- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04134403
Steroids, Thiamine and Ascorbic Acid in Septic Shock (STASIS)
Steroids, Thiamine and Ascorbic Acid Supplementation in Septic Shock (STASIS): A Prospective Crossover Randomized Controlled Study
Study Overview
Detailed Description
This trial is designed as a multi-center prospective, double-blinded, randomized controlled study. The objective of this project is to determine if in patients admitted to the hospital with septic shock (population), does treatment with a bundle including hydrocortisone, thiamine, and ascorbic acid improve in-hospital or 28-day mortality (primary outcomes) or surrogate markers of illness severity including: (1) ICU or hospital length-of-stay, (2) duration of invasive mechanical ventilation, (3) duration of vasopressor administration, (4) incidence and severity of ICU delirium, and (5) illness severity (secondary outcomes). The calculated sample size is 80. Subjects will be followed for 28 days or until hospital discharge.
Patients eligible for inclusion must be admitted with septic shock (as defined by SEPSIS-3) requiring vasopressors to maintain MAP ≥ 65 AND serum lactate level >2 mmol/L after adequate fluid resuscitation (generally recognized at 30 ml/kg crystalloid unless contraindicated as deemed by treating clinician) within the first three hours.
The exclusion criteria are: age < 18 years, pregnant, patients with limitation of care (i.e. do not resuscitate [DNR]), known Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency, and vasopressor use for > 24 hours prior to study enrollment.
Patients in Arm 1 will randomized to receive usual care + hydrocortisone, thiamine and ascorbic acid. Arm 2 will be randomized to receive usual care alone. Crossover is not allowed. If a patient is randomized into study Arm 2, the treating physician may decide to administer study medications if they feel it is in the best interest of the patient. In this case the patient will continue to be analyzed in their assigned arm on an intention to treat basis. Source of participants will be in-hospital and Emergency Department patients.
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Amir Vahedian-Azimi, PhD
- Phone Number: +98 919 6017 138
- Email: amirvahedian63@gmail.com
Study Contact Backup
- Name: Andrew C Miller, MD
- Email: Taqwa1@gmail.com
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Septic shock admitted to the ICU within 24 hours as defined by SEPSIS-3
SEPSIS-3 defines septic shock as sepsis with the following criteria despite adequate fluid resuscitation:
- Vasopressor required to maintain MAP ≥ 65 AND
- Serum lactate level >2.0 mmol/L
- Age ≥ 18 years
- Non-pregnant
- Ability to consent with medical capacity or legally authorized representative (LAR) consent
Exclusion Criteria:
- Age < 18 years
- Pregnant defined by negative serum HCG in all females
- Patients with limitation of care (i.e. DNR)
- Known G6PD deficiency
Excluding primary admission diagnosis including the following:
- Acute stroke
- Acute coronary syndrome
- Active gastrointestinal bleed
- Burn
- Trauma
- Prisoners
- >1 episode of sepsis in hospital admission
- Vasopressor use prior to randomization for more than 24 hours
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Arm 1: Intervention
Arm will be those that are randomized to receive usual care plus hydrocortisone, thiamine and ascorbic acid.
|
Hydrocortisone sodium succinate, 50 mg, every 6 hours, 7 days or until ICU discharge Thiamine, 200 mg, every 12 hours, 4 days or until ICU discharge Ascorbic acid, 1,500 mg, every 6 hours, 4 days or until ICU discharge
|
NO_INTERVENTION: Arm 2: Usual care
Arm will be those that are randomized to receive usual care alone.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
In-hospital or 28-day mortality rate
Time Frame: 28 days or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care versus standard care in septic shock confers an in-hospital and 28-day mortality benefit
|
28 days or discharge (whichever comes first)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Illness Severity (Change in SOFA Score)
Time Frame: 72 hours
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock confers more rapid improvements in illness severity
|
72 hours
|
Hospital length-of-stay ICU LOS Duration of intubation
Time Frame: 1 year or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock confers improved hospital length-of-stay metrics
|
1 year or discharge (whichever comes first)
|
ICU length-of-stay
Time Frame: 90 days or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock confers improved ICU length-of-stay metrics
|
90 days or discharge (whichever comes first)
|
Vasopressor duration (days)
Time Frame: 28 days or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock confers improvement in vasopressor requirements
|
28 days or discharge (whichever comes first)
|
ICU delerium (CAM-ICU score)
Time Frame: 28 days or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock changes the incidence or severity of ICU delerium
|
28 days or discharge (whichever comes first)
|
Mechanical ventilation
Time Frame: 28 days or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock changes the incidence or duration of invasive mechanical ventilation.
|
28 days or discharge (whichever comes first)
|
Cardiac arrest
Time Frame: 28 days or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock changes the incidence of cardiac arrest or need for cardiopulmonary resuscitation
|
28 days or discharge (whichever comes first)
|
Renal replacement therapy
Time Frame: 28 days or discharge (whichever comes first)
|
o determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock changes the incidence of cardiac arrest or need for renal replacement therapy.
|
28 days or discharge (whichever comes first)
|
C-reactive protein
Time Frame: 28 days or discharge (whichever comes first)
|
To determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock changes the biochemical profiling in septic patients including a more rapid improvement in C-reactive protein
|
28 days or discharge (whichever comes first)
|
Procalcitonin
Time Frame: 28 days or discharge (whichever comes first)
|
o determine if the addition of hydrocortisone, thiamine and ascorbic acid to standard care in septic shock changes the biochemical profiling in septic patients including a more rapid improvement in procalcitonin.
|
28 days or discharge (whichever comes first)
|
Collaborators and Investigators
Investigators
- Principal Investigator: Amir Vahedian-Azimi, PhD, Baqiyatallah University of Medical Scienecs
- Principal Investigator: Andrew C Miller, MD, East Carolina University
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- STASIS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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