European Registry for Hemadsorption in Sepsis With the Seraph Filter

Study Overview
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Brief Summary
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Although new techniques like extracorporeal blood purification have lately emerged, septic patients still have very high hospital mortality rates. Sepsis can be induced by either viremia, bacteriemia or in some cases both. Many studies have reported the effectiveness of different hemadsorbers, but patient sample sizes have been inadequate for definitive conclusions. Secondly, there are still no clear inclusion criteria as well as criteria for when to cease hemadsorption mostly due to immune dysregulation or cascade coagulation disorders. The aim of this observational prospective registry is to evaluate the effectiveness of the Seraph® 100 Microbind® Affinity Blood Filter (Seraph 100) in the treatment of septic ICU patients and to evaluate which cluster of these patients should benefit most with this therapy.

Detailed Description
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Hemadsorption was introduced in everyday clinical practice before the COVID-19 pandemic. The efficacy of hemadsorption removal of endotoxins and cytokines is still, by some, controversial due to the fact that most of the studies were performed in a small number of patients with very different diagnoses, comorbidities and disease severity. Furthemore, some studies enrolled patients over a prolonged period of time with very high SOFA scores and multi-organ failure where it is difficult to expect any significant effect of any kind of organ support therapy. The COSA registry reported that the treatment of COVID-19 patients with Seraph 100 was well tolerated and observed lower mortality in the registry when compared to calculated mortality. The primary aim of this observational prospective, multi-center, multistate web-based registry is to define the effectiveness and outcome of Seraph 100 treatment(s), investigate possible advantages of early targeted treatment and to set indications/inclusion criteria for the treatment of ICU septic patients with the method of hemoadsorption.

Official Title
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European Registry for Hemadsorption of Septic Patients With the Seraph 100 Microbind Affinity Blood Filter (ASTREA Study)

Conditions
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Critical Illness, Sepsis, Acute Respiratory Distress Syndrome, Infections - Pathogen Unspecified, Disease, Multi Organ Failure, Systemic Inflammatory Response Syndrome

Intervention / Treatment
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* Device: Hemoperfusion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Sepsis or septic shock: sepsis is defined as the presence of suspected or documented infections along with systemic inflammatory response syndrome; septic shock is defined as the presence of sepsis and acute circulatory failure according to European criteria Society for Intensive Care Medicine laboratory and clinical evidence of systemic inflammation: high levels of inflammatory cytokines such as IL-6 (>25 pg / ml); high values of inflammatory parameters from serum (leukocytes >15x10 9 / l, CRP >40 mg / l, procalcitonin >0.9 mg / l) and a high SOFA score (>2). clinical symptoms of hemodynamic instability requiring vasopressors diagnosis of ARDS deterioration of respiratory status with the onset of respiratory failure requiring mechanical ventilation (respiration rate >30 / min, or oxygen saturation <93%, or PaO2 / FiO2 ratio <300mmHg). Admission to ICU Exclusion Criteria: besides contraindications to the use of the hemoperfusion adopted (as from the manual of instructions), there are no exclusion criteria

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hemoperfusion<br>ICU septic patients treated with hemoperfusion | Device: Hemoperfusion<br>* Commercial membrane for extracorporeal blood purification (hemoperfusion)<br>|
| non-hemoperfusion<br>ICU septic patients non treated with hemoperfusion | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival | Overall Survival after Seraph 100 therapy session | 28 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Define the inclusion criteria for hemoperfusion with Seraph 100 in ICU septic patients | Define the inclusion criteria for extracorporeal blood purification (hemoperfusion) with Seraph 100 in ICU septic patients | 28 days | 
| To assess the correlation between hemoperfusion and positive short-term outcome | Define as to assess the correlation between hemoperfusion and positive short-term outcome (i.e. an improvement in hemodynamic stability and respiratory status will be combined to report SOFA score) | Immediately after first hemoperfusion procedure | 
| To assess the correlation between hemoperfusion and positive short-term outcome | Define as to assess the correlation between hemoperfusion and positive short-term outcome (i.e. an improvement in inflammatory status) | Immediately after first hemoperfusion procedure | 
| To assess the correlation between hemoperfusion and positive short-term outcome | Define as to assess the correlation between hemoperfusion and positive short-term outcome (i.e. an improvement in hemodynamic stability and respiratory status will be combined to report SOFA score) | 72 hours after finishing the hemoperfusion procedure | 
| To assess the correlation between hemoperfusion and positive short-term outcome | Define as to assess the correlation between hemoperfusion and positive short-term outcome (i.e. an improvement in inflammatory status) | 72 hours after finishing the hemoperfusion procedure | 
| To assess the correlation between hemoperfusion and positive long-term outcome | Define as to assess the correlation between hemoperfusion and positive long-term outcome, defined as patient survival at ICU discharge | 28 days | 
| The effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome | Define as to assess the effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome (i.e. improvement in hemodynamic stability and respiratory status will be combined to report SOFA score) | Immediately after first hemoperfusion procedure in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) | 
| The effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome | Define as to assess the effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome (i.e. improvement in inflammatory status) | Immediately after first hemoperfusion procedure in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) | 
| The effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome | Define as to assess the effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome (i.e. an improvement in hemodynamic stability and respiratory status will be combined to report SOFA score) | 72 hours after finishing the procedures with the combination of hemoperfusion and extracorporeal organ support therapy | 
| The effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome | Define as to assess the effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive short-term outcome (i.e. improvement in inflammatory status) | 72 hours after finishing the procedures with the combination of hemoperfusion and extracorporeal organ support therapies (i.e. ECMO, CRRT) | 
| The effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive long-term outcome | The effects of hemoperfusion in combination with other extracorporeal organ support therapies (i.e. ECMO, CRRT) on positive long-term outcome, defined as patient survival at ICU discharge | 28 days | 
| To assess the correlation between hemoperfusion and negative short-term outcome | Define as to assess the correlation between hemoperfusion and negative short-term outcome (i.e. initial signs of humoral immune dysregulation (hypogammaglobulinemia defined as a gamma-globulin fraction below 10%) or cascade coagulation disorders (severe thrombocytopenia <15,000 cells/uL or severe bleeding) | Immediately after first hemoperfusion procedure | 
| To assess the correlation between hemoperfusion and negative short-term outcome | Define as to assess the correlation between hemoperfusion and negative short-term outcome (i.e. initial signs of humoral immune dysregulation (hypogammaglobulinemia defined as a gamma-globulin fraction below 10%) or cascade coagulation disorders (severe thrombocytopenia <15,000 cells/uL or severe bleeding) | 72 hours after finishing the hemoperfusion procedure | 
| Length of ICU stay | Time spend in the ICU after Seraph 100 therapy session | 28 days | 
| Length of Hospital stay | Time spend in the hospital after Seraph 100 therapy session | 60 days | 
| Adverse events | Report of any Seraph 100 therapy related adverse events | 28 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute Respiratory Distress Syndrome, Sepsis, Critical Illness, Multi Organ Failure, Systemic Inflammatory Response Syndrome