Early Identification of SEPsis SIGNs in Emergency Department
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- BioMérieux
- 入组人数
- 815
- 试验地点
- 12
- 主要终点
- number of patients with deterioration within 72-hour period following T0 (enrollment)
研究概览
简要总结
Objective of SepSIGN project is to validate biomarkers able to predict the clinical worsening of patients freshly admitted at Emergency Department. Targeted population is adult patients, freshly admitted at ED, with a suspected or confirmed infection.
详细描述
Sepsis is an important health issue with considerable socio-economic consequences. In 2017, the World Health Association made sepsis a global health priority, and has adopted a resolution to improve the prevention, diagnosis, and management of sepsis.
Over the last decade, a decrease in the mortality rate has been observed; in particular thanks to improved management, more appropriate intervention approaches in the Emergency Department (ED) and better recognition of organ failure. This statement is based on qSOFA and SOFA scores from the international Sepsis-3 definition. Sepsis-3 can help front-line clinicians detect severe patients with a higher risk of mortality but does not predict the clinical deterioration especially in patients without initial organ dysfunction. Furthermore, studies still demonstrate that 20% of patients with infection or uncomplicated sepsis experience disease worsening within 72 hours after ED admission.
Symptoms and signs of sepsis are variable and this makes clinical recognition and assessment very difficult in particular on Emergency Department (ED) patients due to their infectious illness background and the frequent comorbidities.
Unfortunately, as of today, no biological marker has yet been validated to appropriately predict early deterioration in unselected patients admitted to the ED with acute infection, irrespective of their clinical presentation. Physiology of sepsis is complex and some underlying dysfunction could already exist in the early phase of sepsis before patients meet diagnostic criteria. Thus, patients may be clinically asymptomatic at the origin of organ failure. As a result, doubtful patients are often over-hospitalized while they could be treated at home, leading to overcrowding and extra costs for hospitals In these conditions, the main challenge of ED clinicians is differentiating mild infections from life-threatening ones in the heavy workload of ED environment. Objective of SepSIGN project is to validate biomarkers able to predict the clinical worsening of patients freshly admitted at Emergency Department. Targeted population is adult patients freshly admitted at ED, whom blood samples will serve to validate candidate markers.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All of the following criteria:
- •Delay between ED presentation and inclusion must not exceed 12h
- •Age 18 years or greater
- •Acute infection suspected or confirmed
- •That fulfills at least two of the following systemic inflammatory response syndrome (SIRS) criteria:
- •Temperature > 38°C (100.4°F) or < 36°C (96.8°F)
- •Heart rate > 90 bpm
- •Respiratory rate > 20 cycles/min or PaCO2 < 32 mmHg
- •Leukocyte > 12000/mm3 or < 4000/mm3 or 10% bands
- •With a delta SOFA < 2 from baseline
- •At Risk for deterioration defined as:
- •any patient that the emergency department physician has admitted or intends to admit as an inpatient* to the hospital.
- •patients discharged home (outpatient**) who are either i) >65 years old or ii) diagnosed with pneumonia
排除标准
- •Unable to obtain a valid and written consent from a patient or their legally authorized representative in accordance with the local regulatory instances (this include in FR: Person not affiliated to a health insurance scheme, or not a beneficiary of such a scheme. Persons who are the subject of a legal protection order. Person with restricted freedom following a legal or administrative decision and a person admitted without their consent pursuant to Articles L.3212-1 and 3213-1, which are not included in Article L.1122-8 of the French Public Health Code.)
- •Known pregnancy, in labor or breastfeeding
- •Patients with isolated uncomplicated pharyngitis, sinusitis, or otitis media
- •Infectious symptoms present for > 5 days prior to presentation
结局指标
主要结局
number of patients with deterioration within 72-hour period following T0 (enrollment)
时间窗: Up to 72 hours after admission
clinical deterioration of a patient at any time during the 72-hour period following T0 (enrollment), which is defined as any of the following: * increase of SOFA score ≥ 2 points * need of new organ support (respiratory, circulatory, renal) * death An Endpoint Adjudication Committee (EAC) composed of acute care specialists will apply these criteria. This EAC will also confirm /exclude the presence of infection at T0 (enrollment) based on all information available in eCRF.
次要结局
- number of patients with confirmed bacterial and viral infection(Up to 28 days after admission)
- Number of patients with Early and late mortality(Up to 28 days after admission)
- Number of Participants that have been re-admission(Up to 28 days after admission)