Sepsis Clinical Trial
Official title:
Genotypes and Phenotypes in Pediatric SIRS and Sepsis (GAPPSS)
The aim of this investigation is to longitudinally quantify host gene expression and serum proteins in children with infectious and non-infectious SIRS. The investigators hypothesize that children with non-infectious SIRS, with bacterial infection associated SIRS, or with viral infection associated SIRS will exhibit distinct patterns of host gene expression and serum proteins. The investigators further hypothesize that it should be possible to discover sets of mRNA or protein biomarkers that will permit unambiguous diagnosis of non-infectious SIRS, SIRS associated with bacterial infection, and SIRS associated with viral infection.
The investigators will undertake a proof-of-concept, pilot, prospective, observational trial
that aims to recruit ~90 children from the Seattle Children's Hospital Pediatric Intensive
Care Unit (PICU) and Cardiac Intensive Care Unit (CICU). The study will plan to recruit 30
children who are scheduled for surgery to repair congenital cardiac malformations, 15 - 25
immunocompetent children with culture positive sepsis, and 15 - 25 immunocompromised children
with culture positive sepsis, and 30-40 children who are polymerase chain reaction (PCR)
positive for viral respiratory pathogens (RSV, influenza, parainfluenza, rhinovirus, etc),
and who meet the eligibility criteria. In total, accounting for culture negative bacterial
sepsis (estimated 40%), the investigators plan to enroll 50 children with sepsis, 30-40 with
viral sepsis, and 20 children undergoing surgery for congenital heart disease.
Demographic data will be collected at the time of ICU admission. Illness severity will be
quantified by PRISM III and day 1 PELOD scores. Additional measures of sepsis severity will
include oxygenation index, saturation index and duration of mechanical ventilation,
vasoactive inotropic score and duration of vasoactive-inotropic support and highest serum
creatinine on day 1. Resource utilization will be measured as PICU and hospital duration of
stay.
For all children enrolled in the study, blood samples will be obtained on study days 1, 2 and
3. For children with sepsis, if cultures remain sterile or PCR negative, no additional
research blood samples will be obtained. For children with sepsis and a positive culture or
positive PCR by study day 3, additional blood samples will be obtained on the day of PICU
discharge.
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