INTRODUCTION: Uncontrolled systemic inflammation may occur in severe coronavirus disease 19 (COVID-19). We have previously shown that endotoxemia, presumably from the gut, may complicate COVID-19 . However, the role of endotoxin adsorbent (EA) therapy to mitigate organ dysfunction in COVID-19 has not been explored .
METHODS: We conducted a retrospective observational study in COVID-19 patients who received EA therapy at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between March 13 and April 17 , 2020 . Relevant clinical and laboratory data were collected by inpatient chart review .
RESULTS: Among 147 hospitalized COVID-19 patients , 6 patients received EA therapy . All of the 6 patients had severe COVID-19 infection with acute respiratory distress syndrome (ARDS). Among these , 5 of them were mechanically ventilated and 4 had complications of secondary bacterial infection . The endotoxin activity assay (EAA) results of pre-EA therapy ranged from 0.47 to 2.79 . The choices of EA therapy were at the discretion of attending physicians . One patient was treated with oXiris® along with continuous renal replacement therapy, and the others received polymyxin B hemoperfusion sessions . All patients have survived and were finally free from the mechanical ventilation as well as had improvement in PaO2/FiO2 ratio and decreased EAA level after EA therapy .
CONCLUSIONS: We demonstrated the clinical improvement of severe COVID-19 patients with elevated EAA level upon receiving EA therapy . However, the benefit of EA therapy in COVID-19 ARDS is still unclear and needs to be elucidated with randomized controlled study.