Mitochondrial DNA as a Biomarker of Sepsis Severity

Study Overview
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Brief Summary
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Mitochondria are organelles (a specialized subunit of a cell) responsible for providing cells with energy. For reasons not yet understood, mitochondria will release their DNA into blood in response to cellular injury or cell death. With a simple blood draw, investigators can measure the amount of mitochondrial DNA in a patient's blood. The investigators' hypothesis, is that mitochondrial DNA can be used as a surrogate marker of cellular injury to predict patient outcomes. The investigators intend to test their hypothesis by measuring mitochondrial DNA in adult patients presenting to the Emergency Department with sepsis (a life-threatening condition due to an infection) and observing their hospital course.

Detailed Description
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Despite the advances of modern medicine, sepsis persists as one of the leading causes of death in the United States and poses a significant burden on U.S. health care, accounting for more than $24 billion of total hospital costs in 2013. The high mortality and cost of treating sepsis at least partially stems from the consequences of delayed diagnosis. Unfortunately, this delay is attributable to the broad clinical manifestations of the syndrome and the absence of a specific test for sepsis. Realizing this, The Society of Critical Care Medicine and the European Society of Intensive Care Medicine have released guidelines emphasizing the need for diagnostic approaches aimed at the early detection of sepsis. The hope is that early recognition will allow for more aggressive upfront management thereby improving patient outcomes. In 2013, Nakahira et al showed that circulating cell-free mitochondrial DNA levels are associated with sepsis and mortality in patients admitted to the ICU. In contrast to that study, the purpose here is to determine whether circulating cell-free mitochondrial DNA and other biomarkers are associated with the severity of sepsis and 28-day mortality in patients presenting to the ED with sepsis. To accomplish this task, the investigators intend to prospectively collect specimens from patients presenting to NYP-Weill Cornell and NYP-Brooklyn Methodist with suspected sepsis.

Official Title
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Mitochondrial DNA as a Biomarker of Sepsis Severity

Conditions
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Sepsis Syndrome, Sepsis, Severe Sepsis, Septic Shock, Infection

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults presenting to the Emergency Department with suspected sepsis. Exclusion Criteria: Pregnancy. Patients with limitations of care at the time of specimen collection.

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

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| NYP-WCM<br>The NYP-WCM cohort will consist of patients presenting to the NewYork-Presbyterian/Weill Cornell Medicine Emergency Department with suspected sepsis. | |
| NYP-BMH<br>The NYP-BMH cohort will consist of patients presenting to the NewYork-Presbyterian Brooklyn Methodist Hospital Emergency Department with suspected sepsis. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital Mortality | All-Cause | 60 Days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Association with severity of illness as determined by qSOFA Score | qSOFA | 3 Days | 
| Association with severity of illness severity of illness as determined by MEDS Score | MEDS Score | 3 Days | 
| Association with severity of illness as determined by SOFA Score | SOFA Score | 3 Days | 
| Need for Supportive Measures | NIPPV, Mechanical Ventilation, Vasopressors, CVVHD, iNO, ECMO | Up to 60 Days | 
| ICU-Free Days | Number of days free from ICU Admission | 28 Days | 
| Triage Decision | If the patient was discharged home or admitted to the floor, a step-down unit, or an ICU | 3 Days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mitochondrial DNA, Triage, Lactate, Mortality, Emergency Department, Intensive Care Unit, Organ Dysfunction, Biomarker, Prognosis