NOBIS: Clinical Evaluation of Novel Biomarkers in Patients With Septicemia

Sponsor
Medical University of Graz (Other)
Overall Status
Completed
CT.gov ID
NCT01359891
Collaborator
(none)
750
1
129
5.8

Study Details

Study Description

Brief Summary

The protein ST2 is a member of the interleukin-1 receptor family. Blood concentrations of the soluble isoform of ST2 (sST2) are increased in inflammatory and heart diseases and are considered a prognostic marker in both. The Presage™ST2 assay was recently shown to meet the needs of quality specifications of laboratory medicine. Soluble urokinase plasminogen activator receptor (suPAR) levels reflect inflammation and elevated suPAR levels are found in several infectious diseases and cancer. Both sST2 and suPAR have recently been introduced as sensitive biomarkers for patients with septicemia. Both may be promising or even superior alternatives to currently established sepsis markers leading to an improvement of outcome in patients with septicemia. However, a clinical study which clarifies kinetics of values over time/possible correlation with causative pathogen/progress/deterioration of septic patients is urgently needed before these biomarkers can be established in clinical routine.

Primary study objectives To clinically evaluate sST2 and suPAR in patients with bacteremia /septicemia. To correlate results with causative bacterial organisms, response to or failure of antiinfective treatment, severity of clinical status as well as outcome.

To study the kinetics of the test results and to correlate the sST2/suPAR results with other well established infection markers (e.g. C-reactive protein, procalcitonin, blood counts).

Natural endpoints of the study will be patient's death or complete recovery.

This is an explorative study. To meet the objectives both novel biomarkers will be clinically evaluated in a cohort of 500 in-patients with septicemia at the University Hospital Graz. Starting the day a patient's blood culture turned positive the investigators will collect samples every 12h within the first two days and then every 24h.Measurement of sST2 and suPAR values will be done retrospectively. To analyze clinical sensitivity/specificity of the novel biomarkers sST2 and suPAR as prognostic factors for development of bacteremia/septicemia, a second cohort consisting of 250 in-patients will be investigated in a longitudinal matter. Patients without a previous positive blood culture test during the current episode of disease for which blood cultures are ordered by a physician will be included and sST2 and suPAR levels will be determined from samples taken simultaneously with this first blood cultures.

Condition or Disease Intervention/Treatment Phase

    Detailed Description

    The two most common causative pathogens of septicemia (Escherichia coli and Staphylococcus aureus) as well as cases of fungemia (Candida spp., Aspergillus spp., and others) will be included in the first study group. At our hospital the estimated yearly cases of bacteremia/fungemia (230 for Escherichia coli, 150 for Staphylococcus aureus, and 50 for fungi) will be included in the first study group. Furthermore, the two biomarkers will be determined in 70 cases of septicemia with other bacterial pathogens and sepsis due to viral pathogens or viremia for evaluation of further clinical impact of these two biomarkers.

    Study Design

    Study Type:
    Observational
    Actual Enrollment :
    750 participants
    Observational Model:
    Cohort
    Time Perspective:
    Prospective
    Official Title:
    Clinical Evaluation of Novel Biomarkers for Diagnosis, Therapy- Monitoring and Prognosis of Outcome in Patients With Septicemia
    Study Start Date :
    Nov 1, 2010
    Actual Primary Completion Date :
    Aug 1, 2021
    Actual Study Completion Date :
    Aug 1, 2021

    Arms and Interventions

    Arm Intervention/Treatment
    Cohort 1

    All patients >18 years admitted to the University Hospital Graz, Austria, with positive blood cultures tested in the Microbiology Laboratory, Department of Internal Medicine, Medical University Graz, or the Institute for Hygiene, Microbiology and Environmental Medicine, Medical University Graz, are screened for study inclusion. Patients eligible for the study have to have Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecium, Enterococcus faecalis, Streptococcus pneumoniae, Klebsiella pneumoniae or medically relevant fungi / viral pathogens identified as causative pathogen. The estimated total number of patients included in this first study cohort will be 500.

    Cohort 2

    All patients >18 years admitted to the University Hospital Graz, Austria, will be screened for study inclusion if the attending emergency department physicians on the very first visit suspects bacteremia/fungemia/sepsis and consecutively orders blood cultures. Patients will be included in this second cohort if these initially taken blood culture turns positive (n=200) or stays negative (n=50) at the Microbiology Laboratory, Department of Internal Medicine, Medical University Graz. As soon as the number of 50 is reached for the control group enrollment will be stopped for this group. As soon as the proposed number of 250 patients is reached enrolment for this second cohort will be stopped. Patients enrolled in cohort 2 may also be consecutively enrolled in cohort 1.

    Validation Cohort

    To verify the employed Presage™ST2 assay established in our study laboratory for its intended use, a total number of 70 left over plasma samples obtained from septic patients which have prior been tested for sST2 with the same assay at the Department of Laboratory Medicine, Barmherzige Brueder Linz, Austria, will be retested. This cohort therefore serves as a validation cohort.

    Outcome Measures

    Primary Outcome Measures

    1. prognostic value of biomarkers in bacteremia [2 years]

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Patients above 18 years
    Exclusion Criteria:
    • Patients < 18 years

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Medical University Hospital of Graz Graz Styria Austria 8036

    Sponsors and Collaborators

    • Medical University of Graz

    Investigators

    • Principal Investigator: Martin Hoenigl, MD, Medical University of Graz
    • Principal Investigator: Robert Krause, MD, Medical University of Graz
    • Principal Investigator: Reinhard R Raggam, MD, Medical University Hospital Graz

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Robert Krause, MD, ao.Univ.Prof.Dr, Medical University of Graz
    ClinicalTrials.gov Identifier:
    NCT01359891
    Other Study ID Numbers:
    • 21-469
    First Posted:
    May 25, 2011
    Last Update Posted:
    Sep 1, 2021
    Last Verified:
    Aug 1, 2021
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Sep 1, 2021