Clinical trial NCT04695119: Sepsis in the ICU-II
Official title: Sepsis in the Intensive Care Unit-II
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Septic Shock
Sepsis
Cardiomyopathies
Organ Failure, Multiple
Lead sponsor: Linkoeping University
Sponsor class: OTHER_GOV
Collaborators: name: CHU Dijon Bourgogne
name: Ryhov Hospital, Jönköping
name: Bicetre Hospital
name: HÃ´pital EuropÃ©en George Pompidou, APHP, Paris, France
First posted: 2021-01-05
Enrollment: 330
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All consecutive patients admitted to participating ICUs with a presumptive diagnosis of septic shock will be screened for eligibility. Patients fulfilling the Sepsis-III criteria for septic shock will included. Study inclusion must occur within 12h of ICU admission.

Brief summary: Sepsis-induced cardiac dysfunction (SIMD) is a well-known phenomenon yet its diagnosis remains elusive with no accepted definition, or defining pathophysiological mechanism associated with this disease. Systolic dysfunction occurs in 20-70% of patients, and may be severe, yet does not appear to have any prognostic value for mortality. Diastolic function has also been variably described and seems to be related to short-term mortality. However, the contribution of left ventricular systolic and diastolic dysfunction to mortality in sepsis are still far from clear, with uncertain contribution from previous cardiovascular disease, vasopressor and inotropic drugs and mechanical ventilation. Another poorly investigated area is right ventricular dysfunction. Cor pulmonale occurs in up to 25% of patients with septic shock, and is invariably related to pulmonary haemodynamics and mechanical ventilation, yet very little is known about how this affects prognosis. Finally, although the outcome of disease is a function of multiple parameters, septic cardiomyopathy is most frequently characterized based on individual echocardiographic parameters, without considering their interactions or placing them in the context of biomarkers and clinically available haemodynamic data. Available relevant studies are often monocentric, and many fail to consider the various confounders that influence the clinical outcome in sepsis. Therefore, the diagnostic and prognostic value of combinations of clinical, biochemical and haemodynamic variables remains to be established.

Accordingly, the purpose of this study is to identify biomarkers and echocardiographic and haemodynamic signatures characteristic of specific outcomes in SIMD to support the diagnosis and prognosis in SIMD. Specific aims are:

1. To determine the association between left ventricular systolic and diastolic dysfunction, and adverse outcome in SIMD;
2. To determine the association between right ventricular systolic and diastolic dysfunction, and adverse outcome in SIMD;
3. To determine the association between novel biomarkers and adverse outcome in SIMD;
4. To determine the combined value of biomarker, echocardiographic, and haemodynamic variables for predicting adverse outcomes in SIMD;
5. To explore if there are different phenotypes of SIMD using unsupervised machine learning algorithms, and whether they are associated with adverse outcomes.

50 patients will be enrolled in a feasibility study to evaluate the logistical setup for acute echocardiography and biobanking facilities. A further 300 patients will be enrolled with inclusion from peripheral centers once feasibility is confirmed.

Detailed description: UPDATE 26 Feb 2022:

A pilot project was completedafter recruitment of 50 patients confirming the feasibility of data collection, study logistics, biomarker assay set-up and frequency of outcomes. Cancellation of non-COVID related research in 2020\&2021 has caused significant delays. Recruitment of patients will continue during 2022\&2023. At the time of writing 70 patients have been recruited across 4 centres.

Eligibility criteria: Inclusion Criteria:

* Adult patients admitted to ICU and fulfilling the Sepsis-III criteria for septic shock

Exclusion Criteria:

* No informed consent
* Acute coronary syndromes

Primary outcomes:
measure: Myocardial injury
timeFrame: any time during ICU stay within the study period, up to 10 days
measure: Organ failure free days
timeFrame: 30 days of study inclusion
Secondary outcomes:
measure: 30 day mortality
timeFrame: 30 days after study inclusion
measure: 365 day mortality
timeFrame: 365 days after study inclusion
Other outcomes:
measure: Exploratory outcomes
timeFrame: during ICU stay, up to 10 days
measure: Exploratory outcomes
timeFrame: 30 days of study inclusion
Locations:
city: Dijon
country: France
facility: CHU Dijon-Bourgogne
city: Paris
country: France
facility: CHU Georges Pompidou
city: Jönköping
country: Sweden
facility: Ryhov Sjukhus Jönköping
city: Linköping
country: Sweden
facility: Dept of Anaesthesia and Intensive Care
Study officials:
affiliation: Linkoeping University Hospital
name: Michelle Chew, MBBS, PhD
role: STUDY_CHAIR
affiliation: CHU George Pompidou
name: Bernard Cholley, MD, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: CHU Dijon
name: Belaid Bouhemad, MD, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Ryhov Hospital, Jönköping
name: Fredrik Hammarsköjld, MD, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hopital Bicetre
name: Xavier Monnet, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: