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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04761913
Other study ID # 19/20/048
Secondary ID
Status Completed
Phase
First received
Last updated
Start date June 22, 2021
Est. completion date December 31, 2021

Study information

Verified date October 2021
Source Anglia Ruskin University
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

During the COVID-19 pandemic, a small minority of children have been presenting to acute paediatric services with a new syndrome, Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-Cov-2 (PIMS-TS). Children with PIMS-TS present with symptoms of inflammation caused by the immune system going into overdrive - this is likely to be in response to the virus. More severe cases involve inflammation and damage to the heart. The focus of this project is to identify children with milder forms of PIMS-TS who are at risk of progression to more severe disease. Being able to predict the disease course of PIMS-TS at an early stage is important as it will allow clinicians to decide which patients should be treated with immunosuppressants, which have been shown to reduce the severity of the illness but have side effects. Early data suggests that children with PIMS-TS have elevated biomarkers associated with an over-reaction of the body's immune system (also known as a 'cytokine storm') reaction. This study will explore whether children presenting with milder PIMS-TS have elevated 'cytokine storm' blood profiles and whether these profiles differ between children who continue to have a mild disease course compared to those who develop severe disease.


Description:

During the COVID-19 pandemic a minority of children have presented to acute services with clinical features of a new syndrome known as Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-Cov-2 (PIMS-TS). This high inflammatory state, likely triggered by the virus, has overlapping features of Kawasaki's and Toxic Shock Syndrome. The focus of this study is to identify which children presenting with mild PIMS-TS symptoms will go on to develop severe disease requiring intensive care unit (ICU) admission. This is important as data suggests that early aggressive treatment with immunosuppression can lead to a relatively quick resolution in symptoms. The results of this study could allow clinicians to be selective in treating patients in whom the benefits of treatment outweigh the risks. Early data suggests a 'cytokine storm' is involved in the PIMS-TS disease process. This proposed observational study will investigate whether children presenting to the non-ICU setting with features of PIMS-TS have raised cytokine storm biomarkers and whether these may be used to predict which children go onto develop severe disease. The proposed study will include up to 15 hospitals across East of England. NHS clinical care teams will identify patients meeting the inclusion criteria and upload anonymised data into a secure web-based study database. Data will be retrieved for retrospective cases from 1st March 2020 and prospective data entered up until September 2021. One hundred children presenting to acute (non-ICU) paediatric services with symptoms of PIMS-TS during the study period will be included. The primary objective of the study is to describe the 'cytokine storm' biomarker profiles of children aged between 3 months to 16 years presenting with PIMS-TS to the non-ICU setting, focussing on those biomarkers which are readily accessible to district general hospitals (Pro-Beta Natriuretic peptide [BNP], ferritin, and CRP). The secondary aims of the study are to: 1. Compare cytokine storm biomarker profiles of children who have a mild disease course to those who develop severe disease to identify whether there are any differences between these groups 2. Evaluate the association between cytokine storm biomarker profiles and severe events 3. Compare i) demographic characteristics (including pre-existing disease), and ii) other routine clinical investigations of children who have a mild disease course and those who develop severe disease to identify any differences between these 2 groups 4. Evaluate the association between vaccination status and disease severity 5. Compare cytokine storm biomarker profiles of children testing positive and those testing negative for SARS-CoV-2 via PCR on 2x nasopharyngeal swabs to identify any differences between these 2 groups.


Recruitment information / eligibility

Status Completed
Enrollment 40
Est. completion date December 31, 2021
Est. primary completion date December 31, 2021
Accepts healthy volunteers No
Gender All
Age group 3 Months to 16 Years
Eligibility Inclusion Criteria: - Within the age range of 3 months to =16 years - Presenting clinically to non-ICU paediatric acute services at hospitals in the East of England region with symptoms suggestive of PIMS (e.g. incomplete Kawasaki's disease/Toxic Shock Syndrome) i.e. having: persistent fever (>38.0oC for 5 or more days) AND high CRP (>80) AND with one or more of additional features listed in Appendix 1 of the RCPCH document 'Guidance: paediatric multisystem inflammatory syndrome temporarily associated with COVID-19' - Having either a positive or negative SARS-Cov-2 PCR test Exclusion Criteria: - Aged below 3 months old or above 16 years old - Confirmation of any microbial cause other than SARS-Cov-2 (including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus). Determination of such microbial causes is by routine testing i.e. blood culture; pneumococcal, meningococcal, group A strep, staph aureus blood PCR; ASOT; EBV, CMV, adenovirus, enterovirus PCR on blood; urine and stool culture; throat swab culture; stool virology.

Study Design


Related Conditions & MeSH terms

  • COVID-19
  • Paediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-Cov-2
  • Syndrome

Locations

Country Name City State
United Kingdom Mid Essex Hospital Trust Chelmsford Essex
United Kingdom East Suffolk and north Essex NHS Foundation Trust Colchester Essex
United Kingdom James Paget University Hospitals NHS Foundation Trust Great Yarmouth Norfolk
United Kingdom The Princess Alexandra Hospital NHS Trust Harlow Essex
United Kingdom East Suffolk and North Essex Foundation Trust Ipswich Suffolk
United Kingdom Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich Norfolk

Sponsors (1)

Lead Sponsor Collaborator
Anglia Ruskin University

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type Measure Description Time frame Safety issue
Primary Blood biomarker associated with a cytokine storm - Pro-Beta Natriuretic Peptide (measured in pg/mL). Pro-Beta Natriuretic Peptide (BNP) measured as part of routine clinical care. NHS care teams will upload anonymised routine clinical measurements into a secure study database. From date of admission to date of discharge from hospital assessed up to 18 months
Primary Blood biomarker associated with a cytokine storm - Ferritin (measured in µg/L) Ferritin measured as part of routine clinical care. NHS care teams will upload anonymised routine clinical measurements into a secure study database. From date of admission to date of discharge from hospital assessed up to 18 months
Primary Blood Biomarker associated with a cytokine storm - C-Reactive Protein (measured in mg/L) C-Reactive Protein measured as part of routine clinical care. NHS care teams will upload anonymised routine clinical measurements into a secure study database. From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Demographic characteristics including age, sex, ethnicity and pre-existing morbidities Information collected as part of routine clinical care. NHS clinical care teams will upload anonymous data into a secure study database. At admission to hospital
Secondary Hospital stay data Information collected as part of routine clinical care. NHS clinical care teams will upload anonymous data into a secure study database. From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Cytokine storm biomarker measured in mg/L (CRP) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Cytokine storm biomarkers measured in pg/mL (pro-beta natriuretic peptide, IL-6, IFN-gamma, IL-10, TNF-alpha) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Full blood count measures in 10^9/L (white cell count - neutrophil and lymphocyte count and platelet) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Full blood count measures in L/L (haematocrit) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Haemoglobin in g/L or g/dL (measured as part of full blood count and blood gas analysis) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Blood gas analysis measured in KPa (pCO2, pO2) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Blood gas analysis measured in mmol/l (glucose, lactate, Na, K and Cl) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Blood gas analysis measured in mmol/l or mEq/L (HCO3, BE) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Liver function tests measured in g/L (protein, albumin, globulin) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Liver function tests measured in U/L (ALP/ALT) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Liver function tests measured in µmol/L (bilirubin) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Troponin measured in ng/ml or ng/L Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary vitamin D measured in nmol/L Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Amylase, CK, LDH measured in U/L Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Glucose and triglycerides measured in mmol/L Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Urea and electrolytes measured in mmol/L (Na, K, urea) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Urea and electrolytes measured in µmol/L (creatinine) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary ferritin measured in µg/L Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary fibrinogen measured in g/L Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary D-dimer measured in ng/ml Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary PT and APTT measured in seconds Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary INR as a ratio (Patient PT/Control PT) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Acute Kidney Injury graded as no AKI or stage of AKI (1-3) Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Positive or negative COVID-19 antibody test Clinical investigations (blood biomarkers) collected as part of routine clinical care From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Presence or absence of clinical conditions as assessed by ECG/echocardiography Conditions will include: myocarditis, valvulitis, pericardial effusion, coronary artery dilation, or other conditions. From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Presence or absence of clinical conditions as assessed by chest x-ray/chest CT Conditions will include: presence of patchy symmetrical infiltrates, pleural effusion, coronary artery abnormalities (CT with contrast) or other conditions. From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Presence or absence of clinical conditions as assessed by abdominal ultrasound Conditions will include: colitis, ileitis, lymphadenopathy, ascites, hepatosplenomegaly or other conditions. From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Proteinuria as assessed by urinalysis graded as no protein, protein ++ or protein +++ From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Positive or negative COVID swab result as assessed by PCR From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Positive or negative NPA or throat swab result for respiratory panel as assessed by PCR Including: pneumococcal, meningococcal, Group A Strep, Staph Aureus, EBV, CMV, Andenovirus, Enterovirus From date of admission to date of discharge from hospital assessed up to 18 months
Secondary Vaccination status Information collected as part of routine clinical care. NHS clinical care teams will upload anonymous data into a secure study database. At admission to hospital