Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)

Background: In December 2019, pneumonia associated with a novel coronavirus (COVID-19) was reported in Wuhan, China. Acute respiratory distress syndrome (ARDS) is the most frequently observed complication in COVID-19 patients with high mortality rates. Objective of study: To observe the clinical eff...

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Autores principales:	Seyed MohammadReza Hashemian, Navid Shafigh, Golnaz Afzal, Hamidreza Jamaati, Payam Tabarsi, Majid Marjani, Majid Malekmohammad, Seyed Mehdi Mortazavi, Batoul Khoundabi, Davood Mansouri, Afshin Moniri, Abbas Hajifathali, Elham Roshandel, Esmaeil Mortaz, Ian M Adcock
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier España 2021
Materias:	ARDS Critically ill COVID-19 Blood purification Plasmapheresis Cytokine storm Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/251c71fa0b174c62b8732e1118d1ffd1
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spelling	oai:doaj.org-article:251c71fa0b174c62b8732e1118d1ffd12021-11-06T04:33:22ZPlasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)2531-043710.1016/j.pulmoe.2020.10.017https://doaj.org/article/251c71fa0b174c62b8732e1118d1ffd12021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2531043720302543https://doaj.org/toc/2531-0437Background: In December 2019, pneumonia associated with a novel coronavirus (COVID-19) was reported in Wuhan, China. Acute respiratory distress syndrome (ARDS) is the most frequently observed complication in COVID-19 patients with high mortality rates. Objective of study: To observe the clinical effect of plasmapheresis on excessive inflammatory reaction and immune features in patients with severe COVID-19 at risk of ARDS. Materials and methods: In this single-center study, we included 15 confirmed cases of COVID-19 at Masih Daneshvari Hospital, in March 2020 in Tehran, Iran. COVID-19 cases were confirmed by RT-PCR and CT imaging according to WHO guidelines. Plasmapheresis was performed to alleviate cytokine-induced ARDS. The improvement in oxygen delivery (PaO2/FiO2), total number of T cells, liver enzymes, acute reaction proteins, TNF-α and IL-6 levels were evaluated. Results: Inflammatory cytokine levels (TNF-α, IL-6), and acute phase reaction proteins including ferritin and CRP were high before plasmapheresis. After plasmapheresis, the levels of PaO2/FiO2, acute phase reactants, inflammatory mediators, liver enzymes and bilirubin were significantly reduced within a week (p < 0.05). In contrast, although the number of T helper cells decreased immediately after plasmapheresis, they rose to above baseline levels after 1 week. Nine out of fifteen patients on non-invasive positive-pressure ventilation (NIPPV) survived whilst the six patients undergoing invasive mechanical ventilation (IMV) died. Conclusion: Our data suggests that plasmapheresis improves systemic cytokine and immune responses in patients with severe COVID-19 who do not undergo IMV. Further controlled studies are required to explore the efficacy of plasmapheresis treatment in patients with COVID-19.Seyed MohammadReza HashemianNavid ShafighGolnaz AfzalHamidreza JamaatiPayam TabarsiMajid MarjaniMajid MalekmohammadSeyed Mehdi MortazaviBatoul KhoundabiDavood MansouriAfshin MoniriAbbas HajifathaliElham RoshandelEsmaeil MortazIan M AdcockElsevier EspañaarticleARDSCritically ill COVID-19Blood purificationPlasmapheresisCytokine stormDiseases of the respiratory systemRC705-779ENPulmonology, Vol 27, Iss 6, Pp 486-492 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ARDS Critically ill COVID-19 Blood purification Plasmapheresis Cytokine storm Diseases of the respiratory system RC705-779
spellingShingle	ARDS Critically ill COVID-19 Blood purification Plasmapheresis Cytokine storm Diseases of the respiratory system RC705-779 Seyed MohammadReza Hashemian Navid Shafigh Golnaz Afzal Hamidreza Jamaati Payam Tabarsi Majid Marjani Majid Malekmohammad Seyed Mehdi Mortazavi Batoul Khoundabi Davood Mansouri Afshin Moniri Abbas Hajifathali Elham Roshandel Esmaeil Mortaz Ian M Adcock Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)
description	Background: In December 2019, pneumonia associated with a novel coronavirus (COVID-19) was reported in Wuhan, China. Acute respiratory distress syndrome (ARDS) is the most frequently observed complication in COVID-19 patients with high mortality rates. Objective of study: To observe the clinical effect of plasmapheresis on excessive inflammatory reaction and immune features in patients with severe COVID-19 at risk of ARDS. Materials and methods: In this single-center study, we included 15 confirmed cases of COVID-19 at Masih Daneshvari Hospital, in March 2020 in Tehran, Iran. COVID-19 cases were confirmed by RT-PCR and CT imaging according to WHO guidelines. Plasmapheresis was performed to alleviate cytokine-induced ARDS. The improvement in oxygen delivery (PaO2/FiO2), total number of T cells, liver enzymes, acute reaction proteins, TNF-α and IL-6 levels were evaluated. Results: Inflammatory cytokine levels (TNF-α, IL-6), and acute phase reaction proteins including ferritin and CRP were high before plasmapheresis. After plasmapheresis, the levels of PaO2/FiO2, acute phase reactants, inflammatory mediators, liver enzymes and bilirubin were significantly reduced within a week (p < 0.05). In contrast, although the number of T helper cells decreased immediately after plasmapheresis, they rose to above baseline levels after 1 week. Nine out of fifteen patients on non-invasive positive-pressure ventilation (NIPPV) survived whilst the six patients undergoing invasive mechanical ventilation (IMV) died. Conclusion: Our data suggests that plasmapheresis improves systemic cytokine and immune responses in patients with severe COVID-19 who do not undergo IMV. Further controlled studies are required to explore the efficacy of plasmapheresis treatment in patients with COVID-19.
format	article
author	Seyed MohammadReza Hashemian Navid Shafigh Golnaz Afzal Hamidreza Jamaati Payam Tabarsi Majid Marjani Majid Malekmohammad Seyed Mehdi Mortazavi Batoul Khoundabi Davood Mansouri Afshin Moniri Abbas Hajifathali Elham Roshandel Esmaeil Mortaz Ian M Adcock
author_facet	Seyed MohammadReza Hashemian Navid Shafigh Golnaz Afzal Hamidreza Jamaati Payam Tabarsi Majid Marjani Majid Malekmohammad Seyed Mehdi Mortazavi Batoul Khoundabi Davood Mansouri Afshin Moniri Abbas Hajifathali Elham Roshandel Esmaeil Mortaz Ian M Adcock
author_sort	Seyed MohammadReza Hashemian
title	Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)
title_short	Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)
title_full	Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)
title_fullStr	Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)
title_full_unstemmed	Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)
title_sort	plasmapheresis reduces cytokine and immune cell levels in covid-19 patients with acute respiratory distress syndrome (ards)
publisher	Elsevier España
publishDate	2021
url	https://doaj.org/article/251c71fa0b174c62b8732e1118d1ffd1
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Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)

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