SAPFIRE: Sepsis-Associated Purpura Fulminans International Registry - Europe
Study Details
Study Description
Brief Summary
Sepsis-associated Purpura fulminans (SAPF) is a rare life-threatening condition. It is characterized by multiple skin lesions which rapidly progress to necrosis and gangrene. SAPF is a manifestation of widespread clot formation in small blood vessels which emerges secondarily to severe bacterial and viral infections. The clinical presentation of SAPF is dominated by symptoms of severe sepsis and multiple organ failure which are further aggravated by the massive skin lesions.
At present, there are no evidence-based guidelines for the medical management of SAPF. With numerous therapeutic approaches in use, there are no consistent comparisons of their efficacy. Altered role of causal pathogens following the introduction of meningococcal and pneumococcal prophylactic vaccines also remains to be investigated.
The goal of the registry is comprehensive collection and evaluation of information concerning the epidemiology, morbidity, therapy and outcome of SAPF.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Purpura fulminans is the clinical manifestation of disseminated thrombosis in dermal and systemic microcirculation. This rare disease is frequently associated with multiple organ failure and represents a life-threatening condition with mortality exceeding 50 %. In the vast proportion of cases, the condition has been shown to emerge secondary to acquired Protein C deficiency associated with severe sepsis, mostly of meningococcal or pneumococcal origin.
A consistent therapeutic approach to sepsis-associated Purpura fulminans (SAPF) has not been established yet. With exaggerated pro-coagulant activity being confirmed as the key pathogenic aspect, several treatment modalities aiming at the balance restoration in the coagulation cascade have been considered.
SAPF causality might have been substantially altered in the wake of widespread meningococcal and pneumococcal vaccination. There are neither evidence-based treatment guidelines nor comparative evaluation of the efficacy of different therapeutic approaches.
The present registry aims at a) large-scale data accumulation and comprehensive evaluation of the incidence, causality and current treatment strategies of SAPF, b) comparative assessment of treatment strategies including or not including protein C supplementation c) identification of patient subgroups of particular eligibility for Protein C treatment, as judged by established criteria of disease severity assessment, d) feedback of aggregated data to registry contributors, thus permitting quality management and standard updates, e) dissemination of data evaluation summaries and recommendations for the use of Protein C formulations in clinical routine, f) elaboration of a framework for SAPF treatment recommendations and guidelines.
The registry comprises prospective, multicentric open-label data collection on the current state of incidence and management of SAPF, regardless of the etiopathogenic background. It will include comprehensive records on diagnosis, morbidity and management of SAPF, supplied in the form of electronic case report forms (eCRFs) by the participating centers over a period of three years.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Purpura fulminans Patients diagnosed with Purpura fulminans in association with sepsis |
Outcome Measures
Primary Outcome Measures
- Mortality [during hospital stay (estimated up to 3 months)]
All-cause in-hospital mortality assessed at day 1, day 3, day 5, and day 7, ICU and hospital discharge
Secondary Outcome Measures
- Morbidity [7 days]
Changes in signs of organ dysfunction - sequential organ failure assessment score (SOFA), or paediatric logistic organ dysfunction scores (PELOD), at inclusion, day 1, day 3, day 5, and day 7
- Extent and severity of Purpura fulminans lesions [7 days]
Pictorial registration of localization (body parts) and severity (4 grades) of cutaneous lesions at intervals at inclusion, day 1, day 3, day 5, and day 7
- Purpura fulminans related surgery [during hospital stay (estimated up to 3 months)]
Surgical interventions for irreversible purpura damage (debridement, fasciotomy, amputations)
- Invasive pathogen [during hospital stay (estimated up to 3 months)]
Phenotyping of the microbial pathogen and definition of its antibiotic resistance, at hospital discharge
- Site of primary infection [during hospital stay (estimated up to 3 months)]
Organ/system primarily affected by microbial infection, at hospital discharge
- Duration of ICU stay [during ICU stay (estimated up to 3 months)]
Duration of hospitalization in an ICU
- Duration of hospital stay [during hospital stay (estimated up to 3 months)]
Duration of hospitalization in an ICU
- Laboratory indices of organ dysfunction [7 days]
Plasma levels of glucose, lactate and creatine kinase inclusion, day 1, day 3, day 5, and day 7
- Inflammatory parameters [7 days]
Plasma concentrations of C-reactive protein, procalcitonin and interleukin-6 inclusion, day 1, day 3, day 5, and day 7
- Coagulation parameters [7 days]
Recording of plasma concentrations of prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimers, thrombin-antithrombin complex, protein C activity, antithrombin III activity inclusion, day 1, day 3, day 5, and day 7
- Hematological parameters [7 days]
Recording of white blood cell count (WBC) counts, platelet counts and hemoglobin levels at inclusion, day 1, day 3, day 5, and day 7
- Adverse drug reactions [during hospital stay (estimated up to 3 months)]
Adverse Drug Reaction related to specific PF treatment (administration of anticoagulants/blood products) at hospital discharge
Other Outcome Measures
- Antimicrobial therapy [during ICU stay (estimated up to 3 months)]
Recording of type, dosis and duration of antibiotic use at inclusion, day 1, day 3, day 5, day 7, and ICU discharge
- Vasopressors [during ICU stay (estimated up to 3 months)]
Cumulative doses of vasopressor drugs at inclusion, day 1, day 3, day 5, day 7, and at ICU discharge
- Blood products [during ICU stay (estimated up to 3 months)]
Type and cumulative dose of blood products used (RBC, platelets), at day 1, day 3, day 5, day 7, and at ICU discharge
- Anticoagulant treatment [during ICU stay (estimated up to 3 months)]
Type and cumulative dose of anticoagulant therapy at inclusion, day 1, day 3, day 5, and day , and ICU discharge
- Adjunctive therapy [7 days]
Type and cumulative doses of supportive therapy (corticoids, immunoglobulins, plasmapheresis, hemofiltration etc.)
- Duration of mechanical ventilation [during ICU stay (estimated up to 3 months)]
Overall duration of use of mechanical ventilation (hours)
- Need of renal replacement therapy [during ICU stay (estimated up to 3 months)]
Type and duration (hours) of renal replacement therapy at day 1, day 3, day 5, and day 7, and ICU discharge
- ECMO or other circulatory support systems [during ICU stay (estimated up to 3 months)]
Use of ECMO or other circulatory support Systems, day 1, day 3, day 5, and day 7, and ICU discharge
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Diagnosis of sepsis and Purpura fulminans
-
Signed informed consent
Exclusion Criteria:
- Premature neonates (below gestational age of 36 weeks)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University Hospital Jena, Klinik für Anästhesiologie und Intensivmedizin | Jena | Germany | ||
| 2 | University Hospital Jena, Klinik für Kinder- und Jugendmedizin | Jena | Germany | ||
| 3 | Klinikum der Universität München | Munich | Germany | 80337 |
Sponsors and Collaborators
- Jena University Hospital
- Ludwig-Maximilians - University of Munich
- Medical University of Vienna
- University Hospital Tuebingen
- University Hospital of Cologne
- University Hospital, Essen
- University Hospital Inselspital, Berne
- Hannover Medical School
- University Hospital, Basel, Switzerland
- Evangelisches Krankenhaus Bielefeld gGmbH
- Universitätsklinikum Hamburg-Eppendorf
Investigators
- Study Chair: Frank M Brunkhorst, MD, Center for Clinical Studies, Jena University Hospital
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- ZKSJ0065