Septic Shock
Conditions
Keywords
Clock genes, circadian regulation
Brief summary
Despite large efforts trying to improve diagnostic and therapy of sepsis have been made over the last decade (e.g. initiation of the Surviving Sepsis Campaign, defining evidence based sepsis therapy bundles) the mortality of septic shock remains high and causes high socioeconomical burden of disease. The purpose of this pilot study is to evaluate the design and conduct of a projected full scale clinical trial.
Detailed description
A functional clock is required for induction of several proinflammatory genes, not shown in septic patient settings, yet. Clock genes are involved in modulating the activity of several transcription factors that are important regulators of immune functions (e.g. HIF1-α, STAT1, STAT3, and NF-κB) (Bellet MM et al., 2013). Furthermore, polymorphisms such as rs7221412, a common polymorphism near period homolog 1 (PER1), was associated with the timing of activity rhythms and also showed a suggestive time-dependent relationship with both cerebral cortex and monocytes PER1 expression and an association with time of death (Lim ASP et al., 2012). This explorative project is a pilot study. First data are generated for the assessment of the circadian system in patients with septic shock.
Interventions
None listed
Sponsors
Claudia Spies
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male and female patients with age 18 years and above, * Patient at intensive care units (8i, 9i and 1i at Charité - University Medicine Berlin , Campus Virchow- Klinikum), * Septic shock (ACCP/SCCM (American College of Chest Physicians/Society of Critical Care Medicine) consensus definitions) AND Norepinephrine dosage of \>0.3 μg/kg/min for at least 2 hours
Exclusion criteria
* Pregnant or lactating female patient, * Participation in another interventional study (30 days before study inclusion and during study participation), * Acute leucemia, * Severe leukocytosis (\>50,000/nl), * Severe thrombocytopenia (\<5,000/nl), * Autoimmune disease with systemic medication of ≥10 mg prednisolone equivalent or previous transplantation, * Patients receiving interferon therapy (last 14 days), * Patients with known hypersensitivity GM-CSF or known antibodies against GM-CSF, yeast-derived products or any component of the study medication, * Ongoing (concomitant) chemotherapy or radiotherapy for malignancy, * Acute pulmonary embolism or acute myocardial infarction within last 72 hours, * Cardiopulmonary resuscitation within last 7 days, * Moribund patient (life expectancy \<72 hrs.), * Presence of a do-not-resuscitate or do-not-intubate order, * Known human immunodeficiency virus (HIV) infection or chronic viral hepatitis * Lacking willingness to save and hand out data within the study * Accommodation in an institution due to an official or judicial order * The informed consent of the patient or the subject's legally acceptable representative can´t be obtained in time * Patient has a power of attorney or patient's provision, where he/she refuses participation in any clinical trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of circadian regulation | These parameters are measured during intensive care unit stay, for a maximum of 3 days | Circadian regulation by expression of clock genes |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time on mechanical ventilation | They are followed up until the end of intensive care unit stay - or, for a maximum of 28 days | — |
| Intensive care unit length of stay | Participants will be followed for the duration of intensive care stay, an expected average of 4 weeks | — |
| Hospital length of stay | Participants will be followed for the duration of intensive care stay, an expected average of 5 weeks | — |
| Simplified Acute Physiology Score (SOFA II) | They are measured until the end of intensive care unit stay - or, for a maximum of 28 days. | — |
| Sequential Organ Failure Assessment (SOFA) | They are measured until the end of intensive care unit stay - or, for a maximum of 28 days. | — |
| Therapeutic Intervention Scoring System (TISS-28) | They are measured until the end of intensive care unit stay - or, for a maximum of 28 days. | — |
| Mortality | 6 months after intensive care unit discharge | — |
| Cognitive function | Up to 3 and 6 months | Cognitive function is measured by Repeatable Battery for the Assessment of Neuropsychological Status |
| Multiplex-Genexpression analysis | These parameters are measured during intensive care unit stay, for a maximum of 3 days | Ncounter neuroinflammation and micro rna panel are analysed |
| Light frequencies | Light frequencies are measured until the end of intensive care unit stay - or, for a maximum of 28 days | — |
| Light levels (lux) | Light levels are measured until the end of intensive care unit stay - or, for a maximum of 28 days | — |
| Cortisol | This parameter is measured in ng/ml during intensive care unit stay, for a maximum of 3 days | — |
| Melatonin | This parameter is measured in pg/ml during intensive care unit stay, for a maximum of 3 days | — |
| Quality of life | Up to 3 and 6 months | Quality of life is measured by SF-36 questionnaire |
Other
| Measure | Time frame | Description |
|---|---|---|
| Nagalase enzyme activity | This parameter is measured at the beginning of the investigation | Nagalase Enzyme activity is expressed in nmol/min per Milliliter. Analysis is evaluated with the perioperative Nagalase results of 10 patients in the clinical trial Phydelio (EudraCT-No 2008-007237-47). |
| Venous return | This parameter is measured at the beginning of the investigation | Venous return will be assessed after ICU admission by venous return pressure gradient (dVR) |
Countries
Germany
Outcome results
None listed