Preclinical Detection of Sepsis Early in Hospitalized Patients Following Surgery, Injury or Severe Illness

Study Overview
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Brief Summary
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This clinical study is to evaluate a novel biomarker - CNA Rapid Sepsis Dx - to predict the development of sepsis in patients admitted to the hospital with non-sepsis conditions. Using circulating cell-free DNA (cfDNA) in the blood stream, it has been demonstrated to detect infection response days before clinical evidence of sepsis manifests. The hypothesis is that blood biomarkers drawn daily in the hospital will identify patients who develop sepsis within seven days of hospital presentation.

Detailed Description
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This is a prospective observational trial evaluating CNA Rapid Sepsis Dx -novel biomarkers (CNA Diagnostics Inc.; Calgary, Canada) based on circulating cell-free DNA (cfDNA) in the blood stream to identify patients originally admitted with non-sepsis conditions who ultimately develop sepsis according to Sepsis-3 criteria within seven days of hospital presentation. This novel technology has been demonstrated to detect host-related response to infection days before clinical evidence of sepsis manifests. The primary objective of this study is to assess the performance of the novel diagnostic assay, CNA Rapid Sepsis Dx, based on the biomarkers, drawn daily from the day of hospital presentation, to identify patients who ultimately develop sepsis according to Sepsis-3-definition within seven days of hospital presentation. The secondary objective is to correlate the CNA Rapid Sepsis Dx with clinically relevant outcomes such as infections that otherwise do not meet Sepsis-3 criteria, intensive care unit (ICU) length of stay, hospital length of stay, fluid culture results, and hospital mortality.

Official Title
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Preclinical Detection of Sepsis Early in Hospitalized Patients Following Surgery, Injury or Severe Illness (Pre-SEPSIS Trial)

Conditions
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Sepsis

Intervention / Treatment
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* Diagnostic Test: CNA Rapid Sepsis Dx


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient 18 years of age or older at the time of enrollment Presence of any of the following high-risk features: Victims of trauma with either an Injury Severity Score of ≥ 15 or a Glasgow Coma Score of ≤ 8[2] OR Any patient undergoing high-risk surgical procedures including any emergency surgery and high risk elective surgery procedures involving the thorax, esophagus, stomach, small bowel, large bowel [3, 4] OR Any patient being admitted to any ICU setting for any reason with no current evidence or suspicion of active infection (by primary team).[5, 6] Able to collect sample within 24 hours of presentation to the hospital. Exclusion Criteria: Prisoners or in police custody Pregnancy Pre-existing infection for which patient is being treated with antibiotics as an outpatient. Plan for ongoing antibiotic therapy by treating team (up to three doses antibiotics for peri-procedure prophylaxis is allowable). Moribund, unlikely to survive the duration of active enrollment Comfort care measures in place or ordered at time of screening OR indication from treating team that active medical care will not be pursued due to patient's condition or patient's/family's wishes. Palliative care or hospice consult at time of screening.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: CNA Rapid Sepsis Dx|Novel biomarker based on circulating cell-free DNA (cfDNA) in the human blood stream|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical development of sepsis | Sepsis determined according to Sepsis-3 definition | Seven Days from hospital presentation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SIRS sepsis | Infection with systemic inflammatory response syndrome (SIRS) criteria | Seven Days from hospital presentation | 
| Hospital Length of Stay | Duration of hospital stay in survivors and non-survivors from date/time of hospital presentation to order for discharge. | Up to 12 months | 
| Intensive Care Unit Length of Stay | Duration of ICU stay in survivors and non-survivors from date/time of ICU admission to date/time order for transfer / discharge from ICU. | Up to 6 months | 
| Development of non-Sepsis 3 Infections | An infection is suspected (by any degree of confidence) but the subject does not meet criteria for either Sepsis-3 or SIRS sepsis. | Seven Days from hospital presentation | 
| Body Fluid Culture Results | All fluid culture results (blood, CSF, urine, synovial, ascitic, abscess, etc) collected during the study period will be recorded | Seven Days from hospital presentation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Biomarker, Sepsis