Observational Study of Sepsis and Pneumonia to Develop Diagnostic Tests
Recruitment status was Recruiting
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Purpose
We propose to develop novel diagnostic tests for severe sepsis and community acquired pneumonia (CAP). This program, entitled Community Acquired Pneumonia & Sepsis Outcome Diagnostics (CAPSOD), is a multidisciplinary collaboration involving investigators at six organizations: NCGR; Duke University Medical Center, Durham, NC; Henry Ford Hospital, Detroit, MI; Eli Lilly and Company, Indianapolis, IN; Indiana Centers for Applied Protein Sciences, Indianapolis, IN; and ProSanos Corp., La Jolla, CA.
In the United States, Community Acquired Pneumonia is the sixth leading cause of death and the number one cause of death from infectious diseases. Of the 5.6 million annual cases of CAP, 1.1 million require hospitalization for intensive therapy. Sepsis, commonly known as blood poisoning or bloodstream infection, is the tenth leading cause of death in the US and the number one cause of death in non-cardiac intensive care units. Incidence of sepsis is increasing by 9% each year and mortality rates vary between 25 and 50%. Cost to the US healthcare system exceeds $20 billion each year.
In patients with suspected sepsis or early CAP, rapid identification of patients who will develop severe sepsis or CAP is critical for effective management and positive outcome. The CAPSOD study is designed to identify novel tests for early diagnosis of severe sepsis and CAP. When performed in patients at the earliest stages of disease, these tests will have prognostic value, rapidly identifying those who will have poor outcomes or complicated courses.
CAPSOD will prospectively enroll patients with sepsis and CAP at Duke University Medical Center and Henry Ford Hospital. The study will use advanced bioinformatic, metabolomic, proteomic and mRNA sequencing technologies to identify specific protein changes, or biomarkers, in patient blood samples that predict outcome in sepsis and CAP. Development of biomarker-based tests will permit patient selection for appropriate disposition, such as the intensive care unit, and use of intensive medical therapies, thereby reducing mortality and increasing effectiveness of resource allocation.
| Condition |
|---|
|
Sepsis Septicemia Sepsis Syndrome Shock, Septic Community Acquired Pneumonia |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Plasma Protein Biomarker Based Diagnostics of Outcome in Sepsis & CAP |
- Death [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- Septic Shock [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- Severe Sepsis [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- Time to death [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Death [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- Death [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Death [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- Time to severe sepsis [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Severe sepsis [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- Severe sepsis [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Severe sepsis [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- Time to septic shock [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Septic Shock [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- Septic Shock [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Septic shock [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- Cryptic shock (ScvO2<65 or Lactate >2.5 and MAP >65 mmHg [>18 years of age] or SBP >90 [<18 years of age]) [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- Time to Cryptic shock (ScvO2<65 or Lactate >2.5 and MAP >65 mmHg [>18 years of age] or SBP >90 [<18 years of age]) [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- Cryptic shock (ScvO2<65 or Lactate >2.5 and MAP >65 mmHg [>18 years of age] or SBP >90 [<18 years of age]) [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- Cryptic shock (ScvO2<65 or Lactate >2.5 and MAP >65 mmHg [>18 years of age] or SBP >90 [<18 years of age]) [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Cryptic shock (ScvO2<65 or Lactate >2.5 and MAP >65 mmHg [>18 years of age] or SBP >90 [<18 years of age]) [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- Hospitalization [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
- Length of hospital stay [ Time Frame: Days ] [ Designated as safety issue: No ]
- ICU admission [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Length of ICU admission [ Time Frame: Days ] [ Designated as safety issue: No ]
- Disposition [ Time Frame: 28 day ] [ Designated as safety issue: No ]
- Renal dysfunction [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Respiratory dysfunction [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Hematology dysfunction [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Metabolic dysfunction [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Renal SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Lung SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Coagulation SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Liver SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CVS SOFA score [ Time Frame: 28 dadys ] [ Designated as safety issue: No ]
- Time to respiratory SOFA Score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Time to coagulation SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Time to liver SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Time to CVS SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Time to Renal SOFA score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- DIC score >5 (modified ISTH scoring system) [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Time to DIC score > 5 [ Time Frame: Days ] [ Designated as safety issue: No ]
- Development of ALI [ Time Frame: 28 days ] [ Designated as safety issue: Yes ]
- Development of ARDS [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Time to ALI [ Time Frame: Days ] [ Designated as safety issue: No ]
- Time to ARDS [ Time Frame: Days ] [ Designated as safety issue: No ]
- Ventilator [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Ventilator days [ Time Frame: Days ] [ Designated as safety issue: No ]
- MELD score [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Effect of early goal directed therapy on primary and secondary end-points [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Effect of Activated Protein C on primary and secondary end-points [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Effect of stress-dose corticosteroids on primary and secondary end-points [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- Effect of intensive glycemic control on primary and secondary end-points [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- APACHE II score [ Time Frame: enrollment ] [ Designated as safety issue: No ]
- APACHE II score [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
- PRISM III score [ Time Frame: enrollment ] [ Designated as safety issue: No ]
- PRISM III score [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
- SOFA score [ Time Frame: enrollment ] [ Designated as safety issue: No ]
- SOFA score [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
- CAP mortality [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- CAP and severe sepsis [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- CAP and septic shock [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- Severe CAP (ATS criteria) [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- Severe CAP (BTS criteria) [ Time Frame: Day 3 ] [ Designated as safety issue: No ]
- Pneumococcal sepsis [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Staphylococcus aureus sepsis [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Gram negative rod sepsis [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Fungal sepsis [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- SeptiFast result [ Time Frame: Enrollment ] [ Designated as safety issue: No ]
- SeptiFast result [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
- Microbiologic culture result [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- Urinary legionella antigen [ Time Frame: 7 days ] [ Designated as safety issue: No ]
- Microbiologic culture [ Time Frame: 7 days ] [ Designated as safety issue: No ]
- CAP, time to death [ Time Frame: days ] [ Designated as safety issue: No ]
- CAP, mortality [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- CAP, mortality [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- CAP, mortality [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- CAP, time to severe sepsis [ Time Frame: Days ] [ Designated as safety issue: No ]
- CAP, severe sepsis [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- CAP, severe sepsis [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- CAP, severe sepsis [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- CAP, time to septic shock [ Time Frame: days ] [ Designated as safety issue: No ]
- CAP, septic shock [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- CAP, septic shock [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- CAP, septic shock [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- Time to severe CAP (ATS and BTS criteria) [ Time Frame: Days ] [ Designated as safety issue: No ]
- Severe CAP (ATS and BTS criteria) [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
- Severe CAP (ATS and BTS criteria) [ Time Frame: Day 7 ] [ Designated as safety issue: No ]
- Severe CAP (ATS and BTS criteria) [ Time Frame: Day 28 ] [ Designated as safety issue: No ]
- CAP, mechanical ventilation [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CAP, time to mechanical ventilation [ Time Frame: Days ] [ Designated as safety issue: No ]
- CAP, length of mechanical ventilation [ Time Frame: Days ] [ Designated as safety issue: No ]
- CAP, SOFA respiratory score > 2 [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CAP, respiratory component of severe sepsis criteria [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CAP, hospitalized [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
- CAP, length of hospitalization [ Time Frame: Days ] [ Designated as safety issue: No ]
- CAP, ICU admission [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CAP, length of ICU stay [ Time Frame: Days ] [ Designated as safety issue: No ]
- CAP, Disposition [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CAP, ALI [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CAP, ARDS [ Time Frame: 28 days ] [ Designated as safety issue: No ]
- CAP, time to ARDS [ Time Frame: days ] [ Designated as safety issue: No ]
- CAP, time to ALI [ Time Frame: Days ] [ Designated as safety issue: No ]
- CAP, PORT score [ Time Frame: enrollment ] [ Designated as safety issue: No ]
- CAP, PORT score [ Time Frame: 24 hours ] [ Designated as safety issue: No ]
Biospecimen Retention: Samples With DNA
PaxGene whole blood tubes (RNA and DNA), EDTA plasma, serum (subset), microbiologic isolates
| Estimated Enrollment: | 1200 |
| Study Start Date: | December 2005 |
| Estimated Study Completion Date: | July 2010 |
| Estimated Primary Completion Date: | July 2010 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
|---|
|
1
Emergency department patients with sepsis
|
Show Detailed Description
Eligibility| Ages Eligible for Study: | 6 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Emergency department patients > 6 years of age
Inclusion Criteria:
1. Patient has known or acute infection or suspected infection AND patient must meet at least 2 of the following 4 criteria to be enrolled
- A core temperature of >= 38°C (100.4°F) or <= 36°C (96.8°F)
- Patients > 18 years of age, Heart rate of >= 90 beats/min Patients 13-18 years of age, Heart rate of >= 110 beats/min Patients 6-12 years of age, Heart rate of >= 130 beats/min
- Patients > 18 years of age, Respiratory rate of >= 20 breaths/min Patients 13-18 years of age, Respiratory rate of >= 14 breaths/min Patients 6-12 years of age, Respiratory rate of >= 18 breaths/min OR PaCO2 of <= 32 mm Hg OR Use of Mechanical Ventilation for an acute respiratory process
- Patients > 18 years of age, White cell count >= 12,000/mm3 or <= 4,000/mm3 Patients 13-18 years of age, White cell count >= 11,000/mm3 or <= 4,500/mm3 Patients 6-12 years of age, White cell count >= 13,500/mm3 or <= 4,500/mm3 OR A differential count showing > 10% immature neutrophils
Exclusion Criteria:
- Patient is less than 6 years of age.
- Patient is not expected to survive 28 days because of uncorrectable medical condition (apart from pneumonia or sepsis), such as poorly controlled neoplasm or other end-stage disease, or patient has active DNR order
- Human immunodeficiency virus (HIV) infection with a last known CD4 count of <50 mm3
- Acute presence of a cerebral vascular event, active gastrointestinal hemorrhage, seizure (acute episode), drug overdose, burn injury, trauma
- Patient is pregnant
Contacts and Locations| Contact: Stephen F Kingsmore, MB ChB BAO | 505 995 4466 | sfk@ncgr.org |
| United States, Michigan | |
| Henry Ford Hospital | Recruiting |
| Detroit, Michigan, United States, 48202 | |
| Contact: Emanuel P Rivers, MD 800-436-7936 erivers1@hfhs.org | |
| Principal Investigator: Emanuel P Rivers, MD | |
| Principal Investigator: Ronny Otero, MD | |
| United States, North Carolina | |
| Duke University Medical Center | Recruiting |
| Durham, North Carolina, United States, 27710 | |
| Contact: Vance G Fowler, MD 919-668-2549 Fowle003@mc.duke.edu | |
| Principal Investigator: Vance G Fowler, MD | |
| Principal Investigator: Christopher W Woods, MD | |
| Durham VA Medical Center | Recruiting |
| Durham, North Carolina, United States, 27710 | |
| Contact: Christopher Woods, MD 919-451-9795 woods004@mc.duke.edu | |
| Principal Investigator: Christopher Woods, MD | |
| Principal Investigator: | Stephen F Kingsmore, MB ChB BAO | National Center for Genome Resources |
| Study Director: | Vance Jr G Fowler, MD | Duke University |
| Study Director: | Emanuel P Rivers, MD | Henry Ford Hospital |
| Study Director: | Christopher W Woods, MD | Duke University |
| Study Director: | Ralph G Corey, MD | Duke University |
| Study Director: | Ronny Otero, MD | Henry Ford Hospital |
| Study Director: | Brian W Grinnell, PhD | Eli Lilly and Company |
| Study Director: | Brian T Edmonds, PhD | Eli Lilly and Company |
| Study Director: | Mu Wang, PhD | INCAPS |
| Study Director: | James R Ludwig, PhD | INCAPS |
More Information
Additional Information:
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Stephen F. Kingsmore, President, National Center for Genome Resources |
| ClinicalTrials.gov Identifier: | NCT00258869 History of Changes |
| Other Study ID Numbers: | 0001, U01 AI066569 |
| Study First Received: | November 23, 2005 |
| Last Updated: | November 5, 2010 |
| Health Authority: | United States: Federal Government |
Keywords provided by National Center for Genome Resources:
|
prospective studies biological assay body weights and measures chemistry, analytical microchip analytical procedures spectrum analysis, mass molecular diagnostic techniques microbiological techniques drug administration schedule data collection statistics gene expression profiling sequence analysis human experimentation immunoassay |
Trauma severity indices Glasgow Coma score Outcome assessment mortality computer models decision modeling linear models logistic models immunologic model mathematical model non-linear models early diagnosis diagnosis, computer assisted medical informatics prognosis |
Additional relevant MeSH terms:
|
Pneumonia Sepsis Toxemia Shock, Septic Systemic Inflammatory Response Syndrome Lung Diseases |
Respiratory Tract Diseases Respiratory Tract Infections Infection Inflammation Pathologic Processes Shock |
ClinicalTrials.gov processed this record on May 19, 2013