Continuous renal replacement therapy with the addition of CytoSorb cartridge in critically ill patients with COVID‐19 plus acute kidney injury: A case‐series
Why this work is in the frame
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Bibliographic record
Abstract
Abstract Our aim was to investigate continuous renal replacement therapy (CRRT) with CytoSorb cartridge for patients with life‐threatening COVID‐19 plus acute kidney injury (AKI), sepsis, acute respiratory distress syndrome (ARDS), and cytokine release syndrome (CRS). Of 492 COVID‐19 patients admitted to our intensive care unit (ICU), 50 had AKI necessitating CRRT (10.16%) and were enrolled in the study. Upon ICU admission, all had AKI, ARDS, septic shock, and CRS. In addition to CRRT with CytoSorb, all received ARDS‐net ventilation, prone positioning, plus empiric ribavirin, interferon beta‐1b, antibiotics, hydrocortisone, and prophylactic anticoagulation. We retrospectively analyzed inflammatory biomarkers, oxygenation, organ function, duration of mechanical ventilation, ICU length‐of‐stay, and mortality on day‐28 post‐ICU admission. Patients were 49.64 ± 8.90 years old (78% male) with body mass index of 26.70 ± 2.76 kg/m 2 . On ICU admission, mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 22.52 ± 1.1. Sequential Organ Function Assessment (SOFA) score was 9.36 ± 2.068 and the ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen (PaO 2 /FiO 2 ) was 117.46 ± 36.92. Duration of mechanical ventilation was 17.38 ± 7.39 days, ICU length‐of‐stay was 20.70 ± 8.83 days, and mortality 28 days post‐ICU admission was 30%. Nonsurvivors had higher levels of inflammatory biomarkers, and more unresolved shock, ARDS, AKI, and pulmonary emboli (8% vs. 4%, P < .05) compared to survivors. After 2 ± 1 CRRT sessions with CytoSorb, survivors had decreased SOFA scores, lactate dehydrogenase, ferritin, D‐dimers, C‐reactive protein, and interleukin‐6; and increased PaO 2 /FiO 2 ratios, and lymphocyte counts (all P < .05). Receiver‐operator‐curve analysis showed that posttherapy values of interleukin‐6 (cutoff point >620 pg/mL) predicted in‐hospital mortality for critically ill COVID‐19 patients (area‐under‐the‐curve: 0.87, 95% CI: 0.81‐0.93; P = .001). No side effects of therapy were recorded. In this retrospective case‐series, CRRT with the CytoSorb cartridge provided a safe rescue therapy in life‐threatening COVID‐19 with associated AKI, ARDS, sepsis, and hyperinflammation.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it