Coagulation and Fibrinolysis in Pediatric Insulin Titration Trial (CAF-PINT)
- Conditions
- Heart FailureRespiratory Failure
- Registration Number
- NCT01892969
- Lead Sponsor
- University of California, San Francisco
- Brief Summary
Project Summary We propose an ancillary study to The Heart and Lung Failure Pediatric Insulin Titration trial (HALF PINT), which is investigating the impact of normalizing blood glucose using insulin infusions on clinical outcomes among children with hyperglycemia and heart and lung failure. In this ancillary study, we will measure plasma levels of inflammatory, coagulation, and fibrinolysis proteins and genotype DNA for polymorphisms among patients enrolled in the HALF PINT trial. The results from this ancillary study will help us to understand potential mechanisms through which normalizing blood glucose provides benefit, which may lead to development of new therapeutic strategies in critically ill children
- Detailed Description
ABSTRACT Hyperglycemia occurs frequently among critically ill children and is associated with increased morbidity and mortality. Approximately 25% of critically ill children with heart and lung failure (i.e., those receiving mechanical ventilation and/or inotropes) develop hyperglycemia within 24 hours of admission, and if the hyperglycemia is sustained (lasting for \> 50% of PICU stay), it results in a 6-fold increase in the odds of mortality. Previous studies have demonstrated that tight glycemic control with insulin, aimed at achieving normoglycemia (TGC-NL) can result in improvement in mortality and morbidity in selected groups of critically ill patients with hyperglycemia. However, the precise mechanism by which TGC-NL leads to improvement in morbidity and mortality is not known. Hyperglycemia is known to result in a pro-thrombotic state via activation of coagulation and impairment of fibrinolysis. This pro-thrombotic, anti-fibrinolytic state, may lead to intravascular fibrin deposition and micro thrombi, which can be a key contributor to the pathogenesis of multi-organ failure. We propose to take advantage of The Heart and Lung Failure Pediatric Insulin Titration trial (HALF PINT) - an NHLBI-funded randomized, controlled trial designed to study the impact of TGC-NL on clinical outcomes among children with heart and lung failure - to investigate the effect of TGC-NL on inflammation, fibrinolysis, and coagulation and to determine the extent to which improvement in deranged coagulation and fibrinolysis by TGC-NL contributes to improvement in clinical outcomes. We propose to enroll 800 critically ill patients with hyperglycemia and heart and lung failure from the HALF PINT study. Since the parent trial will not collect any blood samples other than for confirmation of blood glucose, we will approach parents or surrogates of children enrolled in the HALF PINT trial and obtain informed consent for participation in this ancillary study. We will collect blood samples (3cc from children 2 years and younger, and 5ml from children 3 years and older) at Days 1, 3, and 5 after randomization. We will measure plasma levels of selected markers of coagulation and fibrinolysis and genotype DNA for polymorphisms in the corresponding genes. We will correlate changes over time in the biomarkers with allocation to treatment arm to test whether the beneficial effects of TGC-NL are achieved via normalization of coagulation and fibrinolysis. We will also genotype for tag SNPs in the corresponding genes and test for association of the plasma and genetic markers with clinical outcomes. The results from this study will provide mechanistic insights into the effect of TGC-NL on clinical outcome and could lead to the use of anti-inflammatory, anti-coagulant or pro-fibrinolytic agents as adjunctive therapies among select groups of critically ill children with hyperglycemia who may not be amenable to tight glucose control or are at higher risk of adverse clinical outcomes from a pro thrombotic environment. Results from this study may lead to identification of protein or genetic markers that will identify critically ill children most likely to benefit from existing anticoagulant therapies such as activated protein C.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 304
All Patients enrolled in the HALF PINT trial
Bleeding Diathesis as manifest by a Most Recent recorded International Normalized ratio (INR) >3
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Biomarkers of Thrombosis and Inflammation (Interleukin 6 (IL6) and Interleukin 8 (IL8) , Plasminogen Activator Inhibitor -1 (PAI-1)) 4 days The researchers will measure IL-6, IL-8 and PAI-1 on patient plasma using a Luminex based multiplex array. All measurements are in pg/mL. The Slope of change in biomarkers from the time of start of insulin infusion to 2 and 4 days after start of insulin infusion will be used as the outcome measure.
- Secondary Outcome Measures
Name Time Method Number of participants with Development of Acute Lung Injury (ALI) 28 days Acute Lung Injury (ALI) measured as hypoxemia with bilateral infiltrates
Trial Locations
- Locations (25)
Children's Healthcare of Atlanta (Emory)
🇺🇸Atlanta, Georgia, United States
Children's Hospital of Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Ann & Robert H. Lurie Children's Hospital of Chicago
🇺🇸Chicago, Illinois, United States
Medical City Children's Dallas
🇺🇸Dallas, Texas, United States
Children's Hospital of Los Angeles
🇺🇸Los Angeles, California, United States
University of Chicago Medicine Comer Children's Hospital
🇺🇸Chicago, Illinois, United States
Children's Hospital of Orange County
🇺🇸Orange, California, United States
University of Louisville Children's Hospital
🇺🇸Louisville, Kentucky, United States
Cincinnati Children's Hospital Medical Center
🇺🇸Cincinnati, Ohio, United States
Children's Hospital and Research Center of Oakland
🇺🇸Oakland, California, United States
Yale - New Haven Children's Hospital
🇺🇸New Haven, Connecticut, United States
Women and Children's Hospital of Buffalo
🇺🇸Buffalo, New York, United States
Indiana University Riley Hospital for Children
🇺🇸Indianapolis, Indiana, United States
C.S. Mott Children's Hospital - Michigan
🇺🇸Ann Arbor, Michigan, United States
Primary Children's Medical Center
🇺🇸Salt Lake City, Utah, United States
Maria Fareri Children's Hospital at Westchester Medical Center
🇺🇸Valhalla, New York, United States
PennState Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Cohen Children's Medical Center of NY/ North Shore LIJ
🇺🇸New Hyde Park, New York, United States
Children's Hospital of Boston
🇺🇸Boston, Massachusetts, United States
Dartmouth Hitchcock Medical Center
🇺🇸Manchester, New Hampshire, United States
Mattel Children's Hospital (UCLA)
🇺🇸Los Angeles, California, United States
Children's Medical Center Dallas
🇺🇸Dallas, Texas, United States
Children's Hospital Colorado - Denver
🇺🇸Aurora, Colorado, United States
Nemours/Alfred I. DuPont Hospital for Children
🇺🇸Wilmington, Delaware, United States
St. Louis Children's Hospital
🇺🇸Saint Louis, Missouri, United States