All over the world, ICU clinicians face hard choices on how to manage severe symptoms and complications of COVID-19 patients with limited ICU resources.

Use it to stabilize

The Alteco LPS Adsorber may be used on COVID-19 patients suspected to have gram-negative bacteria (GNB) infection and/or signs of inflammatory response. By adsorbing endotoxin from the blood, monocyte activity will be reduced which will impact the scale of differentiation into macrophages and cytokines. A treatment with the Alteco LPS Adsorber removes only the endotoxin in the blood. Giving the patient’s immune response a chance to regulate itself, while critical anti-inflammatory cytokines, antibiotic(s) and other stabilization treatment in the blood stream continue doing their job.

Treat sepsis/septic shock

”Now that more scientific data are available on COVID-19, the European Sepsis Alliance can more definitively state that COVID-19 does indeed cause sepsis.” 1

A recent publication2 shows that sepsis is a common complication of the COVID-19 infection. Out of 191 observed COVID-19 patients, 112 gained sepsis, and 54 of those patients died.

Fifty percent of sepsis is caused by GNB in which endotoxin (Lipopolysaccaride = LPS) is present. Endotoxin is the source of differentiation to cytokines and macrophages who in turn activate the inflammatory response in the immune system.

When endotoxin binds to toll-like receptors (TLRs), it activates a signaling cascade causing release of pro-/anti-inflammatory cytokines and coagulation disturbances,3 and life-threatening conditions as septic shock and multi organ failure can occur.

Treating suspected endotoxemia

Hospitalization is the most common risk factor for GNB infections. The longer the stay in the hospital, the higher the risk of infection. Other risk factors that increase the risk of GNB infection include: dialysis or kidney disease (which includes regular use of IV lines or catheters); weakened immune system; use of urinary catheter; recent surgery.

The treatment of GNB infections is complex and has not yet been standardized to any great extent due to patients’ severity of infection and risk factors. The commonly used classes of antimicrobials, the carbapenems have been the gold standard for the systemic treatment of serious infections with GNB. However, the availability of effective antibiotics, one of the cornerstones of modern medicine, is increasingly coming under threat owing to the rise of carbapenem-resistant GNBs. This is why the Alteco LPS Adsorber may be used in complement to ensure best antibiotic management of suspected or confirmed bacterial pneumonia in COVID-19 patients. Antibiotic stays in the bloodstream while endotoxin is being removed.

The management of COVID-19 disease is symptomatic, and supportive care of oxygen therapy represents the major treatment intervention for patients with severe SARS-CoV-2 infection. Mechanical ventilation may be necessary in cases of respiratory failure, whereas hemodynamic support is essential for managing septic shock.

Using mechanical and hemodynamic support heightens the immune response of the patient. It is known for more than a decade that mechanical force gets changed into a chemical stimulus inside the body (mechanotransduction) and may induce severe inflammation. Being on ECMO- and/or a CRRT machine, the immune system gets even more exposed due to complement activation which results in an increase of the endotoxin level.

Mortality rate of COVID-19 patients who require advanced respiratory support, i.e., invasive ventilation, BPAP or CPAP via endotracheal tube, or tracheostomy or extracorporeal respiratory support has recently been released.

A paper from China, involved 710 COVID-19 patients where 52 were admitted to ICU. Of the 22 who eventually required mechanical ventilation, 86% died.4

Intensive Care National Audit and Research Center (ICNARC) in the UK, reported on March 27, 2020 (Report on 775 patients critically ill with COVID-19) that 165 COVID-19 patients were admitted to the ICU. Of the 98 patients who received advanced respiratory support, 66% died compared to the 36% mortality rate of non-COVID patients receiving advanced respiratory support between 2017-2019 reported by ICNARC.

Risk VS benefit

The Alteco LPS Adsorber has been globally used since 2007 to adsorb endotoxin in patients suffering from endotoxemia. It is a CE-marked Class IIa extracorporeal medical device, which is safely used during hemoperfusion with no contraindications, no side-effects or serious adverse events reported.

The Alteco LPS Adsorber is a safe treatment that complements best practice medical management. Use it when it matters to stabilize COVID-19 patients to treat their cytokine storms and secondary GNB infections!

[1] Marvin Zink. 2020APR07. Update: Can COVID-19 Cause Sepsis? Explaining the Relationship Between the Coronavirus Disease and Sepsis.

[2] Fei Zhou, Ting Yu, Ronghui Du, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.

[3] Cohen. The immunopathogenesis of sepsis, Nature 2002.420: 885-891
Clarifications: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) is the name given to the 2019 novel coronavirus (a new strain of coronavirus). COVID-19 is the name given to the disease associated with the virus.

[4] Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; published online Feb 21.