Correlating MicroRNA Changes With Sepsis Outcomes

Study Overview
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Brief Summary
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This trial studies how changes in microRNAs may correlate with sepsis outcomes. Sepsis is a type of severe infection of the blood stream, and its diagnosis may be obscured by many other conditions such as surgery, trauma, and cancer. MicroRNAs are biomarkers found in the blood and tissue. Blood samples may help correlate changes in microRNA expression to patient reactions to a sepsis infection.

Detailed Description
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PRIMARY OBJECTIVES: I. To examine whether the cellular and viral micro ribonucleic acid (miRNA) changes in plasma and peripheral mononuclear blood cells (PMNCs) correlate with the diagnosis and outcome of sepsis. SECONDARY OBJECTIVES: I. To distinguish systemic inflammatory response syndrome (SIRS) without infection from sepsis and septic shock. OUTLINE: Patients are assigned to 1 of 2 groups. GROUP A: Patients undergo blood specimen collection at baseline (before surgery), the day after surgery, either the day of hospital discharge or the day of sepsis diagnosis, and 6 days after the baseline blood draw if still hospitalized. GROUP B: Patients undergo blood specimen collection at baseline (day of sepsis diagnosis), the day after baseline, and on day 7 from baseline if still hospitalized.

Official Title
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Profile of miRNA Changes in Sepsis and Surgical Trauma

Conditions
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Septicemia

Intervention / Treatment
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* Procedure: Biospecimen Collection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Electively scheduled for surgical operation that require general anesthesia and expected duration of hospitalization of longer than one day (for patients in Perioperative Evaluation & Management [POEM]) or high clinical suspicion of sepsis by the emergency physician (for patients in emergency center) Ability to give informed consent. If the patient is incapacitated and unable to give informed consent, the next-of-kin or a person who has the power of attorney must be present for informed consent. For patients in the emergency center only, two or more of the following SIRS criteria: Leukocytes > 12,000/mm^3 or < 4,000/mm^3 or > 10% immature (band) forms, provided that no filgrastim or pegfilgrastim was administered within 30 days and no leukemia Heart rate > 90 beats/minute (min) Respiratory rate > 20 breaths/min or partial pressure of carbon dioxide (CO2) < 32 mmHg Oral temperature > 38 degrees Celsius (C) or < 36 degrees C or axillary temperature > 37 degrees C or < 35 degrees C Exclusion Criteria: Inability to give informed consent or a person who has power of attorney for medical decision is not available Being moribund (for patients in emergency center) or cancellation of surgery (for patients in POEM) Active Do Not Resuscitate or Do Not Intubate order
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 |
| --- | --- |
| Group A (biospecimen collection)<br>Patients undergo blood specimen collection at baseline (before surgery), the day after surgery, either the day of hospital discharge or the day of sepsis diagnosis, and 6 days after the baseline blood draw if still hospitalized. | Procedure: Biospecimen Collection<br>* Undergo blood biospecimen collection<br>|
| Group B (biospecimen collection)<br>Patients undergo blood specimen collection at baseline (day of sepsis diagnosis), the day after baseline, and on day 7 from baseline if still hospitalized. | Procedure: Biospecimen Collection<br>* Undergo blood biospecimen collection<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in cellular and viral micro ribonucleic acids (miRNAs) | For each of the cellular and viral miRNAs, samples from patients with sepsis versus (vs.) patients with systemic inflammatory response syndrome (SIRS) without sepsis vs. patients presenting for pre-op evaluation (reference group without SIRS or sepsis) will be compared by one-way analysis of variance. Will compare the miRNA expression intergroup differences. | Baseline up to day 1 | 
| 7-day mortality rate | Will be correlated with miRNA changes. Will compare the changes of the miRNAs from baseline to day 1 between the patients who were still alive 7 days after diagnosis of sepsis and those who died within 7 days of sepsis diagnosis. | Baseline up to day 7 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| T and B cells immune phenotypes |  | Up to 2 years |