Introduction: Severe COVID-19 pneumonia can activate a cytokine storm. Hemoperfusion can reduce pro-inflammatory cytokines in sepsis but is still debated in the COVID-19 setting. Thus, we sought to investigate the benefits of HA-330 cytokine adsorption through clinical and laboratory outcomes. Methods: We conducted a single-center prospective observational study in adults with severe COVID-19 pneumonia admitted to the intensive care unit (ICU) at Chiang Mai University Hospital (Chiang Mai, Thailand). Those with cytokine storms indicated by organ injury, including acute respiratory distress syndrome (ARDS), and high inflammatory markers were included. Patients treated with the HA-330 device were classified as a hemoperfusion group, while those without cytokine adsorption were classified as a control group. We compared the outcomes on day 7 after treatment and evaluated the factors associated with 60-day mortality. Results: A total of 112 patients were enrolled. Thirty-eight patients received hemoperfusion, while 74 patients did not. Baseline cytokine storm parameters were comparable. In univariate analysis, there was an improvement in clinical and laboratory effects from hemoperfusion therapy. In multivariate analysis, APACHE II score, SOFA score, PaO2/FiO2, the number of hemoperfusion sessions, the amount of blood purified, hs-CRP, and IL-6 were associated with mortality. Using at least 3 sessions of hemoperfusion could mitigate the 60-day mortality (adjusted odds ratio 0.25, 95% CI 0.03-0.33, p=0.001). By categorizing the amount of blood treated into 3 groups of <1 L/kg, 1-2 L/kg, and ≥2 L/kg, there was a linear dose-response association with survival, which was better in the higher volume purified (mortality 60% vs 33.3% vs 0%, respectively, p=0.015). Conclusions: The early initiation of HA-330 hemoperfusion could improve the severity score and laboratory outcomes of COVID-19 ARDS. The optimal dose of at least three sessions or the amount of blood purified greater than 1 L/kg were associated with a reduction in 60-day mortality.

Introduction: Severe COVID-19 pneumonia can activate a cytokine storm. Hemoperfusion can reduce pro-inflammatory cytokines in sepsis but is still debated in the COVID-19 setting. Thus, we sought to investigate the benefits of HA-330 cytokine adsorption through clinical and laboratory outcomes. Methods: We conducted a single-center prospective observational study in adults with severe COVID-19 pneumonia admitted to the intensive care unit (ICU) at Chiang Mai University Hospital (Chiang Mai, Thailand). Those with cytokine storms indicated by organ injury, including acute respiratory distress syndrome (ARDS), and high inflammatory markers were included. Patients treated with the HA-330 device were classified as a hemoperfusion group, while those without cytokine adsorption were classified as a control group. We compared the outcomes on day 7 after treatment and evaluated the factors associated with 60-day mortality. Results: A total of 112 patients were enrolled. Thirty-eight patients received hemoperfusion, while 74 patients did not. Baseline cytokine storm parameters were comparable. In univariate analysis, there was an improvement in clinical and laboratory effects from hemoperfusion therapy. In multivariate analysis, APACHE II score, SOFA score, PaO2/FiO2, the number of hemoperfusion sessions, the amount of blood purified, hs-CRP, and IL-6 were associated with mortality. Using at least 3 sessions of hemoperfusion could mitigate the 60-day mortality (adjusted odds ratio 0.25, 95% CI 0.03-0.33, p=0.001). By categorizing the amount of blood treated into 3 groups of <1 L/kg, 1-2 L/kg, and ≥2 L/kg, there was a linear dose-response association with survival, which was better in the higher volume purified (mortality 60% vs 33.3% vs 0%, respectively, p=0.015). Conclusions: The early initiation of HA-330 hemoperfusion could improve the severity score and laboratory outcomes of COVID-19 ARDS. The optimal dose of at least three sessions or the amount of blood purified greater than 1 L/kg were associated with a reduction in 60-day mortality.

Background: Mortality following hemodialysis initiation may influence the decision to initiate hemodialysis in elderly patients. Our objective is to demonstrate mortality following hemodialysis initiation in elderly (≥70 years) and to derive a prediction risk score based on clinical and laboratory indicators to determine risk of all-cause mortality in patients aged ≥80 years.Methods: We identified elderly (≥70 years) who initiated maintenance hemodialysis between January 2005 and December 2016 using data from the Thai Renal Replacement Therapy Registry. The mortality rate was determined based on age categories. A predictive risk score for all-cause mortality was created for 4,451 patients aged ≥80 years by using demographics, laboratory values, and interview-based parameters. Using a flexible parametric survival analysis, we predicted mortality 3, 6 months, 1, 5, and 10 years after hemodialysis initiation.Results: 17,354 patients (≥70 years) were included, mean age 76.9±5.1 years, 46.5% male, and 6,309 (36.4%) died. Patient aged <80 years had a median survival time of 110.6 months. A 9-point risk score was developed to predict mortality in patients aged ≥80 years: age>85 years, male, body mass index<18.5 kg/m2, hemoglobin<10.0 g/dL, albumin<3.5 g/dL, substantial assistance required in daily living (1 point each), and Karnofsky Performance Score<50 (3 points). C-statistic of 0.797 indicated high model discrimination. Internal validation demonstrated good agreement between observed and anticipated mortality.Conclusions: Hemodialysis is appropriate for patients aged 70–80 years. A risk score for mortality in patients aged ≥80 years has been developed. The score is based on seven readily obtainable and evaluable clinical characteristics.

Background: Mortality following hemodialysis initiation may influence the decision to initiate hemodialysis in elderly patients. Our objective is to demonstrate mortality following hemodialysis initiation in elderly (≥70 years) and to derive a prediction risk score based on clinical and laboratory indicators to determine risk of all-cause mortality in patients aged ≥80 years.Methods: We identified elderly (≥70 years) who initiated maintenance hemodialysis between January 2005 and December 2016 using data from the Thai Renal Replacement Therapy Registry. The mortality rate was determined based on age categories. A predictive risk score for all-cause mortality was created for 4,451 patients aged ≥80 years by using demographics, laboratory values, and interview-based parameters. Using a flexible parametric survival analysis, we predicted mortality 3, 6 months, 1, 5, and 10 years after hemodialysis initiation.Results: 17,354 patients (≥70 years) were included, mean age 76.9±5.1 years, 46.5% male, and 6,309 (36.4%) died. Patient aged <80 years had a median survival time of 110.6 months. A 9-point risk score was developed to predict mortality in patients aged ≥80 years: age>85 years, male, body mass index<18.5 kg/m2, hemoglobin<10.0 g/dL, albumin<3.5 g/dL, substantial assistance required in daily living (1 point each), and Karnofsky Performance Score<50 (3 points). C-statistic of 0.797 indicated high model discrimination. Internal validation demonstrated good agreement between observed and anticipated mortality.Conclusions: Hemodialysis is appropriate for patients aged 70–80 years. A risk score for mortality in patients aged ≥80 years has been developed. The score is based on seven readily obtainable and evaluable clinical characteristics.

Background: Mortality following hemodialysis initiation may influence the decision to initiate hemodialysis in elderly patients. Our objective is to demonstrate mortality following hemodialysis initiation in elderly (≥70 years) and to derive a prediction risk score based on clinical and laboratory indicators to determine risk of all-cause mortality in patients aged ≥80 years.Methods: We identified elderly (≥70 years) who initiated maintenance hemodialysis between January 2005 and December 2016 using data from the Thai Renal Replacement Therapy Registry. The mortality rate was determined based on age categories. A predictive risk score for all-cause mortality was created for 4,451 patients aged ≥80 years by using demographics, laboratory values, and interview-based parameters. Using a flexible parametric survival analysis, we predicted mortality 3, 6 months, 1, 5, and 10 years after hemodialysis initiation.Results: 17,354 patients (≥70 years) were included, mean age 76.9±5.1 years, 46.5% male, and 6,309 (36.4%) died. Patient aged <80 years had a median survival time of 110.6 months. A 9-point risk score was developed to predict mortality in patients aged ≥80 years: age>85 years, male, body mass index<18.5 kg/m2, hemoglobin<10.0 g/dL, albumin<3.5 g/dL, substantial assistance required in daily living (1 point each), and Karnofsky Performance Score<50 (3 points). C-statistic of 0.797 indicated high model discrimination. Internal validation demonstrated good agreement between observed and anticipated mortality.Conclusions: Hemodialysis is appropriate for patients aged 70–80 years. A risk score for mortality in patients aged ≥80 years has been developed. The score is based on seven readily obtainable and evaluable clinical characteristics.

Background: Mortality following hemodialysis initiation may influence the decision to initiate hemodialysis in elderly patients. Our objective is to demonstrate mortality following hemodialysis initiation in elderly (≥70 years) and to derive a prediction risk score based on clinical and laboratory indicators to determine risk of all-cause mortality in patients aged ≥80 years.Methods: We identified elderly (≥70 years) who initiated maintenance hemodialysis between January 2005 and December 2016 using data from the Thai Renal Replacement Therapy Registry. The mortality rate was determined based on age categories. A predictive risk score for all-cause mortality was created for 4,451 patients aged ≥80 years by using demographics, laboratory values, and interview-based parameters. Using a flexible parametric survival analysis, we predicted mortality 3, 6 months, 1, 5, and 10 years after hemodialysis initiation.Results: 17,354 patients (≥70 years) were included, mean age 76.9±5.1 years, 46.5% male, and 6,309 (36.4%) died. Patient aged <80 years had a median survival time of 110.6 months. A 9-point risk score was developed to predict mortality in patients aged ≥80 years: age>85 years, male, body mass index<18.5 kg/m2, hemoglobin<10.0 g/dL, albumin<3.5 g/dL, substantial assistance required in daily living (1 point each), and Karnofsky Performance Score<50 (3 points). C-statistic of 0.797 indicated high model discrimination. Internal validation demonstrated good agreement between observed and anticipated mortality.Conclusions: Hemodialysis is appropriate for patients aged 70–80 years. A risk score for mortality in patients aged ≥80 years has been developed. The score is based on seven readily obtainable and evaluable clinical characteristics.