Sequential Extracorporeal Blood Purification Is Associated with Prolonged Survival among ICU Patients with COVID-19 and Confirmed Bacterial Superinfection

Introduction: This study investigates the impact of sequential extracorporeal treatments with oXiris(& REG;) or CytoSorb(& REG;) plus Seraph-100(& REG;) on the clinical and laboratory parameters of critically ill COVID-19 patients with bacterial superinfection. Methods: Patients admitted to the intensive care unit with COVID-19, bacterial superinfection, and undergoing blood purification (BP) were enrolled in this prospective, single-center, observational study. "standard BP" with oXiris(& REG;) or CytoSorb(& REG;) were used in 35 COVID-19 patients with bacterial infection. Seraph-100(& REG;) was added in 33 patients when available serially in the same oXiris(& REG;) circuit or as sequential treatment with CytoSorb(& REG;) as a sequential BP. Results: A significant reduction in SOFA score 3 days after treatment was observed in patients undergoing sequential BP (11.3 vs. 8.17, p < 0.01) compared to those undergoing "standard BP" (11.0 vs. 10.3, p > 0.05). The difference between the observed and expected mortality rate based on APACHE IV was greater in the sequential BP group (42.4% vs. 81.7%, p < 0.001) than the "standard BP" (74.2% vs. 81.7%, p > 0.05). Patients treated with sequential BP had a longer survival than those treated with "standard BP" (22.4 vs. 18.7 months; p < 0.001). Conclusions: The sequential approach may enhance the positive effect of BP on organ dysfunction among critically ill patients with COVID-19 and bacterial superinfection.