The Impact of Hemoperfusion on Clinical Outcomes in Severe COVID-19 Patients: A Retrospective Propensity Score-Matched Study

Abstract

Background: Severe COVID-19 is frequently complicated by hyperinflammation and is associated with a high mortality rate. Objectives: Adjunctive hemoperfusion (HP) aims to remove inflammatory mediators; however, its clinical benefits remain controversial. Methods: This retrospective 1:1 propensity score-matched case-control study included 70 patients with severe COVID-19 who were admitted to the intensive care unit (ICU) at Dr. Gharazi Hospital, Malayer, Iran, from March 2020 to September 2022. Patients received adjunctive HP using Jafron cartridges plus standard care (n = 35) or standard care alone (n = 35). Results: After matching, baseline characteristics were well balanced. Adjunctive hemoperfusion was associated with a significantly greater reduction in C-reactive protein (46% ± 14% vs. 18% ± 9%; P < 0.001), a greater improvement in peripheral oxygen saturation (SpO2; +7% ± 2% vs. +2% ± 1%; P = 0.01), a shorter ICU length of stay (11.2 ± 4.1 vs. 16.5 ± 5.8 days; P = 0.03), and a lower need for mechanical ventilation (40.0% vs. 62.9%; P = 0.04). Mortality in the intensive care unit was numerically lower in the HP group (20.0% vs. 34.3%; P = 0.08) but did not reach statistical significance. No procedure-related deaths occurred. Conclusions: In this propensity-matched cohort, adjunctive hemoperfusion was associated with attenuated systemic inflammation, improved oxygenation, a reduced need for mechanical ventilation, and a shorter ICU stay. These findings should be interpreted cautiously given the retrospective design.