Direct hemoperfusion using a polymyxin B-immobilized polystyrene column for COVID-19

J Clin Apher. 2021 Jun;36(3):313-321. doi: 10.1002/jca.21861. Epub 2020 Dec 15.


Objective: To evaluate the efficacy and safety of direct hemoperfusion using a polymyxin B-immobilized polystyrene column (PMX-DHP) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive pneumonia patients.

Methods: This study was a case series conducted at a designated infectious diseases hospital. Twelve SARS-CoV-2-positive patients with partial pressure of arterial oxygen/percentage of inspired oxygen (P/F) ratio < 300 were treated with PMX-DHP on two consecutive days each during hospitalization. We defined day 1 as the first day when PMX-DHP was performed. PMX-DHP efficacy was assessed on days 7 and 14 after the first treatment based on eight categories. Subsequently, improvement in P/F ratio and urinary biomarkers on days 4 and 8, malfunctions, and ventilator and extracorporeal membrane oxygenation avoidance rates were also evaluated.

Results: On day 14 after the first treatment, disease severity decreased in 58.3% of the patients. P/F ratio increased while urine β2-microglobulin decreased on days 4 and 8. Cytokine measurement pre- and post-PMX-DHP revealed decreased levels of interleukin-6 and the factors involved in vascular endothelial injury, including vascular endothelial growth factor. Twenty-two PMX-DHPs were performed, of which seven and five PMX-DHPs led to increased inlet pressure and membrane coagulation, respectively. When the membranes coagulated, the circuitry needed to be reconfigured. Circuit problems were usually observed when D-dimer and fibrin degradation product levels were high before PMX-DHP.

Conclusions: Future studies are expected to determine the therapeutic effect of PMX-DHP on COVID-19. Because of the relatively high risk of circuit coagulation, coagulation capacity should be assessed beforehand.

Keywords: cytokine; pneumonia; steroids.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arteries / metabolism
  • Biomarkers / urine
  • Blood Gas Analysis
  • COVID-19 / therapy*
  • Cytokines / blood
  • Endothelium, Vascular / metabolism
  • Female
  • Hemoperfusion / instrumentation*
  • Hemoperfusion / methods*
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Oxygen / metabolism
  • Polymyxin B / chemistry*
  • Polystyrenes / chemistry*
  • Respiration, Artificial
  • Retrospective Studies
  • Risk
  • beta 2-Microglobulin / urine


  • Biomarkers
  • Cytokines
  • Polystyrenes
  • beta 2-Microglobulin
  • Polymyxin B
  • Oxygen