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Review
. 2022 Apr 4;2(1):15.
doi: 10.1186/s44158-022-00043-w.

Blood purification in sepsis and COVID-19: what´s new in cytokine and endotoxin hemoadsorption

Juan Carlos Ruiz-Rodríguez  1   2   3 , Erika P Plata-Menchaca  1   2 , Luis Chiscano-Camón  1   2   3 , Adolf Ruiz-Sanmartin  1   2   3 , Ricard Ferrer  4   5   6
Affiliations
Review

Blood purification in sepsis and COVID-19: what´s new in cytokine and endotoxin hemoadsorption

Juan Carlos Ruiz-Rodríguez et al. J Anesth Analg Crit Care. .

Abstract

Sepsis and COVID-19 are two clinical conditions that can lead to a dysregulated inflammatory state causing multiorgan dysfunction, hypercytokinemia, and a high risk of death. Specific subgroups of critically ill patients with particular characteristics could benefit from rescue treatment with hemoadsorption. There is a lack of adequately designed randomized controlled trials evaluating the potential benefits of cytokine or endotoxin hemoadsorption. Critically ill COVID-19 patients with severe acute respiratory failure poorly responsive to conventional treatment could be candidates to receive cytokine hemoadsorption in the presence of high levels of interleukin 6. This treatment can also be suitable for patients with refractory septic shock and hypercytokinemia. In the context of high endotoxin activity, hemoadsorption with polymyxin B could improve clinical parameters and the prognosis of patients with refractory septic shock. Predictive enrichment, using biomarkers or other individual features, identifies potential responders to cytokine, endotoxin, or sequential hemoadsorption. Besides, recognizing the particular subsets of patients likely to respond to one or both types of hemoadsorption will aid the design of future studies that accurately validate the effectiveness of these therapies.

Keywords: Acute respiratory distress syndrome; COVID-19; Cytokine hemoadsorption; Cytosorb; Endotoxin Hemoperfusion; Hypercytokinemia; Polymyxin B; SARS-CoV-2 pneumonia; Sepsis.

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Conflict of interest statement

JCR have received fees from Palex. RF have received fees from Cytosorbents and Estor. The rest of the authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Potential applications of cytokine and endotoxin hemoadsorption in sepsis and COVID-19. ECMO: extracorporeal membrane oxygenation
See this image and copyright information in PMC

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