Polymyxin B hemoperfusion in COVID-19 Patients with endotoxic shock: Case Series from EUPHAS II registry

The Corona Virus Disease 19 (COVID-19) has been shown to involve the gastrointestinal tract, which implies bacterial translocation and endotoxemia.The aim of this study was to evaluate the role of extracorporeal endotoxin removal by Polymyxin B Hemoperfusion (PMX-HP), in the treatment of patients with COVID-19 and secondary bacterial infection. We conducted a subgroup analysis of a multicenter, multinational, prospective, observational web-based database (EUPHAS2 registry). We included 12 patients with SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) from nasal/oral swab, admitted to the ICU between February and May 2020, who were affected by septic shock and received PMX-HP as per clinical indication of the attending physician. Septic shock was diagnosed in 9 patients (75%), with a median time between symptoms onset and PMX-HP treatment of 16 (14-22) days. We identified gram negative bacteria in most of the microbiological culture (N=17, 65%), followed by gram positive bacteria in (N=4, 15%), fungi (N=3, 12%) and no growth (N= 2, 8%). SOFA score progressively improved over the next 120 hours following PMX-HP and it was associated with median endotoxin activity assay (EAA) decrease from 0.78 [0.70-0.92] at T0 to 0.60 [0.44-0.72] at T120 (p = 0.245). A direct correlation was observed between SOFA score and EAA. Lung Injury Score (LIS) decreased associated to hemodynamic improvement over the same period. No statistically significant difference was observed for RIFLE score at each time point. Nine out of 12 patients (75%) required CRRT because of AKI. In a series of consecutive COVID-19 patients with endotoxic shock, PMX-HP was associated with organ function recovery, hemodynamic improvement and contemporary EAA level reduction. No PMX-HP related complication were observed.