yet.

References

  • 1. England JT, Abdulla A, Biggs CM, et al. Weathering the COVID-19 storm: Lessons from hematologic cytokine syndromes. Blood Reviews volume 45 Jan 2021, 100707.
  • 2.TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, COVID-19 Ağır Pnömoni, ARDS, Sepsis, Septik Şok Yönetimi Bilimsel Danışma Kurulu Çalışması, 23 Ekim 2020.
  • 3. Halaçlı B, Topeli A. Treatment of the Cytokine Storm in COVID-19. J Crit Intensive Care 2020; 11(Suppl.1):36−40.
  • 4.Cano EJ, Fuentes XF, Campioli CC et al. Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes Chest 2021 Mar; 159(3): 1019–40.
  • 5.The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 N Engl J Med 2021; 384:693-704
  • 6.COVID-19 Tanı ve Tedavisinde Kanıta Dayalı Öneriler ve Türk Toraks Derneği COVID-19 Görev Grubu Görüş Raporu, Türk Toraks Derneği COVID-19 E-Kitapları Serisi, Aralık 2020.
  • 7.Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117:10970-5.
  • 8.Aziz M, Haghbin H, Abu Sitta E, et al. Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis. J Med Virol. 2021;93:1620–30.
  • 9.TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, Antisitokin-Antiinflamatuar Tedaviler, Koagülopati Yönetimi, 07 Kasım 2020.
  • 10.Nguyen AA, Habiballah SB,Platt CD, Geha RS, et al. Immunoglobulins in the treatment of COVID-19 infection: Proceed with caution! Clinical Immunology 216 (2020) 108459.
  • 11. Pourahmad R, Moazzami B, Rezaei N. Efficacy of Plasmapheresis and Immunoglobulin Replacement Therapy (IVIG) on Patients with COVID-19 SN Compr Clin Med. 2.1407–11 (2020).
  • 12. Keith P, Day M, Choe C, Perkins L. The successful use of therapeutic plasma exchange for severe COVID-19 acute respiratory distress syndrome with multiple organ failure SAGE Open Medical Case Reports (2020)8: 1–4.
  • 13. Kaplan AA. Therapeutic plasma exchange: a technical and operational review. J Clin Apher. 2013;28(1):3–10.
  • 14.Ishikawa T, Abe S, Kojima Y, Sano T, et al. Prediction of a sustained viral response in chronic hepatitis C patients who undergo induction therapy with double filtration plasmapheresis plus interferon-β/ribavirin. Exp Ther Med. 2015 May;9(5):1646-50. 15
  • 15.Faqihi F, Alharthy A, Alodat M, et al. A pilot study of therapeutic plasma exchange for serious SARS CoV-2 disease (COVID-19): A structured summary of a randomized controlled trial study protocol.Trials 21, 506 (2020).

COVID-19'a Bağlı Gelişen Hiperinflamatuvar Yanıtın Yoğun Bakımda Tedavisi: Antisitokinler, Plazmaferez, IVIG, Sitokin Filtresi

Year 2022, Volume 12, Issue 2, 228 - 232, 15.03.2022
https://doi.org/10.16899/jcm.1030022

Abstract

AMAÇ: Çalışmamızda, COVID-19 ilişkili hiperinflamatuvar yanıt (HIS) gelişen 144 hastamızda uyguladığımız tedavilerin sağkalıma etkilerini incelemeyi amaçladık. GEREÇ VE YÖNTEM: 1 Kasım 2020 ve 31 Ocak 2021 aralığında COVID-19’ a bağlı ağır solunum yetmezliği ile yoğun bakımlarımızda takip ettiğimiz 323 hasta retrospektif olarak taranmıştır. Bu hastalardan 144 kişide COVID-19’a bağlı HIS varlığı düşünülerek tedavilerinde pulse steroid, antisitokin ajanlar, plazmaferez ve IVIG uygulamalarına yer verilmiştir. Bu tedavi uygulamalarının bir kısmı tek başına bir kısmı bir arada kullanılmıştır ve hastaların demografik özellikleri Tablo 1 ‘de gösterilmiştir. Hastanemizde COVID-19 ilişkili hastalık tablosunun yönetimi, multidisipliner bir komite tarafından yürütülmektedir. Bu komitenin kararları doğrultusunda, tanıdan yaklaşık 7 gün geçtikten sonra hiperinflamatuvar yanıt bulguları gelişen hastalara pulse steroid verilmiştir. Daha ileri tedavi gerekliliği gösteren hastalarda , kontrendikasyon olmaması gözetilerek; antisitokin ajanlara, plazmaferez ve IVIG’ e geçilmiştir. BULGULAR: Tüm tedavi ajanları değerlendirildiğinde, sağkalım üzerindeki etkilerinde farklılık gözlenmemiştir. Çalışmanın kapsadığı dönemde, yoğun bakımda takip ettiğimiz tüm COVID-19 hastalarımızın mortalite oranı %68 iken, HIS gelişmiş olan hastalarımızın mortalitesi %81 olarak bulunmuştur. SONUÇ: Takip ettiğimiz tüm hastalarda mortalite oranımız daha düşük iken; beklentilerimiz doğrultusunda HIS görülen hastalarda mortalite oranının yüksek olduğunu söyleyebiliriz. Çalışmamızda tedavi modalitelerinin birbirine üstünlüğünün görülmemesini, COVID-19 hastalarının homojen olmamasına ve kanıtlı tedavilerin henüz olmamasına bağlamaktayız.

References

  • 1. England JT, Abdulla A, Biggs CM, et al. Weathering the COVID-19 storm: Lessons from hematologic cytokine syndromes. Blood Reviews volume 45 Jan 2021, 100707.
  • 2.TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, COVID-19 Ağır Pnömoni, ARDS, Sepsis, Septik Şok Yönetimi Bilimsel Danışma Kurulu Çalışması, 23 Ekim 2020.
  • 3. Halaçlı B, Topeli A. Treatment of the Cytokine Storm in COVID-19. J Crit Intensive Care 2020; 11(Suppl.1):36−40.
  • 4.Cano EJ, Fuentes XF, Campioli CC et al. Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes Chest 2021 Mar; 159(3): 1019–40.
  • 5.The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 N Engl J Med 2021; 384:693-704
  • 6.COVID-19 Tanı ve Tedavisinde Kanıta Dayalı Öneriler ve Türk Toraks Derneği COVID-19 Görev Grubu Görüş Raporu, Türk Toraks Derneği COVID-19 E-Kitapları Serisi, Aralık 2020.
  • 7.Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117:10970-5.
  • 8.Aziz M, Haghbin H, Abu Sitta E, et al. Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis. J Med Virol. 2021;93:1620–30.
  • 9.TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, Antisitokin-Antiinflamatuar Tedaviler, Koagülopati Yönetimi, 07 Kasım 2020.
  • 10.Nguyen AA, Habiballah SB,Platt CD, Geha RS, et al. Immunoglobulins in the treatment of COVID-19 infection: Proceed with caution! Clinical Immunology 216 (2020) 108459.
  • 11. Pourahmad R, Moazzami B, Rezaei N. Efficacy of Plasmapheresis and Immunoglobulin Replacement Therapy (IVIG) on Patients with COVID-19 SN Compr Clin Med. 2.1407–11 (2020).
  • 12. Keith P, Day M, Choe C, Perkins L. The successful use of therapeutic plasma exchange for severe COVID-19 acute respiratory distress syndrome with multiple organ failure SAGE Open Medical Case Reports (2020)8: 1–4.
  • 13. Kaplan AA. Therapeutic plasma exchange: a technical and operational review. J Clin Apher. 2013;28(1):3–10.
  • 14.Ishikawa T, Abe S, Kojima Y, Sano T, et al. Prediction of a sustained viral response in chronic hepatitis C patients who undergo induction therapy with double filtration plasmapheresis plus interferon-β/ribavirin. Exp Ther Med. 2015 May;9(5):1646-50. 15
  • 15.Faqihi F, Alharthy A, Alodat M, et al. A pilot study of therapeutic plasma exchange for serious SARS CoV-2 disease (COVID-19): A structured summary of a randomized controlled trial study protocol.Trials 21, 506 (2020).

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Original Research
Authors

Burcu İLERİ FİKRİ (Primary Author)
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ, YOĞUN BAKIM KLİNİĞİ
0000-0002-9220-5294
Türkiye


Alev ÖZTAŞ
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ, YOĞUN BAKIM KLİNİĞİ
0000-0002-8423-6824
Türkiye


Ezgi Direnç YÜCEL This is me
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ, ANESTEZİYOLOJİ VE REANİMASYON KLİNİĞİ
0000-0002-5157-734X
Türkiye


Mesut AYER
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ, HEMATOLOJİ KLİNİĞİ
0000-0003-1977-0104
Türkiye


Güldem TURAN
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ, YOĞUN BAKIM KLİNİĞİ
0000-0002-7281-1705
Türkiye

Early Pub Date January 1, 2022
Publication Date March 15, 2022
Acceptance Date January 10, 2022
Published in Issue Year 2022, Volume 12, Issue 2

Cite

AMA İleri Fikri B. , Öztaş A. , Yücel E. D. , Ayer M. , Turan G. Treatment of COVID-19-Releated Hyperinflammatory Response In Intensive Care Unit: Pulse Steroid, Anticytokines, IVIG, Plasmapheresis.. J Contemp Med. 2022; 12(2): 228-232.