COOLEY- Study: ACute on ChrOnic Liver FailurE Using the CYtosorb Device
- Conditions
- Acute-On-Chronic Liver FailureSarcopeniaAnticoagulant Adverse ReactionUltrasonography
- Interventions
- Device: CytoSorb
- Registration Number
- NCT06079021
- Lead Sponsor
- University Hospital, Antwerp
- Brief Summary
A Prospective, Single-Center trial, in Patients With Acute on Chronic Liver Failure. Study of Standard Medical Care Plus CytoSorb® Compared to Standard Medical Care Alone in a historical group.
- Detailed Description
The study team wants to investigate the effect of Cytosorb hemoadsorption on the bilirubin level as well as on the ammonia level changes induced by the therapy in patients with Acute on Chronic Liver Failure (ACLF) .
In this group of patients with ACLF grade 2 and 3 the investigators want to determine the prevalence and development of sarcopenia by sequential quadriceps and thenar ultrasound images and by handgrip strength measurement.
The investigators will objectify muscle mass by skeletal muscle ultrasound of quadriceps and thenar muscles in this sickest subgroup of cirrhotic patients. Ultrasound forms a part of the daily clinical routine in ICU. The study team wants to compare both measurements and objectify the evolution to study the reliability and validity of ultrasound to quantify muscles in chronic liver disease and its clinical values. Most of ultrasonographic studies are based on quadriceps exploration, which is more inconvenient and takes more time than exploring the hands because patients need to remove clothes and lie down. The study team also hypothesizes that thenar muscles are less subject to fluid overload than the quadriceps muscles are.
When available, lumbar skeletal muscle indices will be compared by computed tomography or magnetic resonance imaging.
In this group of patients with ACLF, receiving Continuous Renal Replacement Therapy (CRRT) the appropriate choice of anticoagulant remains controversial. The objective of this study is to compare the efficacy and safety of regional citrate anticoagulation (RCA) and Low Molecular Weight Heparin (LMWH) in critically ill ACLF patients requiring CRRT. These two commercially available anticoagulation methods are used in daily practice in the ICU. The first 10 patients will receive anticoagulation with LMWH with monitoring of anti-Xa. The second cohort of patients will receive RCA.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 20
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adult patients (≥ 18 years) admitted to the University Hospital of Antwerp (UZA), Belgium.
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Written informed consent from patient or if not possible due to encephalopathy (> grade 2): legal representative
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acute-on-chronic liver failure (ACLF) grade ≥ 2:
- Acute decompensation event (identifiable trigger)
- Hepatic encephalopathy grade ≥ 2
- Acute kidney injury (AKI) according to Kidney Disease: Improving Global Outcome (KDIGO) criteria stage 3 (≥ 3-fold increase of serum creatinine OR increase of serum creatinine to ≥ 4 mg/dl OR urine output ≤ 0.3 ml/kg/h for ≥ 24 hours OR anuria for ≥ 12 hours)
- Serum bilirubin ≥ 10 mg/dl
- Hemodynamic instability with vasopressor support (norepinephrine > 0.05 mcg/kg/min)
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• known patient will against participation in the study or against the measures applied in the study
- a decision made prior to inclusion to stop further treatment of the patient within the next 24 hours
- no complete remission of malignancy including hepatocellular carcinoma within the past 12 months
- ongoing intermittent or CRRT before study inclusion
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description CytoSorb hemoadsorption CytoSorb Patients with acute on chronic liver failure will receive CytoSorb treatment for 72 hours. The aim is to remove the molecules that drive systemic inflammation.
- Primary Outcome Measures
Name Time Method The impact of CytoSorb on serum bilirubin removal 24 and 72 hours 20 participants with a serum bilirubin of ≥ 10 mg/dl will undergo CytoSorb for 72 hours
Changes in ammonia and severity of hepatic encephalopathy during treatment period 24 and 72 hours The West Haven criteria are used for grading the severity of hepatic encephalopathy, which include 5 grades ranging from minimal (slightly impaired) to grade IV (comatose)
- Secondary Outcome Measures
Name Time Method Ventilation 0, 24 and 72 hours Duration of mechanical ventilation,
Cytosorb filter up to 28 days after enrolment Adverse events attributable to CytoSorb up to 28 days after enrolment
Sarcopenia 0, 24 and 72 hours Prevalence and development of sarcopenia
ACLF (Acute on Chronic Liver Failure) Grading first week Assessment of ACLF grading (minimum 0 - maximum 3; higher score means a worse outcome) during the 72h intervention up to 1 week after diagnosis of ACLF
changes in hemodynamic profile 24 and 72 hours Change in hemodynamic profile (i.e. mean arterial pressure normalized to norepinephrine equivalents) during the 72-h study intervention.
Vasopressors 24 and 72 hours Duration of vasopressor support in days
SOFA Score 0, 72 and 168 hours Changes in Sequential Organ Failure Assessment (SOFA) (minimum 0-maximum 24; higher score means a worse outcome) score during the 72h study period and up to 1 week after.
scores 15 days Changes in CLIF-C (Chronic Liver Failure Consortium)(minimu 0 - maximum 100; higher score means a worse outcome) score during the 72-h intervention, up to 15 days after diagnosis of ACLF
Cytokines 0, 24 and 72 hours Changes in cytokines (IL-6, IL-8, IL-16, TNF (tumor necrosis factor)-alpha) value (pg/ml)
Mortality 28, 60 and 90 days after enrolment Mortality at 28, 60 and 90 days after enrolment
Improvement of Renal function after application of CytoSorb 7, 14, 21 and 90 days after enrolment Acute kidney injury (AKI) according to Kidney Disease: Improving Global Outcome (KDIGO) criteria stage 3 (≥ 3-fold increase of serum creatinine OR increase of serum creatinine to ≥ 4 mg/dl OR urine output ≤ 0.3 ml/kg/h for ≥ 24 hours OR anuria for ≥ 12 hours) will receive CytoSorb treatmetn. Serum creatinine will be measured at day 7, 14, 21 and 90 days
Change in Bile acids 72 hours after enrolment Bile acids after 72 hours
Change in inflammatory values: procalcitonin Day 0, Day 1 and Day 3 measurement of procalcitonin (reference \< 0.5 ng/mL)
Change in inflammatory values: lactate Day 0, Day 1 and Day 3 measurement of lactate (reference \< 2 mmol/L)
Anticoagulation 0, 24 and 72 hours Adverse events attributable to anticoagulation
SAPS II score Day 0, Day 3, Day 7 Simplified Acute Physiology Score II (SAPS II) (minimum 0 - maximum 163; higher score means a worse outcome) during the 72-h study intervention and up to 1 week after
Trial Locations
- Locations (1)
UZA
🇧🇪Edegem, Antwerp, Belgium