EFFECT OF HEMOSORPTION WITH EXTRACORPOREAL AUTOHEMOMAGNETIC THERAPY VERSUS DRUG THERAPY WITH IL-6 RECEPTOR ANTAGONISTS ON CLINICAL AND LABORATORY PARAMETERS OF PATIENTS WITH SEVERE COVID-19
Authors:   Grodno State Medical University, Grodno, Belarus, Rakashevich D. N. , Yakubtsevich R. E. ,   Grodno State Medical University, Grodno, Belarus, Parfinovich I. A. ,   Lida Central District Hospital, Lida, Belarus, Valentyukevich V. V. ,   Grodno Regional Infectious Diseases Clinical Hospital, Grodno, Belarus
Published: July 2023

Background: SARS-CoV-2 infection in 10-20% of cases is characterized by hypercytokinemia, and in this context, the use of interleukin-6 (IL-6) receptor blockers, in particular tocilizumab and levilimab, is pathogenetically justified, but anticytokine hemosorption is also used in such cases. It is impossible to determine which method is preferable in patients with severe COVID-19 due to the lack of large comparative studies of medical and extracorporeal anticytokine therapies. Purpose: To evaluate the effect of hemosorption through the Нemo-Рroteasosorb hemorosorbent in combination with extracorporeal autohemomagnetic therapy and medical therapy with IL-6 receptor antagonists on the respiratory status, hemostasis, acid-base state of the blood, the detoxification function of the liver and kidneys in patients with severe COVID-19 infection. Material and methods: The clinical and laboratory findings of 102 patients with a severe course of coronavirus infection, who developed cytokine storm, were evaluated. All patients were divided into three groups: hemosorption with magnetic blood treatment («HS+MBT») (41 patients), Tocilizumab group (40 patients) and Levilimab group (20 patients). The following indicators were studied: erythrocyte count and platelet count; hemoglobin level; concentration of total protein, creatinine, urea, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fibrinogen, D-dimers; acid-base state and blood gas composition. To assess the respiratory status, the respiratory index (RI), ROX index, total oxygen flow, and dynamics of the level of respiratory support were evaluated. To assess hemodynamics, mean arterial pressure and heart rate were determined, the body temperature of the patients was also measured. Results: The results obtained demonstrate that with the combined use of MBT and hemosorption through the Hemo-Proteasosorb sorbent in patients with severe COVID-19, there were no significant fluctuations in hemodynamic parameters, levels of urea, creatinine, total bilirubin, AST and ALT. At the same time, the use of tocilizumab was associated with an increase in the levels of urea, total bilirubin and ALT. In the Levilimab group there was an increase in the concentration of urea. The use of HS+MBT was associated with a decrease in the level of fibrinogen, which was noted on the next day, as well as a tendency to a decrease in D-dimers. At the same time, during the treatment with IL-6 receptor blockers, a significant decrease in the level of fibrinogen was noted only on days 6-8. The number of thromboembolic complications was also lower in the patients with extracorporeal detoxification. With HS+MBT, an increase in the respiratory status indicators (RI, ROX-index, decrease in total oxygen flow) was observed already on the next day, while in the Tocilizumab and Levilimab groups, an increase in these indicators was noted only on days 6-8. A decrease in the ROX index and the absence of dynamics in the total oxygen flow were found on the next day in both groups. In the HS+MBT group, the obtained results indicated that the given technique both prevents more significantly the transition to the next level of respiratory support and contributes to its decrease as compared to IL-6 receptor blockers. Analysis of the acid-base state of the blood following HS + MBT showed a decrease in the level of lactate and an increase in HCO3, as well as deficiency/excess of bases, which indicated compensation for metabolic acidosis. Similar results with the use of IL-6 receptor blockers were obtained only on the 6th-8th day of the study, but no normalization of the lactate concentration in the blood of patients was found at any stage. Conclusion: The use of HS+MBT has a number of advantages over the treatment with IL-6 receptor blockers, which is manifested by the absence of cardio, hepato- and nephrotoxicity, as well as more significant positive effect on hemostasis, respiratory status and acid-base status of patients.