Presepsin Biomarker for Ventilator-associated Pneumonia Diagnosis in COVID-19 Patients

Covid19 Clinical Trial

Official title:

Presepsin as an Early Biomarker for Ventilator-associated Pneumonia (VAP) Diagnosis in COVID-19 Patients: a Prospective Double Blind Observational Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04840940
• Other study ID #: MACOSX
• Status: Recruiting
• Start date: December 21, 2020
• Est. completion date: December 21, 2021

Study information

• Verified date: April 2021
• Source: San Luigi Gonzaga Hospital
• Contact: Pietro Caironi
• Phone: 0039 0119026510
• Email: pietro.caironi[@]unito.it
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This study is observational and double blind. It evaluates the validity of presepsin (a serum biomarker of bacterial infections) as early biomarker of Ventilator Associated Pneumonia. It will be measured at day 0 (ICU admission) and every 48 hours in every patient with Sars-Cov 2 interstitial pneumonia requiring invasive mechanical ventilation (see inclusion ad exclusion criteria) until Day 30, ICU discharge or ICU death. There will be no change in clinical practice and in pneumonia diagnosis. We will examine how the elevation of presepsin level could be an early marker of ventilator associated pneumonia or a marker of bacterial pneumonia at ICU admission, before the microbiological results or clinical diagnosis.

Description:

This study will be a single center, double blind observational study.

Measurements of presepsin blood level will be performed in all patients with interstitial Sars-Cov-2 pneumonia admitted to ICU, at the time of the start of invasive mechanical ventilation and every 48 hours for the first 30 days of ICU stay. Surveillance respiratory samples (endotracheal aspiration) will be performed according to clinical practice (at ICU admission and every Mondays and Thursdays in all patients undergoing invasive mechanical ventilation).

In all patients admitted to ICU with invasive mechanically ventilation, a bronchoalveolar lavage with rapid microbiological method (film array for the research of the main respiratory pathogens) will be performed, according to common clinical practice.

VAP diagnosis will be made based upon the evidence of new lung infiltrates (chest radiography or chest computed tomography) in association with the presence of a pathogen isolated in the non-invasive respiratory sample with semi-quantitative method, according to IDSA and American Thoracic Society guidelines, as well as the presence of other sign of infection (fever, leukocytosis, worsening of oxygenation).

The attending physician in charge of the patient enrolled, clinically making the diagnosis of VAP will be blinded of presepsin levels. As a consequence, during the study period, no variation of the clinical practice applied will be performed, and no influence on the care provided to patients included will be determined by the measurement of plasma presepsin.

In the current study, we aim to answer to the following questions:

• Does a high level of plasma presepsin in patients with a Sars Cov 2 interstitial pneumonia at the time of ICU admission predict the presence of a bacterial respiratory co-infection?

• Do presepsin levels early predict the occurrence of VAP in patients with COVID-19 disease?

• Does such variation become evident at the time of VAC, therefore anticipating the diagnosis of IVAC? The latter issue might be particularly important in order to commence antibiotic therapy earlier than the diagnosis of IVAC.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 50
• Est. completion date: December 21, 2021
• Est. primary completion date: December 21, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• ICU patients with Sars Cov 2 interstitial pneumonia requiring invasive mechanical ventilation

Exclusion Criteria:

• Age less than 18 years

• Pregnancy

• Chronic renal failure stage III or more

• End stage liver disease

• Patients already present in the ICU at the beginning of the study

Related Conditions & MeSH terms

• Covid19
• Pneumonia
• Pneumonia, Ventilator-Associated
• Ventilator Associated Pneumonia

Locations

Country	Name	City	State
Italy	SCDU Anestesia e Rianimazione, AOU San Luigi Gonzaga	Orbassano	Turin

Sponsors (1)

Lead Sponsor	Collaborator
San Luigi Gonzaga Hospital

Country where clinical trial is conducted

Italy, 

References & Publications (22)

Berton DC, Kalil AC, Teixeira PJ. Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia. Cochrane Database Syst Rev. 2012 Jan 18;1:CD006482. doi: 10.1002/14651858.CD006482 — View Citation

COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021 Jan;47(1):60-73. doi: 10.1007/s00 — View Citation

Erb CT, Patel B, Orr JE, Bice T, Richards JB, Metersky ML, Wilson KC, Thomson CC. Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia. Ann Am Thorac Soc. 2016 Dec;13(12):2258-2260. — View Citation

Fagon JY. Biological markers and diagnosis of ventilator-associated pneumonia. Crit Care. 2011;15(2):130. doi: 10.1186/cc10050. Epub 2011 Mar 9. — View Citation

Ferrarese A, Frigo AC, Mion MM, Plebani M, Russo FP, Germani G, Gambato M, Cillo U, Cattelan A, Burra P, Senzolo M. Diagnostic and prognostic role of presepsin in patients with cirrhosis and bacterial infection. Clin Chem Lab Med. 2020 Oct 23. pii: cclm-2 — View Citation

Fukada A, Kitagawa Y, Matsuoka M, Sakai J, Imai K, Tarumoto N, Orihara Y, Kawamura R, Takeuchi S, Maesaki S, Maeda T. Presepsin as a predictive biomarker of severity in COVID-19: A case series. J Med Virol. 2021 Jan;93(1):99-101. doi: 10.1002/jmv.26164. E — View Citation

Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O'Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL. Management of Adults Wit — View Citation

Klouche K, Cristol JP, Devin J, Gilles V, Kuster N, Larcher R, Amigues L, Corne P, Jonquet O, Dupuy AM. Diagnostic and prognostic value of soluble CD14 subtype (Presepsin) for sepsis and community-acquired pneumonia in ICU patients. Ann Intensive Care. 20 — View Citation

Luyt CE, Combes A, Reynaud C, Hekimian G, Nieszkowska A, Tonnellier M, Aubry A, Trouillet JL, Bernard M, Chastre J. Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med. 2008 Aug;34(8):1434-40. doi: 10.1007/ — View Citation

Luyt CE, Guérin V, Combes A, Trouillet JL, Ayed SB, Bernard M, Gibert C, Chastre J. Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2005 Jan 1;171(1):48-53. Epub 2004 Sep 24. — View Citation

Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, Diekema D, Fridkin S, Greene L, Guh A, Gutterman D, Hammer B, Henderson D, Hess D, Hill NS, Horan T, Kollef M, Levy M, Septimus E, VanAntwerpen C, Wright D, Lipsett P. Developing a new, national appro — View Citation

Masson S, Caironi P, Fanizza C, Thomae R, Bernasconi R, Noto A, Oggioni R, Pasetti GS, Romero M, Tognoni G, Latini R, Gattinoni L. Circulating presepsin (soluble CD14 subtype) as a marker of host response in patients with severe sepsis or septic shock: da — View Citation

Masson S, Caironi P, Spanuth E, Thomae R, Panigada M, Sangiorgi G, Fumagalli R, Mauri T, Isgrò S, Fanizza C, Romero M, Tognoni G, Latini R, Gattinoni L; ALBIOS Study Investigators. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality pr — View Citation

Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, Hanisch EW, Klarin B, Koeman M, Krueger WA, Lacherade JC, Lorente L, Memish ZA, Morrow LE, Nardi G, van Nieuwenhoven CA, O'Keefe GE, Nakos G, Scannapieco FA, Seguin P, Staudinger T, Topel — View Citation

Memar MY, Baghi HB. Presepsin: A promising biomarker for the detection of bacterial infections. Biomed Pharmacother. 2019 Mar;111:649-656. doi: 10.1016/j.biopha.2018.12.124. Epub 2019 Jan 3. Review. — View Citation

Mussap M, Noto A, Fravega M, Fanos V. Soluble CD14 subtype presepsin (sCD14-ST) and lipopolysaccharide binding protein (LBP) in neonatal sepsis: new clinical and analytical perspectives for two old biomarkers. J Matern Fetal Neonatal Med. 2011 Oct;24 Supp — View Citation

Nagata T, Yasuda Y, Ando M, Abe T, Katsuno T, Kato S, Tsuboi N, Matsuo S, Maruyama S. Clinical impact of kidney function on presepsin levels. PLoS One. 2015 Jun 1;10(6):e0129159. doi: 10.1371/journal.pone.0129159. eCollection 2015. — View Citation

Okamura Y, Yokoi H. Development of a point-of-care assay system for measurement of presepsin (sCD14-ST). Clin Chim Acta. 2011 Nov 20;412(23-24):2157-61. doi: 10.1016/j.cca.2011.07.024. Epub 2011 Aug 3. — View Citation

Schirinzi A, Cazzolla AP, Lovero R, Lo Muzio L, Testa NF, Ciavarella D, Palmieri G, Pozzessere P, Procacci V, Di Serio F, Santacroce L. New Insights in Laboratory Testing for COVID-19 Patients: Looking for the Role and Predictive Value of Human epididymis — View Citation

Wu CC, Lan HM, Han ST, Chaou CH, Yeh CF, Liu SH, Li CH, Blaney GN 3rd, Liu ZY, Chen KF. Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and C-reactive protein: a systematic review and meta-analysis. Ann Intensive Care. 2017 S — View Citation

Zaninotto M, Mion MM, Cosma C, Rinaldi D, Plebani M. Presepsin in risk stratification of SARS-CoV-2 patients. Clin Chim Acta. 2020 Aug;507:161-163. doi: 10.1016/j.cca.2020.04.020. Epub 2020 Apr 22. — View Citation

Zhang X, Liu D, Liu YN, Wang R, Xie LX. The accuracy of presepsin (sCD14-ST) for the diagnosis of sepsis in adults: a meta-analysis. Crit Care. 2015 Sep 11;19:323. doi: 10.1186/s13054-015-1032-4. — View Citation

* Note: There are 22 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To evaluate daily variations of presepsin levels as an early marker of VAP in COVID 19 patients	Circulating presepsin levels every other day (from day 0 to day 30)	Time from ICU admission to day 30 or to ICU discharge or to ICU death
Secondary	To evaluate whether presepsin level can predict the presence of a bacterial respiratory co-infection at the time of ICU admission in patient with Sars-CoV-2 interstitial pneumonia	Circulating presepsin levels every other day (from day 0 to day 2)	Time from ICU admission to day 2
Secondary	To evaluate the role of circulating presepsin time course during the treatment of VAP as a clinical marker of the adequacy of the antibiotic therapy applied	Circulating presepsin levels every other day (from day 0 to day 30)	Time from ICU admission to day 30 or to ICU discharge or to ICU death
Secondary	To evaluate whether plasma levels of presepsin may distinguish the presence of VAP versus VAT (ventilator-associated tracheobronchitis).	Circulating presepsin levels every other day (from day 0 to day 30)	Time from ICU admission to day 30 or to ICU discharge or to ICU death