Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03644030
Other study ID # CardioMass
Secondary ID
Status Completed
Phase
First received
Last updated
Start date September 6, 2018
Est. completion date September 1, 2019

Study information

Verified date September 2018
Source Aristotle University Of Thessaloniki
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

In general, malnutrition in surgical patients is associated with a higher risk of postoperative infections, decreased immune response, more cardiac complications, prolonged mechanical ventilation , and a higher rate of reimportation due to several other complications than lead to an increase in morbidity and mortality, a prolongation of the total hospitalization time in the ICU[intensive care unit ] and the chamber, and a delay in the healing of the surgical trauma .

The presence of a low percentage of lean mass, as calculated by the technique of bioelectric conductivity, practically means a small percentage of muscle tissue. However, muscle tissue is an important, if not the only source of amino acids for both protein synthesis and gluconeogenesis in stress conditions, such as surgery and the first postoperative days. Thus, post-operative patients in general, and cardio-operated patients, in particular, having a low lean mass have minimal reserves to the stress requirements, resulting in an increased risk of complications.

In the last few years, the most reliable indicator of malnutrition- in addition to the lean mass index - began to be considered the phase angle, which is also calculated when measuring the bioreduction of electrical conductivity, although there is a very recent challenge . The phase angle expresses the relationship between the electrical reactance, i.e. the state of the cell membrane, to resist the permeability and the resistance, i.e. the restriction to the flow of the electrical current through the body, mainly related to the water of the tissues . Like the FFM[fat-free mass]- index, the phase angle uses the total water of the tissues, and thus also reflects the cell mass. In addition, however, it also measures the resistance of cell membranes, so it also evaluates their quality and is therefore considered to be a reliable indicator of poor nutritional status , although some also maintain demur due to the possible poor distribution of extracellular fluid in cardiological patients.

From all of the above, it appears that there are some gaps in the evaluation of the patients who are going to undergo cardiac surgery regarding their nutritional status, both because the classic nutrition control indicators are not fully documented as being reliable for these patients, and there are no studies to monitor and compare body composition directly to any other index postoperatively.


Description:

The study protocol-mandated baseline data will include demographics, comorbidities, EuroSCORE[European System for Cardiac Operative Risk Evaluation] II, C-reactive protein, left ventricular ejection fraction (by transthoracic echocardiography) and peak expiratory flow rate (assessed by spirometry). Physical performance status will be assessed by APACHE [Acute Physiology And Chronic Health Evaluation] II score. Furthermore, SOFA [Sequential [Sepsis-related] Organ Failure Assessment] score will be assessed preoperatively and up to 7th postoperative day.

Preoperatively and on the 7th postoperative day, the following parameters will be calculated or measured and then recorded:

- Anthropometric data including body height, weight and waist circumference measurement, estimation of waist/circumference ratio and calculation of body mass index [BMI].

- Nutritional status will be assessed by MUST[Malnutrition Universal Screening Tool] score

- Body composition analysis using bioelectrical impedance analysis [BIA], will be performed for the calculation of FFM [fat-free mass] and fat mass [FM] indicators, intracellular, extracellular and total water [ICW, ECW, TBW] and phase angle parameter [PhA]. Additionally, muscular power will be assessed by handgrip strength [HGS], the upper third triangle perimeter and skin fold thickness will be measured.

- Daily calorie and protein needs of each patient will be calculated

During hospitalization, the following parameters will be recorded:

- Type of diet [parenteral, intestinal, oral]

- Post-operative infections involving respiratory system, medieval space, sternum trauma, lower limb trauma (if present) and endocarditis.

- The occurrence of organ dysfunction or sepsis. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction will be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which will be associated with an in-hospital mortality greater than 10%.

- Thromboembolic events such as stroke, peripheral venous thrombosis and pulmonary embolism.

- Acute renal failure.

- Re-operation for bleeding.

- Need for inotropic or vasoactive support.

- Hospitalization data (intubation> 24 hours, duration of mechanical ventilation and ICU stay, duration of hospital stay, in-hospital mortality


Recruitment information / eligibility

Status Completed
Enrollment 179
Est. completion date September 1, 2019
Est. primary completion date August 15, 2019
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria:

- age >18 years

- planned introduction for cardiac operation with CPB[cardiopulmonary bypass]

- coronary artery bypass surgery

- heart valve surgery [heart valve surgery]

Exclusion Criteria:

- non-consent of the patient

- urgent admissions - operations

- pacemaker exist

- congenital heart disease

- recent [<3-month] open-heart surgery

Study Design


Related Conditions & MeSH terms


Locations

Country Name City State
Greece AHEPA University Hospital Thessaloníki

Sponsors (1)

Lead Sponsor Collaborator
Aristotle University Of Thessaloniki

Country where clinical trial is conducted

Greece, 

References & Publications (12)

Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ Jr, Couper GS, Allred EN, Cohn LH, Rizzo RJ. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg. 1999 Nov;118(5):866-73. — View Citation

Gomez-Perez SL, Haus JM, Sheean P, Patel B, Mar W, Chaudhry V, McKeever L, Braunschweig C. Measuring Abdominal Circumference and Skeletal Muscle From a Single Cross-Sectional Computed Tomography Image: A Step-by-Step Guide for Clinicians Using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr. 2016 Mar;40(3):308-18. doi: 10.1177/0148607115604149. Epub 2015 Sep 21. Erratum in: JPEN J Parenter Enteral Nutr. 2016 Jul;40(5):742-3. — View Citation

Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, Lomivorotov VN, Karaskov AM. Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg. 2013 May;16(5):612-8. doi: 10.1093/icvts/ivs549. Epub 2013 Jan 29. — View Citation

Soeters PB, Schols AM. Advances in understanding and assessing malnutrition. Curr Opin Clin Nutr Metab Care. 2009 Sep;12(5):487-94. doi: 10.1097/MCO.0b013e32832da243. Review. — View Citation

Tsaousi G, Kokkota S, Papakostas P, Stavrou G, Doumaki E, Kotzampassi K. Body composition analysis for discrimination of prolonged hospital stay in colorectal cancer surgery patients. Eur J Cancer Care (Engl). 2017 Nov;26(6). doi: 10.1111/ecc.12491. Epub 2016 Mar 16. — View Citation

Tsaousi G, Panidis S, Stavrou G, Tsouskas J, Panagiotou D, Kotzampassi K. Prognostic indices of poor nutritional status and their impact on prolonged hospital stay in a Greek university hospital. Biomed Res Int. 2014;2014:924270. doi: 10.1155/2014/924270. Epub 2014 Mar 23. — View Citation

van Straten AH, Bramer S, Soliman Hamad MA, van Zundert AA, Martens EJ, Schönberger JP, de Wolf AM. Effect of body mass index on early and late mortality after coronary artery bypass grafting. Ann Thorac Surg. 2010 Jan;89(1):30-7. doi: 10.1016/j.athoracsur.2009.09.050. — View Citation

van Venrooij LM, de Vos R, Borgmeijer-Hoelen MM, Haaring C, de Mol BA. Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery. Am J Clin Nutr. 2008 Jun;87(6):1656-61. — View Citation

van Venrooij LM, de Vos R, Zijlstra E, Borgmeijer-Hoelen MM, van Leeuwen PA, de Mol BA. The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: a prospective cohort study. J Thorac Cardiovasc Surg. 2011 Nov;142(5):1263-9. doi: 10.1016/j.jtcvs.2011.07.033. Epub 2011 Aug 19. — View Citation

Visser M, van Venrooij LM, Vulperhorst L, de Vos R, Wisselink W, van Leeuwen PA, de Mol BA. Sarcopenic obesity is associated with adverse clinical outcome after cardiac surgery. Nutr Metab Cardiovasc Dis. 2013 Jun;23(6):511-8. doi: 10.1016/j.numecd.2011.12.001. Epub 2012 Mar 6. — View Citation

Visser M, van Venrooij LM, Wanders DC, de Vos R, Wisselink W, van Leeuwen PA, de Mol BA. The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients. Clin Nutr. 2012 Dec;31(6):981-6. doi: 10.1016/j.clnu.2012.05.002. Epub 2012 May 27. — View Citation

Wagner BD, Grunwald GK, Rumsfeld JS, Hill JO, Ho PM, Wyatt HR, Shroyer AL. Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Ann Thorac Surg. 2007 Jul;84(1):10-6. — View Citation

* Note: There are 12 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Phase angle in patients undergoing cardiac surgery as indicator of their nutrition status. Phase angle [PhA(°) = (reactance/electrical resistance) × (180°/?)] will be measured in degrees using bioelectrical impedance analysis and check whether it can be considered as a reliable indicator of the nutrition status of cardiac surgery patients undergoing cardiac surgery during the preoperative and postoperative periods. PhA will be calculated by using the sum of impedance and reactance of the right arm, trunk, and right leg and based on the following equation, PhA(°) = (Reactance/Resistance) × (180°/?). ? is the mathematical value of 3.1415 and This conversion is performed to convert the final value from radians into degrees.The normal range of phase angle is 5.84 ± 0.75.The primary change is the reduction of the mean phase angle postoperative by 1.0 unit (standard deviation ± 2.0) and this leads to increased morbidity, mortality. 7 days post operation
Secondary FFM[fat-free mass] index(kilograms/(meter x meter)- kg/m-2) in patients undergoing cardiac surgery as indicator of their nutrition status measure of FFM [fat-free mass] index( kgm-2) using bioelectrical impedance analysis and check if it can be a reliable indicator of the nutrition status of patients undergoing cardiac surgery during the preoperative and post-operative periods and how this leads to increased morbidity, mortality. 7 days post operation
Secondary Tissue edema index [extracellular(Litre) / total water(Litre) - ECW / TBW] in patients undergoing cardiac surgery as indicator of their nutrition status. measure of the tissue edema index [extracellular(Litre) / total water(Litre) - ECW / TBW] using bioelectrical impedance analysis and check if it can be a reliable indicator of the nutrition status of patients undergoing cardiac surgery during the preoperative and post-operative periods and if this associated with postoperative complications. 7 days post operation
See also
  Status Clinical Trial Phase
Active, not recruiting NCT05095324 - The Biomarker Prediction Model of Septic Risk in Infected Patients
Completed NCT02714595 - Study of Cefiderocol (S-649266) or Best Available Therapy for the Treatment of Severe Infections Caused by Carbapenem-resistant Gram-negative Pathogens Phase 3
Completed NCT02867267 - The Efficacy and Safety of Ta1 for Sepsis Phase 3
Completed NCT04804306 - Sepsis Post Market Clinical Utility Simple Endpoint Study - HUMC
Recruiting NCT05578196 - Fecal Microbial Transplantation in Critically Ill Patients With Severe Infections. N/A
Terminated NCT04117568 - The Role of Emergency Neutrophils and Glycans in Postoperative and Septic Patients
Completed NCT03550794 - Thiamine as a Renal Protective Agent in Septic Shock Phase 2
Completed NCT04332861 - Evaluation of Infection in Obstructing Urolithiasis
Completed NCT04227652 - Control of Fever in Septic Patients N/A
Enrolling by invitation NCT05052203 - Researching the Effects of Sepsis on Quality Of Life, Vitality, Epigenome and Gene Expression During RecoverY From Sepsis
Terminated NCT03335124 - The Effect of Vitamin C, Thiamine and Hydrocortisone on Clinical Course and Outcome in Patients With Severe Sepsis and Septic Shock Phase 4
Recruiting NCT04005001 - Machine Learning Sepsis Alert Notification Using Clinical Data Phase 2
Completed NCT03258684 - Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Sepsis and Septic Shock N/A
Recruiting NCT05217836 - Iron Metabolism Disorders in Patients With Sepsis or Septic Shock.
Completed NCT05018546 - Safety and Efficacy of Different Irrigation System in Retrograde Intrarenal Surgery N/A
Completed NCT03295825 - Heparin Binding Protein in Early Sepsis Diagnosis N/A
Not yet recruiting NCT06045130 - PUFAs in Preterm Infants
Not yet recruiting NCT05361135 - 18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in S. Aureus Bacteraemia N/A
Not yet recruiting NCT05443854 - Impact of Aminoglycosides-based Antibiotics Combination and Protective Isolation on Outcomes in Critically-ill Neutropenic Patients With Sepsis: (Combination-Lock01) Phase 3
Not yet recruiting NCT04516395 - Optimizing Antibiotic Dosing Regimens for the Treatment of Infection Caused by Carbapenem Resistant Enterobacteriaceae N/A