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Vitamin D in Ventilated ICU Patients (R21 HL-110044)

This study has been completed.
Sponsor:
Collaborator:
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
Greg S. Martin, M.D., M.Sc., Emory University
ClinicalTrials.gov Identifier:
NCT01372995
First received: June 13, 2011
Last updated: November 10, 2016
Last verified: November 2016
  Purpose

The increasing rate of hospital-acquired infection and antibiotic resistance are major causes of prolonged ICU stay and death in hospitalized patients. The enormous impact of ICU-related infection demands the need for cost-effective therapies that can be rapidly implemented to improve patient immune response to control infection. Unfortunately, little high-quality comparative effectiveness research has been performed on micronutrient treatment regimens as methods to decrease hospital-acquired infection in critically ill patients. Critically ill medical and surgical patients have an extremely high prevalence of vitamin D insufficiency.

We will perform a rigorous, double-blind, randomized, controlled, pilot clinical trial in ventilator-dependent ICU patients to test the clinical/metabolic safety and efficacy of two doses of oral high-dose vitamin D3 therapy versus standard therapy (no supplemental vitamin D). The primary endpoint is to test whether high-dose regimens [either 50,000 or 100,000 international units (IU) of enteral vitamin D3 given daily for 5 consecutive days (total dose = 250,000 or 500,000 IU, respectively) increase plasma 25(OH)D concentrations into a desirable range (> 30 ng/mL).


Condition Intervention Phase
Respiratory Failure Drug: Enteral Vitamin D3 50,000 IU Drug: Enteral Vitamin D3 100,000IU Other: Inactive substance Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: High-Dose Vitamin D and Antimicrobial Peptide Expression in Lung Failure

Resource links provided by NLM:


Further study details as provided by Greg S. Martin, M.D., M.Sc., Emory University:

Primary Outcome Measures:
  • Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Baseline [ Time Frame: Baseline ]
    The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the baseline measurement.

  • Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 7 [ Time Frame: Day 7 ]
    The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 7 measurement.

  • Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 14 [ Time Frame: Day 14 ]
    The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 14 measurement.

  • Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 21 [ Time Frame: Day 21 ]
    The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 21 measurement.

  • Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 28 [ Time Frame: Day 28 ]
    The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 28 measurement.

  • Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 84 [ Time Frame: Day 84 ]
    The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 84 measurement.


Secondary Outcome Measures:
  • Change in Plasma LL-37 Levels [ Time Frame: Baseline, Day 7, Day 14 ]
    Plasma LL-37 was measured at Baseline, Day 7 and Day 14.

  • Duration of Time on Ventilator [ Time Frame: 12 weeks ]
    The number of days spent on mechanical ventilation was collected for all study participants and the average number of days for each study arm is reported.

  • Duration of Time in Intensive Care Unit (ICU) [ Time Frame: 12 weeks ]
    The number of days spent in the intensive care unit (ICU) was collected for each participant and the average number of days for each study arm is reported.

  • Duration of Time in Hospital [ Time Frame: 12 weeks ]
    The number of days that each participant spent in the hospital was collected and the average number of days for each study arm is reported.

  • Change in Sequential Organ Failure Assessment (SOFA) Score [ Time Frame: Baseline, Day 7 ]
    Change in Sequential Organ Failure Assessment (SOFA) score between Baseline and Day 7. The Sequential Organ Failure Assessment (SOFA) score is a mortality prediction score that is based on the degree of dysfunction of 6 organ systems (respiratory, nervous, cardiovascular, liver, coagulation, and kidneys). A score ranges from 0-24. 0 (normal) to 4 (high degree of dysfunction) is given for each organ system, with a higher score indicating greater severity. A score of 0-6 is associated with a mortality rate of less than 10% while a score between 16 and 24 is associated with a greater than 90% mortality rate. Scores decreasing between the Baseline and Day 7 measurements are represented as negative values for the change in SOFA score.

  • Number of Hospital Acquired Infections [ Time Frame: 12 weeks ]
    The number of study participants who had a hospital acquired infection.

  • Number of Hospital Mortality Cases [ Time Frame: 12 weeks ]
    The number of study participants who died while in the hospital was collected.

  • Day 84 Mortality [ Time Frame: Day 84 ]
    The number of participants who died prior to the end of the study (Day 84) was collected.


Enrollment: 31
Study Start Date: July 2011
Study Completion Date: April 2014
Primary Completion Date: April 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Enteral vitamin D3 50,000 IU
An arm where subjects receive 50,000 IU of Vitamin D for 5 days.
Drug: Enteral Vitamin D3 50,000 IU
Enteral Vitamin D3 50,000IU x 5 days (total dose 250,000IU)
Experimental: Enteral Vitamin D3 100,000 IU
Arm where subjects receive 100,000 IU of Vitamin D for 5 days
Drug: Enteral Vitamin D3 100,000IU
Enteral Vitamin D3 100,000IU over 5 days (total 500,000IU)
Placebo Comparator: Inactive Substance
Arm where patients receive inactive substance for 5 days.
Other: Inactive substance
Inactive substance given enterally for 5 days.

Detailed Description:
  1. We will evaluate, over 12 weeks, the safety and efficacy of two high-dose vitamin D3 regimens in severely ill ICU patients. Vitamin D or placebo ( depending on study arm) will be given sequentially in divided doses for 5 days
  2. We will explore whether these vitamin D regimens are capable of increasing the production of key antimicrobial peptides LL-37 and hBD-2 ( substances produced by our bodies to fight infections), in both the blood and in lung.
  3. We will determine whether a higher vitamin D level in the blood is associated with a decrease in hospital infection rates and other complications in high-risk ICU patients with respiratory failure.

Study Design:

Enrollment goal is 36 patients. Once consent is obtained subjects will be randomly assigned to one of three study groups. Each group consists of 12 patients with enteral access ; a placebo arm, an arm where subjects receive 50,000 IU of Vitamin D for 5 days, and a third arm where subjects receive 100,000 IU of Vitamin D for 5 days.

Methods: Baseline blood samples (25-hydroxyvitamin D, vitamin D binding protein, ionized calcium, LL-37,and hBD-2) will be taken on study day 7,14,21,28,84 days. On study day 1 and 8, LL-37, hBD-2, cathelicidin from BAL fluid will also be analyzed. Patients will be given either placebo, Vitamin D3 50,000 IU x 5 days (total 250,000 IU) or Vitamin D3 100,000 IU x 5 days (total 500,000 IU) with an intention to treat model. Baseline data on the patients including demographic, laboratory, documented infections, severity illness score (APACHE II) and organ dysfunction score (SOFA) will be collected. ELISA assay on the serum and BAL will be performed.

  Eligibility

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Receiving care in an intensive care unit (ICU)
  • Age greater than 18 years
  • Expected to require mechanical ventilation for at least 72 hours after entry
  • Expected to survive and remain in the ICU for at least 96 hours after study entry
  • To enable delivery of study drug, the subject has enteral access in place and is deemed able to tolerate enteral drug administration

Exclusion Criteria:

  • Inability to obtain or declined informed consent from the subject and/or legally authorized representative
  • Pregnancy
  • Ongoing shock
  • Current hypercalcemia (albumin-corrected serum calcium > 10.8 mg/dL or ionized calcium > 5.2 mg/dL)
  • History of therapy with high-dose vitamin D to treat vitamin D deficiency within previous 6 months
  • History of disorders associated with hypercalcemia; history of cancer with history of hypercalcemia within the past 1 year, hyperparathyroidism, sarcoidosis, nephrolithiasis]
  • Chronic renal dysfunction requiring chronic dialysis
  • Known history of cirrhosis
  • History of AIDS
  • The patient has received any investigational drug within 60 days prior to study entry.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01372995

Locations
United States, Georgia
Emory University Hospital Midtown
Atlanta, Georgia, United States, 30308
Emory University Hospital
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
National Heart, Lung, and Blood Institute (NHLBI)
Investigators
Principal Investigator: Greg Martin, MD, MSc Emory University
Principal Investigator: Thomas Ziegler, MD Emory University
  More Information

Publications:

Responsible Party: Greg S. Martin, M.D., M.Sc., Associate Professor, Emory University
ClinicalTrials.gov Identifier: NCT01372995     History of Changes
Other Study ID Numbers: IRB00049610
Study First Received: June 13, 2011
Results First Received: July 28, 2016
Last Updated: November 10, 2016

Keywords provided by Greg S. Martin, M.D., M.Sc., Emory University:
critical care
nosocomial infection
antiAntimicrobial peptide expression
LL-37
hBD-2
cathelicidin
microbial peptide

Additional relevant MeSH terms:
Respiratory Insufficiency
Respiration Disorders
Respiratory Tract Diseases
Vitamins
Vitamin D
Ergocalciferols
Cholecalciferol
Micronutrients
Growth Substances
Physiological Effects of Drugs
Bone Density Conservation Agents

ClinicalTrials.gov processed this record on August 17, 2017