Clinical trial NCT05161104: A Multicenter Cross-sectional Study of Cardiac Ultrasound Phenotypes in Patients With Sepsis
Official title: A Multicenter Cross-sectional Study of Cardiac Ultrasound Phenotypes in Patients With Sepsis
Study type: OBSERVATIONAL
Overall status: ENROLLING_BY_INVITATION
Conditions: Cardiac Ultrasound Phenotypes
Septic Myocardial Suppression
Hyperdynamic State Left Ventricular Function in Sepsis Patients
Outcome
Lead sponsor: Fujian Provincial Hospital
Sponsor class: OTHER
First posted: 2021-12-16
Enrollment: 200
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CROSSOVER
Time perspective: CROSS_SECTIONAL
Sampling method: PROBABILITY_SAMPLE
Study population: All patients with sepsis or septic shock who conform to Sepsis 3.0 diagnostic criteria and were more than or equal to 18 years of age who were admitted to each center were included. Sepsis was defined as an increase of ≥2 points from baseline in sequential organ failure assessment (SOFA) score due to infection; septic shock was defined as persistent hypotension on top of sepsis, requiring vasoactive drugs to maintain a mean arterial pressure(MAP) ≥65 mmHg and a blood lactate level \>2 mmol/L despite adequate fluid resuscitation.

Brief summary: The heart, one of the most important organs for oxygen supply and consumption, is frequently involved in sepsis, i.e. septic cardiomyopathy, also known as septic myocardial suppression. The occurrence of septic myocardial suppression increases mortality in septic patients. Recent studies have found that left ventricular hyperdynamic state (EF \> 70%) is associated with intra-ICU mortality in septic patients, possibly because it reflects unresolved vascular paralysis from sepsis . For septic myocardial suppression, there is still a lack of uniform criteria for diagnosis, but it is well established that the cardiac ultrasound phenotype of septic myocardial suppression can be left ventricular systolic insufficiency (LVSD), left ventricular diastolic insufficiency (LVDD), right ventricular insufficiency (RVD), diffuse ventricular insufficiency, and mixed ventricular insufficiency. According to incomplete statistics, the prevalence of LVSD ranges from 12 to 60%, the prevalence of LVDD is higher, 20% to 79%, and the prevalence of RVD varies from 30% to 55%. However, based on the current understanding of septic myocardial suppression, the relationship between each staging and its prognosis is unclear, and echocardiography can rapidly identify septic myocardial suppression and guide the classification of septic myocardial suppression to further optimize the diagnosis and treatment process of sepsis, especially to avoid over-resuscitation during fluid resuscitation and perform reverse resuscitation in a timely manner to improve patient prognosis and reduce hospitalization time. The aim of this study is to classify and evaluate the prognosis of patients with different septic cardiac ultrasound phenotypes in multiple centers across China by measuring the right and left heart systolic and diastolic indices by echocardiography, recording the baseline conditions and clinical indices of patients, and combining them with the prognosis.


Eligibility criteria: Inclusion Criteria:

- All patients with sepsis or septic shock who conform to Sepsis 3.0 diagnostic criteria

Exclusion Criteria:

1. Patients with preexisting chronic heart disease such as cardiomyopathy, chronic pulmonary heart disease, severe cardiac valve disease, coronary heart disease, congenital heart disease, pericardial disease, etc. and with cardiac function ≥ grade III (NYHA classification) prior to sepsis.
2. End-stage malignancies.
3. Severe trauma.
4. Pregnancy.
5. Patients for whom transthoracic echocardiography data are not available.

Primary outcomes:
measure: in-hospital mortality
timeFrame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 12 months
measure: 28-day mortality
timeFrame: From patient admission to day 28
Secondary outcomes:
measure: length of stay in the ICU
timeFrame: days from patient transfer to ICU to transfer out，an average of 1 week
measure: number of days of mechanical ventilation
timeFrame: Days the patient was mechanically ventilated until the cessation of mechanical ventilation，an average of 1 week
Other outcomes:
Locations:
city: Fuzhou
country: China
facility: Fujian Provincial Hospital
state: Fujian
Study officials:
References:
citation: Zhang H, Wang X, Yin W, Zhang H, Liu L, Pan P, Zhu Y, Huang W, Xing Z, Yao B, Wang C, Lin T, Yu R, Shang X. A multicenter prospective cohort study of cardiac ultrasound phenotypes in patients with sepsis: Study protocol for a multicenter prospective cohort trial. Front Med (Lausanne). 2022 Jul 27;9:938536. doi: 10.3389/fmed.2022.938536. eCollection 2022.