c-easie: Early Administration of Vitamin C in Patients With Sepsis or Septic Shock in Emergency Departments
Study Details
Study Description
Brief Summary
In this clinical trial the effect of early administration of Vitamin C is investigated in patients admitted at the emergency department with sepsis or septic shock.
When a patient has sepsis, his/her body is causing damage to its own tissues and organs as result of an infection. This can lead to septic shock. The patient has a low blood pressure, his/her organs stop working and the patient may even die.
The aim of this trial is to investigate the efficiency of Vitamin C in sepsis and septic shock. Vitamin C is a vitamin present in various foods and has been approved as dietary supplement by the Belgian authorities. Over the years it has been proven that Vitamin C is very safe. In addition, several studies have shown that Vitamin C can also have a protective effect. It can reduce organ damage and increase survival rates. Although several studies suggest that Vitamin C can help fight sepsis, it is not yet used in practice. This Belgian trial, in which several hospitals participate, hopes to provide a clear answer to the question: "Should Vitamin C be administered to patients admitted in an emergency department with sepsis or septic shock?"
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 3 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Placebo Comparator: standard care + placebo The 'standard care' group will receive intermittent infusion of normal saline (3 ampoules of 5 ml 9mg/ml normal saline diluted in 50 ml of normal saline, every 6 hours) during 4 days or until hospital discharge and is started within 6 hours after presentation (time of triage) in the ED. |
Drug: Normal saline
IV
Other Names:
|
Active Comparator: standard care + Vitamin C The 'standard care + Vitamin C' group will receive intermittent infusion of Vitamin C (3 ampoules of 500 mg/5ml Vitamin C diluted in 50 ml of normal saline, every 6 hours) during 4 days or until hospital discharge and is started within 6 hours after presentation (time of triage) in the ED. |
Drug: Vitamin C
IV
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Sequential Organ Failure Assessment (SOFA) score [5 days]
Average post-baseline patient SOFA score, SOFA score range: 0-24, with 24 being the worst outcome (death)
Secondary Outcome Measures
- 28-day mortality [28 days]
- Maximum SOFA score [5 days]
Maximum SOFA score measured during 5 intervention period. SOFA score ranging from 0 to 24, with 24 begin the worst outcome (death)
- Length of hospital stay [3 months]
Total length of hospital stay of the patient (including beyond intervention period)
- Length of ICU stay [3 months]
Total length of ICU stay of the patient (including beyond intervention period)
- Duration Vasopressors [5 days]
Total duration where vasopression is required (hours)
- Dosage Vasopressors [5 days]
Total dosage of Vasopressors required (mcg/kg/min)
- need for Renal Replacement Therapy (RRT) [5 days]
was RRT needed
- duration of Renal Replacement Therapy (RRT) [5 days]
total duration of RRT (hours)
- Ventilator days [3 months]
Total number of days the patient requires ventilator support (including beyond intervention period)
- Steroids [5 days]
Total dose of steroids given
- Quality of life questionnaire (EQ-5D-5L) [3 months]
The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state. The EQ VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'. The VAS can be used as a quantitative measure of health outcome that reflect the patient's own judgement.
- Time to return to work [3 months]
Time to return to work of the patient after ED admission (in days)
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patient has a 'suspected infection': this requires the combination of antibiotic administration and body fluid cultures within the first 6 hours after Emergency Department presentation.
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Patient has a NEWS score ≥ 5.
Exclusion Criteria:
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Patient (≥18 years old) or legally authorized representative didn't provide informed consent. Delayed informed consent can be applied in cases where the patient is critically ill and no LAR is available.
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antibiotic administration as a single dose or as a prophylactic treatment.
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antibiotics administered without an accompanying body fluid culture according to the timeframe (within 6 hours after emergency department presentation).
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'Do no intubate' or 'comfort measures only' status.
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Failure to randomize within 6 hours after Emergency Department presentation.
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Weight < 45 kg.
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Pregnant or breastfeeding.
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Known allergy for Vitamin C.
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Known history of oxalate nephropathy or hyperoxaluria.
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Known history of glucose-6-phosphate dehydrogenase deficiency.
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Known history of chronic iron overload due to iron storage and other diseases.
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The patient is already on IV steroids for a reason other than septic shock.
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Proven active COVID-19 infection (positive swab and/or CT scan positive for COVID-19 within 14 days prior to or at ED presentation).
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Participation in an interventional trial with an investigational medicinal product (IMP) or device
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | GasthuisZusters Antwerpen | Antwerp | Belgium | ||
2 | Universitair Ziekenhuis Antwerpen | Antwerp | Belgium | ||
3 | Centre Hospitalier Universitaire Saint-Pierre Bruxelles | Brussels | Belgium | ||
4 | Universitair Ziekenhuis Brussel | Brussels | Belgium | ||
5 | Université Libre de Bruxelles Erasme | Brussels | Belgium | ||
6 | Universitaire Ziekenhuizen Leuven | Leuven | Belgium | ||
7 | Centre Hospitalier Universitaire de Liège | Liège | Belgium | ||
8 | Algemeen Ziekenhuis Turnhout | Turnhout | Belgium |
Sponsors and Collaborators
- Universitaire Ziekenhuizen Leuven
- Federaal Kenniscentrum voor Gezondheidszorg, Belgium
Investigators
- Principal Investigator: Didier Desruelles, MD, Universitaire Ziekenhuizen Leuven
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- S63213
- 2020-001862-12
- KCE 19-1237