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Acetaminophen for the Reduction of Oxidative Injury in Severe Sepsis (ACROSS)

This study has been completed.
Information provided by (Responsible Party):
David Janz, Vanderbilt University Identifier:
First received: November 26, 2012
Last updated: March 19, 2015
Last verified: March 2015

Cell-free hemoglobin can be measured in the plasma of patients with sickle cell anemia, hemodialysis, after red blood cell transfusion, and in patients with sepsis. Cell-free hemoglobin in these patient population has been associated with poor outcomes, including an association with an increased risk of death. Acetaminophen may have a protective effect in these patient populations by inhibiting hemoprotein-mediated lipid peroxidation. The purpose of the present trial is to study the effect of acetaminophen on lipid peroxidation in adults with severe sepsis and detectable cell-free hemoglobin.

The primary hypothesis is that systemic markers of oxidative stress and lipid peroxidation, as measured by F2-isoprostanes, will be significantly lower in patients with severe sepsis and detectable cell-free hemoglobin who receive acetaminophen compared to placebo. The secondary hypothesis is that patients with severe sepsis and detectable cell-free hemoglobin treated with acetaminophen will have better clinical outcomes, including decreased incidence of acute kidney injury and lower rates of hospital mortality, compared to those who receive placebo.

Condition Intervention Phase
Severe Sepsis Drug: Acetaminophen Drug: placebo 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: Phase IIa Randomized Controlled Trial of Acetaminophen for the Reduction of Oxidative Stress in Severe Sepsis

Resource links provided by NLM:

Further study details as provided by David Janz, Vanderbilt University:

Primary Outcome Measures:
  • F2-isoprostanes After 72 Hours of Acetaminophen or Placebo [ Time Frame: 72 hours after randomization ]
    F2-isoprostanes are a marker of oxidative stress, specifically lipid peroxidation.

Secondary Outcome Measures:
  • In-hospital Mortality [ Time Frame: Patients will be followed through the end of their hospital stay, an average of 5 weeks ]
  • Serum Creatinine After 72 Hours of Treatment With Acetaminophen or Placebo, Adjusted for Baseline Creatinine [ Time Frame: 72 hours ]

Enrollment: 44
Study Start Date: April 2013
Study Completion Date: December 2013
Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Acetaminophen
Patients will receive acetaminophen at the dose of 1 gram by mouth or by enteral feeding tube every six hours for a total of 72 hours.
Drug: Acetaminophen
Placebo Comparator: Placebo
Patients will receive placebo by mouth or by enteral feeding tube every six hours for 72 hours.
Drug: placebo


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

Inclusion Criteria:

  • Males and Female >=18 years old
  • Admitted to an Intensive Care Unit
  • Severe Sepsis
  • Detectable plasma cell-free hemoglobin

Exclusion Criteria:

  • patients who received acetaminophen in the past 48 hours prior to enrollment
  • intolerance or allergy to acetaminophen
  • measured AST/ALT >400 U/L in the 24 hours prior to enrollment
  • chronic liver disease defined by a Child-Pugh score >4
  • cannot swallow or have no enteral feeding access
  • patients with no detectable cell-free hemoglobin
  • patients transitioned to palliative care
  • pregnant patients or women of childbearing potential without a documented pregnancy test
  Contacts and Locations
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Please refer to this study by its identifier: NCT01739361

United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States, 37232
Sponsors and Collaborators
Vanderbilt University
  More Information

Responsible Party: David Janz, Principal Investigator, Vanderbilt University Identifier: NCT01739361     History of Changes
Other Study ID Numbers: APAP-121486
Study First Received: November 26, 2012
Results First Received: March 11, 2015
Last Updated: March 19, 2015

Additional relevant MeSH terms:
Systemic Inflammatory Response Syndrome
Pathologic Processes
Analgesics, Non-Narcotic
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Antipyretics processed this record on September 21, 2017