" Étude Des altérations du système rénine-angiotensine-aldostérone au Cours du Choc Septique " Alterations of the Renin-angiotensin-aldosterone System in sEptic Shock
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 320
- 主要终点
- To determine the incidence of relative angiotensin II deficiency during septic shock
研究概览
简要总结
Septic shock is a common and life-threatening condition associated with an in-hospital mortality rate exceeding 40%. The symptomatic management of septic shock relies primarily on vasopressor therapy, particularly norepinephrine. However, the use of high doses of norepinephrine may lead to adverse effects, prompting the search for alternative therapeutic strategies, including angiotensin II, which has recently been investigated as an adjunctive vasopressor.
Indeed, alterations of the renin-angiotensin-aldosterone system (RAAS), particularly a relative deficiency of angiotensin II, have been hypothesized to occur during septic shock. However, to date, no human study has used gold-standard techniques for measuring RAAS peptides to confirm this hypothesis.
Furthermore, it remains unclear whether these alterations are specific to septic shock or may also be observed in less severe infections (sepsis) or in other forms of circulatory failure, such as cardiogenic shock.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Basic Science
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Adult patients with septic shock:
- •Proven or suspected infection.
- •Persistent arterial hypotension requiring norepinephrine administration to maintain a mean arterial pressure above 65 mmHg despite adequate fluid resuscitation.
- •Hyperlactatemia > 2 mmol/L.
- •Adult critically ill control patients with sepsis without circulatory failure:
- •Proven or suspected infection.
- •Absence of persistent arterial hypotension requiring norepinephrine administration to maintain a mean arterial pressure above 65 mmHg.
- •An increase of at least 2 points in the SOFA score attributable to infection.
- •Adult critically ill control patients with cardiogenic shock:
- •Acute cardiac disease, such as myocardial infarction.
- •Persistent arterial hypotension requiring norepinephrine administration to maintain a mean arterial pressure above 65 mmHg despite adequate fluid resuscitation.
- •Low cardiac output: cardiac index < 2.2 L/min/m² or the need for inotropic support (including norepinephrine) to maintain a cardiac index > 2.2 L/min/m².
- •Elevated left ventricular filling pressures, measured invasively or estimated by echocardiography.
- •Hyperlactatemia > 2 mmol/L.
- •Adult healthy volunteers:
- •Absence of active or chronic disease.
- •Absence of long-term medication use.
- •No surgery or medication intake within the previous month.
- •Absence of ongoing pregnancy.
- •Non-smoker.
排除标准
- •Patients deprived of liberty by judicial or administrative decision.
- •Patients admitted to the intensive care unit for more than 48 hours.
- •Patients previously enrolled in an interventional study with overlapping follow-up.
- •Patients benefiting from State Medical Aid (AME).
研究组 & 干预措施
Patients with septic shock
Blood samples will be collected at 6, 24, and 72 hours after study inclusion
干预措施: Collection of fluid samples (Other)
critically ill control patients
Critically ill control patients, including patients with sepsis without circulatory failure and patients with cardiogenic shock, will undergo blood sampling at 6, 24, and 72 hours.
干预措施: Collection of fluid samples (Other)
healthy volunteer
blood sampling at inclusion
干预措施: Collection of fluid samples (Other)
结局指标
主要结局
To determine the incidence of relative angiotensin II deficiency during septic shock
时间窗: From enrollment to 72 hours
The incidence of relative angiotensin II deficiency at the different study time points (6, 24, and 72 hours), defined as a circulating angiotensin II concentration below or equal to the 95th percentile of healthy subjects in the presence of arterial hypotension (mean arterial pressure \< 65 mmHg) or the need for vasopressor support to maintain a mean arterial pressure \> 65 mmHg. This definition is similar to that used in previous studies to define relative vasopressin deficiency during septic shock.
次要结局
未报告次要终点