Urinary Heparanase Activity as a Predictor of Acute Kidney Injury in Critically Ill Adults

Study Overview
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Brief Summary
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Across the world, the most common cause of dying in the ICU is a disease called sepsis. Sepsis is a disease in which the body's protective response to infection becomes too intense, unnecessarily damaging important organs in the body. Kidney damage during sepsis is particularly bad, as a person's chance of survival drops significantly when he or she develops kidney failure. This study plans to learn more about how to detect (and thus prevent) kidney failure early in sepsis. The current tests doctors use only detect kidney failure once it's already happened. We must therefore find better ways of detecting kidney failure earlier, when there is still a chance to protect the kidneys. In this study, patients will provide a one-time sample of urine. We will check this urine for signs of a protein called heparanase, which we believe is important in early kidney failure. We will then see if high heparanase activity in urine predicts the risk of developing kidney failure. We will compare results from patients with sepsis with results from patients with trauma, allowing us to determine if heparanase is only important in sepsis kidney failure.

Official Title
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Urinary Heparanase Activity as a Predictor of Acute Kidney Injury in Critically Ill Adults

Conditions
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Sepsis, Trauma, Shock, Acute Kidney Injury

Intervention / Treatment
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* Other: Urine collection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. Septic shock or major trauma. Septic shock will be defined by standard criteria including (a) the presence of the systemic inflammatory response syndrome (SIRS), (b) evidence of infection, and (c) treatment with vasopressor medications for > 4 hours despite > 30 ml/kg intravenous crystalloid resuscitation. As a critically-ill comparator group, we will also enroll adult patients admitted (within 24 hours prior to screening) to the Denver Health Surgical ICU with major trauma, as defined by an Injury Severity Score of > 15. Exclusion Criteria: Exclusion criteria include anuria, prisoners, absence of a routinely-inserted urine collection device, or gross hematuria. Additionally, patients with known genitourinary malignancy will be excluded, given that cancers are known to overexpress heparanase. Additional exclusion criteria include age < 18 years, and pregnant women.

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 |
| --- | --- |
| Septic shock or major trauma<br>Patients admitted within 24 hours to ICU for septic shock or major trauma (ISS > 15). Septic shock is defined by sepsis with hypotension requiring >4 hours of vasopressor support over previous 24 hours. | Other: Urine collection<br>* Collection of 5 ml urine from urinary collection device (e.g. foley catheter).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute kidney injury | Acute kidney injury will be determined using RIFLE criteria, based upon change in serum creatinine or urine output. | 72 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Heparanase, Sepsis, Trauma, Shock, Acute kidney injury