Sepsis in the ICU-II

Sepsis Clinical Trial

Official title:

Sepsis in the Intensive Care Unit-II

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04695119
• Other study ID #: SICU-II
• Status: Recruiting
• Start date: September 17, 2018
• Est. completion date: December 31, 2023

Study information

• Verified date: February 2022
• Source: Linkoeping University
• Contact: Michelle S Chew, MBBS, PHD
• Phone: +46101030000
• Email: michelle.chew[@]liu.se
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Sepsis-induced cardiac dysfunction (SIMD) is a well-known phenomenon yet its diagnosis remains elusive with no accepted definition, or defining pathophysiological mechanism associated with this disease. Systolic dysfunction occurs in 20-70% of patients, and may be severe, yet does not appear to have any prognostic value for mortality. Diastolic function has also been variably described and seems to be related to short-term mortality. However, the contribution of left ventricular systolic and diastolic dysfunction to mortality in sepsis are still far from clear, with uncertain contribution from previous cardiovascular disease, vasopressor and inotropic drugs and mechanical ventilation. Another poorly investigated area is right ventricular dysfunction. Cor pulmonale occurs in up to 25% of patients with septic shock, and is invariably related to pulmonary haemodynamics and mechanical ventilation, yet very little is known about how this affects prognosis. Finally, although the outcome of disease is a function of multiple parameters, septic cardiomyopathy is most frequently characterized based on individual echocardiographic parameters, without considering their interactions or placing them in the context of biomarkers and clinically available haemodynamic data. Available relevant studies are often monocentric, and many fail to consider the various confounders that influence the clinical outcome in sepsis. Therefore, the diagnostic and prognostic value of combinations of clinical, biochemical and haemodynamic variables remains to be established. Accordingly, the purpose of this study is to identify biomarkers and echocardiographic and haemodynamic signatures characteristic of specific outcomes in SIMD to support the diagnosis and prognosis in SIMD. Specific aims are: 1. To determine the association between left ventricular systolic and diastolic dysfunction, and adverse outcome in SIMD; 2. To determine the association between right ventricular systolic and diastolic dysfunction, and adverse outcome in SIMD; 3. To determine the association between novel biomarkers and adverse outcome in SIMD; 4. To determine the combined value of biomarker, echocardiographic, and haemodynamic variables for predicting adverse outcomes in SIMD; 5. To explore if there are different phenotypes of SIMD using unsupervised machine learning algorithms, and whether they are associated with adverse outcomes. 50 patients will be enrolled in a feasibility study to evaluate the logistical setup for acute echocardiography and biobanking facilities. A further 300 patients will be enrolled with inclusion from peripheral centers once feasibility is confirmed.

Description:

UPDATE 26 Feb 2022: A pilot project was completedafter recruitment of 50 patients confirming the feasibility of data collection, study logistics, biomarker assay set-up and frequency of outcomes. Cancellation of non-COVID related research in 2020&2021 has caused significant delays. Recruitment of patients will continue during 2022&2023. At the time of writing 70 patients have been recruited across 4 centres.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 330
• Est. completion date: December 31, 2023
• Est. primary completion date: December 31, 2023
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adult patients admitted to ICU and fulfilling the Sepsis-III criteria for septic shock

Exclusion Criteria:

• No informed consent
• Acute coronary syndromes

Related Conditions & MeSH terms

• Cardiomyopathies
• Multiple Organ Failure
• Organ Failure, Multiple
• Sepsis
• Septic Shock
• Toxemia

Intervention

Other:
• Exposure is septic shock (defined according to Sepsis-III) and standard treatment according to departmental protocols.
Collection of data, biomarker and echocardiography analysis will be centralized and blinded. Assessment of endpoints will be blinded.

Locations

Country	Name	City	State
France	CHU Dijon-Bourgogne	Dijon
France	CHU Georges Pompidou	Paris
Sweden	Ryhov Sjukhus Jönköping	Jönköping
Sweden	Dept of Anaesthesia and Intensive Care	Linköping

Sponsors (6)

Lead Sponsor	Collaborator
Linkoeping University	CHU Dijon Bourgogne, CHU George Pompidou, Paris, Hôpital Dupuytren, Hospitaux Universitaires Paris Sud, Ryhov Hospital, Jönköping

Countries where clinical trial is conducted

France,  Sweden, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Exploratory outcomes	Vasopressor inotropic score	during ICU stay, up to 10 days
Other	Exploratory outcomes	Days free of mechanical ventilation	30 days of study inclusion
Primary	Myocardial injury	increased hsTnT	any time during ICU stay within the study period, up to 10 days
Primary	Organ failure free days	Organ failure	30 days of study inclusion
Secondary	30 day mortality	Short term mortality	30 days after study inclusion
Secondary	365 day mortality	Long term mortality	365 days after study inclusion