CortiCORONA: Biomarkers for Dexamethasone Response in Sars-Cov-2 / COVID-19 Pneumonia
Study Details
Study Description
Brief Summary
The primary objective of this study is to demonstrate (at the time of admission) biomarkers of interest (Human Plasma BAK125 panel + interferon panel) for dexamethasone responders versus non-responders in SARS-CoV-2 hypoxemic pneumonia.
The secondary objectives are to describe and compare between groups:
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The number of days without mechanical ventilation
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The need for mechanical ventilation
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28-day mortality
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Progression towards acute respiratory distress syndrome (ARDS)
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Change in the qSOFA score
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Length of hospitalization
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The change in the extent of lesions on thoracic computed tomography scan between inclusion and D7 (or the day of discharge from hospital if <D7)
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Change in biomarkers on D0, D2, D4, D7 (NFS, liver tests (ASAT, ALAT), Creatinine, Albumin, CRP, D-dimers, Ferritin, LDH, lymphocyte phenotyping)
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Demonstrate other biomarkers of interest from the usual management (NFS, liver function tests (ASAT, ALAT), Creatinine, Albumin, CRP, D-dimers, Ferritin, LDH, lymphocyte phenotyping)
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Change in biomarkers evaluated by mass spectrometry (on a blood sample) on D0 and D7 +/- 2 days
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The initial viral load (within 48 hours preceding D0) and at D7 of inclusion estimated from the nasopharyngeal SARS-CoV-2 RT-PCR
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Initial SARS-CoV-2 serology and on D7 from inclusion
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The A38G polymorphism of the gene coding for Club Cell Secretory Protein (CCSP) for each patient
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Short-term complications related to corticosteroid therapy
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The quantitative and qualitative impact of corticosteroid therapy on lymphocytes from patients with COVID-19.
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
This is a prospective multicenter cohort of patients treated with the usual standard of care including systemic corticosteroid therapy with dexamethasone 6 mg / day.
INCLUSION (D0): The patients are examined on the day of their hospital admission. After an initial eligibility check and if interest is expressed by the patient, a specific inclusion visit is carried out.
FOLLOW-UP: Patients are clinically evaluated at least twice a day (Clinical examination, SpO2, vital signs) during hospitalization. Chest computed tomography and SARS-CoV-2 serology are performed on D0. Viral load is evaluated by the polymerase chain reaction which allowed the diagnosis of covid-19 in the 48 hours preceding D0 and on D7. The evaluation of conventional biomarkers of interest (blood count, hepatic assessment (ASAT, ALAT), serum creatinine, albuminemia, CRP, D-Dimers, LDH, Ferritin) are carried out on D0 (before the 1st dose of corticosteroids), D2 , J4 and J7. The evaluation of biomarkers of interest evaluated by mass spectrometry is carried out on D0 and D7 +/- 2 days.
A follow-up call on D28 is carried out (telephone call, collection of vital status and hospitalizations).
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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The study population The study population corresponds to patients hospitalized for proven SARS-COV-2 pneumonia with an indication (hypoxemia) for dexamethasone (see eligibility criteria) |
Outcome Measures
Primary Outcome Measures
- Treatment failure (yes/no) [Hospital discharge (expected maximum of 28 days)]
Treatment failure is defined as the need to transfer the patient to intensive care for mechanical ventilation.
Secondary Outcome Measures
- Human Plasma BAK-125 proteomics profile [Baseline (day 0)]
PeptiQuantTM Plus, Human Plasma BAK 125, Cambridge Isotope Laboratories, Inc
- Human Plasma BAK-125 proteomics profile [Day 7]
PeptiQuantTM Plus, Human Plasma BAK 125, Cambridge Isotope Laboratories, Inc
- Circulating blood interferon level [Baseline (day 0)]
- Circulating blood interferon level [Day 7]
- A vector of repeated measures of SpO2 [Throughout initial hospitalization (expected maximum of 28 days)]
Measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of FiO2 [Throughout initial hospitalization (expected maximum of 28 days)]
Measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of temperature (°C) [Throughout initial hospitalization (expected maximum of 28 days)]
Measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of respiratory rate (cycles per minute) [Throughout initial hospitalization (expected maximum of 28 days)]
Measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of pulse (bpm) [Throughout initial hospitalization (expected maximum of 28 days)]
Measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of systolic blood pressure (mmHg) [Throughout initial hospitalization (expected maximum of 28 days)]
Measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of diastolic blood pressure (mmHg) [Throughout initial hospitalization (expected maximum of 28 days)]
Measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of capillary glycemia (g/L) [Throughout initial hospitalization (expected maximum of 28 days)]
Capillary glycemia will be measured at least twice per day throughout the initial hospitalization period.
- A vector of repeated measures of the qSOFA score [Throughout initial hospitalization (expected maximum of 28 days)]
The Quick Sequential Organ Failure Assessment (qSOFA) score will be assessed at least twice per day throughout the initial hospitalization period. The quick Sepsis-related organ failure assessment (qSOFA) score ranges from 0 to 3 points, with '3' indicating the worst health state. It uses three criteria, assigning one point for low blood pressure (systolic blood pressure ≤100 mmHg), high respiratory rate (≥22 breaths per min), or altered mentation.
- Hemoglobin [Baseline (day 0)]
- Hemoglobin [Day 2]
- Hemoglobin [Day 4]
- Hemoglobin [Day 7 (or day of discharge if before day 7)]
- Platelet count [Baseline (day 0)]
- Platelet count [Day 2]
- Platelet count [Day 4]
- Platelet count [Day 7 (or day of discharge if before day 7)]
- White blood cell count [Baseline (day 0)]
- White blood cell count [Day 2]
- White blood cell count [Day 4]
- White blood cell count [Day 7 (or day of discharge if before day 7)]
- Neutrophil percentage [Baseline (day 0)]
- Neutrophil percentage [Day 2]
- Neutrophil percentage [Day 4]
- Neutrophil percentage [Day 7 (or day of discharge if before day 7)]
- Eosinophil percentage [Baseline (day 0)]
- Eosinophil percentage [Day 2]
- Eosinophil percentage [Day 4]
- Eosinophil percentage [Day 7 (or day of discharge if before day 7)]
- Basophil percentage [Baseline (day 0)]
- Basophil percentage [Day 2]
- Basophil percentage [Day 4]
- Basophil percentage [Day 7 (or day of discharge if before day 7)]
- Lymphocyte percentage [Baseline (day 0)]
- Lymphocyte percentage [Day 2]
- Lymphocyte percentage [Day 4]
- Lymphocyte percentage [Day 7 (or day of discharge if before day 7)]
- Monocyte percentage [Baseline (day 0)]
- Monocyte percentage [Day 2]
- Monocyte percentage [Day 4]
- Monocyte percentage [Day 7 (or day of discharge if before day 7)]
- Prothrombin rate (%) [Baseline (day 0)]
- Prothrombin rate (%) [Day 2]
- Prothrombin rate (%) [Day 4]
- Prothrombin rate (%) [Day 7 (or day of discharge if before day 7)]
- Activated partial thromboplastin time ratio [Baseline (Day 0)]
- Activated partial thromboplastin time ratio [Day 2]
- Activated partial thromboplastin time ratio [Day 4]
- Activated partial thromboplastin time ratio [Day 7 (or day of discharge if before day 7)]
- Fibrinogen (g/L) [Baseline (Day 0)]
- Fibrinogen (g/L) [Day 2]
- Fibrinogen (g/L) [Day 4]
- Fibrinogen (g/L) [Day 7 (or day of discharge if before day 7)]
- D-Dimers (μg/mL) [Baseline (Day 0)]
- D-Dimers (μg/mL) [Day 2]
- D-Dimers (μg/mL) [Day 4]
- D-Dimers (μg/mL) [Day 7 (or day of discharge if before day 7)]
- Aspartate aminotransferase (ASAT; UI/L) [Baseline (Day 0)]
- Aspartate aminotransferase (ASAT; UI/L) [Day 2]
- Aspartate aminotransferase (ASAT; UI/L) [Day 4]
- Aspartate aminotransferase (ASAT; UI/L) [Day 7 (or day of discharge if before day 7)]
- Alanine aminotransferase (ALAT; UI/L) [Baseline (Day 0)]
- Alanine aminotransferase (ALAT; UI/L) [Day 2]
- Alanine aminotransferase (ALAT; UI/L) [Day 4]
- Alanine aminotransferase (ALAT; UI/L) [Day 7 (or day of discharge if before day 7)]
- Glucose (mmol/L) [Baseline (Day 0)]
- Glucose (mmol/L) [Day 2]
- Glucose (mmol/L) [Day 4]
- Glucose (mmol/L) [Day 7 (or day of discharge if before day 7)]
- Glycated haemoglobin (HbA1c; %) [Baseline (Day 0)]
- Glycated haemoglobin (HbA1c; %) [Day 2]
- Glycated haemoglobin (HbA1c; %) [Day 4]
- Glycated haemoglobin (HbA1c; %) [Day 7 (or day of discharge if before day 7)]
- Urea (mmol/L) [Baseline (Day 0)]
- Urea (mmol/L) [Day 2]
- Urea (mmol/L) [Day 4]
- Urea (mmol/L) [Day 7 (or day of discharge if before day 7)]
- Creatinine (µmol/L) [Baseline (Day 0)]
- Creatinine (µmol/L) [Day 2]
- Creatinine (µmol/L) [Day 4]
- Creatinine (µmol/L) [Day 7 (or day of discharge if before day 7)]
- Estimated glomerular filtration rate (eGFR, ml/min/1.73m^2) [Baseline (Day 0)]
- Estimated glomerular filtration rate (eGFR, ml/min/1.73m^2) [Day 2]
- Estimated glomerular filtration rate (eGFR, ml/min/1.73m^2) [Day 4]
- Estimated glomerular filtration rate (eGFR, ml/min/1.73m^2) [Day 7 (or day of discharge if before day 7)]
- Albumin (g/L) [Baseline (Day 0)]
- Albumin (g/L) [Day 2]
- Albumin (g/L) [Day 4]
- Albumin (g/L) [Day 7 (or day of discharge if before day 7)]
- C reactive protein (CRP, mg/L) [Baseline (Day 0)]
- C reactive protein (CRP, mg/L) [Day 2]
- C reactive protein (CRP, mg/L) [Day 4]
- C reactive protein (CRP, mg/L) [Day 7 (or day of discharge if before day 7)]
- Lactate dehydrogenase (LDH, UI/L) [Baseline (Day 0)]
- Lactate dehydrogenase (LDH, UI/L) [Day 2]
- Lactate dehydrogenase (LDH, UI/L) [Day 4]
- Lactate dehydrogenase (LDH, UI/L) [Day 7 (or day of discharge if before day 7)]
- Hypersensitive troponin T (µg/L) [Baseline (Day 0)]
- Hypersensitive troponin T (µg/L) [Day 2]
- Hypersensitive troponin T (µg/L) [Day 4]
- Hypersensitive troponin T (µg/L) [Day 7 (or day of discharge if before day 7)]
- Ferritin (µg/L) [Baseline (Day 0)]
- Ferritin (µg/L) [Day 2]
- Ferritin (µg/L) [Day 4]
- Ferritin (µg/L) [Day 7 (or day of discharge if before day 7)]
- CD4 cell count [Baseline (Day 0)]
CD4 refers to cluster of differentiation 4.
- CD4 cell count [Day 2]
CD4 refers to cluster of differentiation 4.
- CD4 cell count [Day 4]
CD4 refers to cluster of differentiation 4.
- CD4 cell count [Day 7 (or day of discharge if before day 7)]
CD4 refers to cluster of differentiation 4.
- CD8 cell count [Baseline (Day 0)]
CD8 refers to cluster of differentiation 8.
- CD8 cell count [Day 2]
CD8 refers to cluster of differentiation 8.
- CD8 cell count [Day 4]
CD8 refers to cluster of differentiation 8.
- CD8 cell count [Day 7 (or day of discharge if before day 7)]
CD8 refers to cluster of differentiation 8.
- Natural killer cell count [Baseline (Day 0)]
- Natural killer cell count [Day 2]
- Natural killer cell count [Day 4]
- Natural killer cell count [Day 7 (or day of discharge if before day 7)]
- Activated T cell percentage [Baseline (Day 0)]
- Activated T cell percentage [Day 2]
- Activated T cell percentage [Day 4]
- Activated T cell percentage [Day 7 (or day of discharge if before day 7)]
- Change in SARS-CoV-2 real-time polymerase chain reaction cycle threshold [Baseline to day 7 (or day of discharge if before day 7)]
- Change in SARS-CoV-2 IgG serology (% of control signal = PCS) [Baseline to day 7 (or day of discharge if before day 7)]
- Change in SARS-CoV-2 IgM serology (% of control signal = PCS) [Baseline to day 7 (or day of discharge if before day 7)]
- Change from positivity at baseline to negativity at Day 7: yes/no for SARS-CoV-2 real time polymerase chain reaction [Day 7 (or day of discharge if before day 7)]
- Change from positivity at baseline to negativity at Day 7: yes/no for SARS-CoV-2 IgG serology [Day 7 (or day of discharge if before day 7)]
- Change from positivity at baseline to negativity at Day 7: yes/no for SARS-CoV-2 IgM serology [Day 7 (or day of discharge if before day 7)]
- Reduction in the extent of lesions visualized on computed tomography chest scan: yes/no for grand glass opacities [Day 7 (or day of discharge if before day 7) +- 1 day of leeway for logistics]
A reduction in the extent of lesions is defined by a ⩾20% reduction in parenchymal involvement compared to the initial assessment
- Reduction in the extent of lesions visualized on computed tomography chest scan: yes/no for consolidation [Day 7 (or day of discharge if before day 7) +- 1 day of leeway for logistics]
A reduction in the extent of lesions is defined by a ⩾20% reduction in parenchymal involvement compared to the initial assessment
- Reduction in the extent of lesions visualized on computed tomography chest scan: yes/no for total lesions [Day 7 (or day of discharge if before day 7) +- 1 day of leeway for logistics]
A reduction in the extent of lesions is defined by a ⩾20% reduction in parenchymal involvement compared to the initial assessment
- Requirement for low flow oxygen therapy during the initial hospitalisation: yes/no [Day of hospital discharge (expected maximum of 28 days)]
- Requirement for high flow oxygen therapy during the initial hospitalisation: yes/no [Day of hospital discharge (expected maximum of 28 days)]
- Requirement for non-invasive ventilation during the initial hospitalisation: yes/no [Day of hospital discharge (expected maximum of 28 days)]
- Requirement for invasive ventilation during the initial hospitalisation: yes/no [Day of hospital discharge (expected maximum of 28 days)]
- Requirement for dialysis during the initial hospitalisation: yes/no [Day of hospital discharge (expected maximum of 28 days)]
- Requirement for extracorporeal membrane oxygenation during the initial hospitalisation: yes/no [Day of hospital discharge (expected maximum of 28 days)]
- Classification of acute respiratory distress syndrome (ARDS) according to the Berlin criteria during initial hospitalization: absent, mild, moderate or severe [Day of hospital discharge (expected maximum of 28 days)]
- Length of stay (hours) in intensive care [Day of hospital discharge (expected maximum of 28 days)]
- Length of stay (hours) in hospital [Day of hospital discharge (expected maximum of 28 days)]
- Days alive and without low flow oxygen therapy [Day 28]
- Days alive and without high flow oxygen therapy [Day 28]
- Days alive and without any oxygen therapy [Day 28]
- Days alive and without non-invasive ventilation [Day 28]
- Days alive and without invasive ventilation [Day 28]
- Days alive and without extracorporeal membrane oxygenation [Day 28]
- Days alive and without intensive care [Day 28]
- Days alive and without hospitalisation [Day 28]
- Mortality [Day of hospital discharge (expected maximum of 28 days)]
- Mortality [Day 28]
- Club cell secrectory protein polymorphism A38G [Between day 0 and day 28]
Other Outcome Measures
- Presence/absence of incident hyperglycemia during hospitalization [Day of hospital discharge (expected maximum of 28 days)]
- Presence/absence of secondary infection during hospitalization [Day of hospital discharge (expected maximum of 28 days)]
- Presence/absence of cardiovascular event (ischemic, stroke, other) during hospitalization [Day of hospital discharge (expected maximum of 28 days)]
- Presence/absence of digestive hemorrhage during hospitalization [Day of hospital discharge (expected maximum of 28 days)]
- Presence/absence of neuro-psychiatric event (acute delirium, depressive syndrome, decompensation of an underlying psychiatric pathology) during hospitalization [Day of hospital discharge (expected maximum of 28 days)]
- Adverse events [Day of hospital discharge (expected maximum of 28 days)]
- Adverse events [Day 28]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Hospitalization for SARS-COV-2 pneumonia
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SARS-COV-2 infection proven by polymerase chain reaction (Nasopharyngeal or other respiratory sampling (expectoration, tracheal aspiration, bronchoalveolar lavage fluid)
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Presence of at least one of the following clinical signs of infectious pneumonia: fever (>38°C), cough, dyspnoea, thoracic pain, crackling/rales
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Presence of at least one of the following on a lung computed tomography scan performed within two days of inclusion/randomisation: uni- or bilateral ground glass opacities, consolidations, alveolar condensations, inter- or intra-lobular reticulations, crazy paving
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Indication for dexamethasone corticotherapy (defined by the presence of hypoxemia with room-air SpO2 <94% or a requirement for oxygen therapy to maintain Sp02 >94%)
Exclusion Criteria:
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Systemic long-term anti-inflammatory treatment (corticosteroids or anti-interleukins) for chronic disease
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Systemic corticosteroid treatment in the 15 days preceding the eligibility visit (for disease other than COVID-19)
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Systemic corticosteroid treatment for COVID-19 started more than 48h before the eligibility visit
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Absolute contraindication for systemic corticosteroid treatment
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Aside from the current acute episode, life expectancy of <6 months
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Patient unable to comply with all study procedures (e.g. contraindication for thoracic scans or bloodwork)
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Protected populations according to the French public health code (Pregnant, parturient or lactating women; adults under any form of guardianship; prisoners or persons under any form of judicial protection)
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Potential interference from other studies (Participation in any clinical trial of an investigational agent or procedure within one month prior to screening or during the study; exclusion period determined by another study.)
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It is impossible to correctly inform the patient (e.g. language barrier)
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Absence of free, informed and written consent signed by the participant and the investigator (at the latest on the day of inclusion and before any examination required by the research)
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Non-beneficiary of the French social security, single-payer health insurance system
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Clinique du Parc | Montpellier | France | ||
2 | University Hospitals of Montpellier | Montpellier | France |
Sponsors and Collaborators
- University Hospital, Montpellier
Investigators
- Study Director: Clement Boissin, MD, University Hospital, Montpellier
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- RECHMPL20_0292
- 2020-A0206-33
- PHRCI-20-013