- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05441878
20% Albumin vs. Balanced Salt Solution as Resuscitation Fluid in Cirrhosis With Sepsis Induced Hypotension
June 28, 2022 updated by: Madhumita Premkumar, Postgraduate Institute of Medical Education and Research
To Compare 20% Albumin vs. Balanced Salt Solution as Resuscitation Fluid and Identify Fluid Responsiveness Criteria in Critically Ill Patients With Cirrhosis With Sepsis Induced Hypotension; a Prospective Randomized Controlled Trial.
Patients with cirrhosis patients have a high incidence of sepsis which can trigger decompensation and may result in prolonged hospital stay and increased mortality.
About 30%-50% admissions of patients with cirrhosis have sepsis at presentation and about 15% patients admitted to hospital develop sepsis during the hospital stay .
After infection develops, the patient may develop acute kidney injury (AKI), shock, encephalopathy or disseminated intravascular coagulation (DIC) further decreasing the chances of survival.
In fact, sepsis in patients with cirrhosis is associated with 15% in-hospital mortality, approximately double that of patients without sepsis.
So, sepsis is directly responsible for 30-50% of deaths in cirrhosis .
Therefore, it is critical to manage sepsis early and appropriately in cirrhosis to reduce the complications and mortality.
Early administration of fluids, source control and empirical antibiotics along with vasopressors if refractory shock are essential components of treatment in all patients with sepsis.
Currently, the most accepted strategy for early sepsis management is a combination of early goal directed therapy (EGDT) and physiological parameters, such as urine output, lactate clearance, and administration of antibiotics, within 1 hour of presentation .
The use of central venous pressure assessment is fallacious for gauging adequacy of fluid resuscitation in cirrhosis, and the difficulty of performing echocardiographic assessments in the setting of ascites and cirrhotic cardiomyopathy is also well described .
Study Overview
Status
Recruiting
Intervention / Treatment
Study Type
Interventional
Enrollment (Anticipated)
150
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
-
Chandigarh, India, 160012
- Recruiting
- Postgraduate Institute of Medical Education and Research
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 65 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Clinical/Imaging or Biopsy proven liver cirrhosis of any etiology who consent for enrolment.
- Hypotension (Mean arterial pressure <65mmHg or Systolic blood pressure <90mmHg)
- Aged between18-65 yrs
Exclusion Criteria:
- Already received colloid or more than 2 litres of fluid without baseline echocardiographic assessment.
- Already on vasopressors/inotropes
- Severe pre-existing cardiopulmonary disease
- Acute Respiratory Distress Syndrome (ARDS)
- Active bleeding like variceal bleed
- Cerebrovascular events
- Chronic renal disease - End Stage Renal Disease (ESRD)/ patient on renal replacement therapy
- Admission to ICU following liver transplantation, burns, cardiac surgery
- Brain death or likely brain death within 24 hours
- Previous adverse reaction to human albumin solution
- Pregnant or lactating women
- Informed consent refused by patient or attendants
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: 20% Albumin arm
20% Albumin in a dose of 20-40 gm per day as infusion over 12-24 h
|
Albumin arm for resuscitation fluid
Only Balanced salt solution will be used.
|
ACTIVE_COMPARATOR: Balanced salt solution arm
Fluid resuscitation protocol includes use of an immediate 500 ml bolus of crystalloid i.e., balanced salt solution (BSS) or 0.9% normal saline (Rescue phase), followed by 20 ml/kg fluid in the first 6 hours titrated to target MAP of > 65mmHg.The second phase of fluid resuscitation (Optimization phase) will be performed as per IVC targets, attainment of lactate clearance, and LUS score to prevent overload.
|
Only Balanced salt solution will be used.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess IVC dynamics.
Time Frame: At enrolment
|
To compare the IVC dynamics in patients with cirrhosis and sepsis induced hypotension
|
At enrolment
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess IVC dynamics.
Time Frame: At 6 hours
|
To compare the IVC dynamics in patients with cirrhosis and sepsis induced hypotension
|
At 6 hours
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess IVC dynamics.
Time Frame: At 24 hours
|
To compare the IVC dynamics in patients with cirrhosis and sepsis induced hypotension
|
At 24 hours
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess IVC dynamics.
Time Frame: At 48 hours.
|
To compare the IVC dynamics in patients with cirrhosis and sepsis induced hypotension
|
At 48 hours.
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess dynamic changes in cardiac output, stroke volume and E/e' echocardiographic parameters.
Time Frame: At enrolment
|
To compare the cardiac output in patients with cirrhosis and sepsis induced hypotension
|
At enrolment
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess dynamic changes in cardiac output, stroke volume and E/e' echocardiographic parameters.
Time Frame: At 24 hours
|
To compare the cardiac output in patients with cirrhosis and sepsis induced hypotension
|
At 24 hours
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess dynamic changes in cardiac output, stroke volume and E/e' echocardiographic parameters.
Time Frame: At 48 hours.
|
To compare the cardiac output in patients with cirrhosis and sepsis induced hypotension
|
At 48 hours.
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess new onset of hepatorenal syndrome (HRS) or acute kidney injury (AKI)
Time Frame: At enrolment
|
To compare the new onset of hepatorenal syndrome (HRS) or acute kidney injury (AKI)in patients with cirrhosis and sepsis induced hypotension
|
At enrolment
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension and assess new onset of hepatorenal syndrome (HRS) or acute kidney injury (AKI)
Time Frame: At 48 hours.
|
To compare the new onset of hepatorenal syndrome (HRS) or acute kidney injury (AKI)in patients with cirrhosis and sepsis induced hypotension
|
At 48 hours.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Urinary marker of AKI (NGal)
Time Frame: At enrolment
|
At enrolment
|
|
Change in urinary markers of AKI (NGal)
Time Frame: At 24 hours.
|
At 24 hours.
|
|
Change in urinary markers of AKI(NGal)
Time Frame: At 48 hours.
|
At 48 hours.
|
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension., and assess vasopressor requirement
Time Frame: At enrolment
|
To compare the vasopressor requirement in patients with cirrhosis and sepsis induced hypotension
|
At enrolment
|
To compare the efficacy of 20% Albumin vs Plasmalyte in the first 3 -6 hours of volume resuscitation in cirrhosis with sepsis induced hypotension., and assess vasopressor requirement
Time Frame: At 24 hours
|
To compare the vasopressor requirement in patients with cirrhosis and sepsis induced hypotension
|
At 24 hours
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Moreau R, Hadengue A, Soupison T, Kirstetter P, Mamzer MF, Vanjak D, Vauquelin P, Assous M, Sicot C. Septic shock in patients with cirrhosis: hemodynamic and metabolic characteristics and intensive care unit outcome. Crit Care Med. 1992 Jun;20(6):746-50. doi: 10.1097/00003246-199206000-00008.
- ARISE Investigators; ANZICS Clinical Trials Group; Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014 Oct 16;371(16):1496-506. doi: 10.1056/NEJMoa1404380. Epub 2014 Oct 1.
- Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8. doi: 10.1378/chest.07-2331.
- Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, Boccia S, Colloredo-Mels G, Corigliano P, Fornaciari G, Marenco G, Pistara R, Salvagnini M, Sangiovanni A. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001 Jan-Feb;33(1):41-8. doi: 10.1016/s1590-8658(01)80134-1.
- Navasa M, Fernandez J, Rodes J. Bacterial infections in liver cirrhosis. Ital J Gastroenterol Hepatol. 1999 Oct;31(7):616-25.
- Wong F, Bernardi M, Balk R, Christman B, Moreau R, Garcia-Tsao G, Patch D, Soriano G, Hoefs J, Navasa M; International Ascites Club. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut. 2005 May;54(5):718-25. doi: 10.1136/gut.2004.038679.
- Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM; ProMISe Trial Investigators. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015 Apr 2;372(14):1301-11. doi: 10.1056/NEJMoa1500896. Epub 2015 Mar 17.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
August 15, 2020
Primary Completion (ANTICIPATED)
October 1, 2023
Study Completion (ANTICIPATED)
December 1, 2023
Study Registration Dates
First Submitted
April 26, 2022
First Submitted That Met QC Criteria
June 28, 2022
First Posted (ACTUAL)
July 1, 2022
Study Record Updates
Last Update Posted (ACTUAL)
July 1, 2022
Last Update Submitted That Met QC Criteria
June 28, 2022
Last Verified
June 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Hepatic Insufficiency
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Infections
- Systemic Inflammatory Response Syndrome
- Inflammation
- Liver Diseases
- Liver Failure, Acute
- Sepsis
- End Stage Liver Disease
- Fibrosis
- Liver Failure
- Acute-On-Chronic Liver Failure
- Shock, Septic
- Shock
- Liver Cirrhosis
- Hypotension
- Hypovolemia
Other Study ID Numbers
- IEC/11/2019/1496
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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.
Clinical Trials on Acute-On-Chronic Liver Failure
-
Chulalongkorn UniversityRecruitingAcute-On-Chronic Liver Failure | Acute on Chronic Hepatic FailureThailand
-
Third Affiliated Hospital, Sun Yat-Sen UniversityWithdrawnLiver Failure, Acute on ChronicChina
-
Tianjin Weikai Bioeng., Ltd.Tianjin Nankai HospitalUnknownLiver Failure, Acute on ChronicChina
-
Aga Khan UniversityNational Institute of Liver & GI Diseases, PakistanNot yet recruiting
-
Nanfang Hospital of Southern Medical UniversityCompletedLiver Injury | Liver Failure, Acute on Chronic
-
Pere GinesClinica Universidad de Navarra, Universidad de NavarraTerminatedAllogenic Bone Marrow Mesenchymal Stem Cell Therapy in Acute-on-chronic Liver Failure (Liveradvance)Acute on Chronic Hepatic FailureSpain
-
Nanfang Hospital of Southern Medical UniversityCompletedThrombelastography,Acute on Chronic Liver Failure, PlateletChina
-
Hexaell Biotech Co., Ltd.RecruitingLiver Failure | Hepatitis | Acute on Chronic Hepatic FailureChina
-
Hepa Wash GmbHTerminatedAcute on Chronic Hepatic FailureGermany
-
Institute of Liver and Biliary Sciences, IndiaCompletedAcute on Chronic Hepatic FailureIndia
Clinical Trials on 20% albumin
-
Institute of Liver and Biliary Sciences, IndiaNot yet recruitingLiver Cirrhosis | Spontaneous Bacterial PeritonitisIndia
-
University Hospital Inselspital, BerneCompletedBlood Loss, Surgical | Fluid RetentionSwitzerland
-
Joachim ZdolsekRecruitingGynecologic Cancer | Colorectal Cancer | Colorectal Disorders | Urologic Cancer | Benign NeoplasmSweden
-
Rachael CusackGrifols Biologicals, LLCRecruitingSepsis | Septic Shock | Sepsis, SevereIreland
-
Instituto Grifols, S.A.Hospital Clinic of BarcelonaCompletedCirrhosis | AscitesSpain
-
University Hospital, LinkoepingCompleted
-
Technical University of MunichCompleted
-
University Hospital Inselspital, BerneCompletedBlood Loss, Surgical | Fluid RetentionSwitzerland
-
Govind Ballabh Pant HospitalSuspended
-
Instituto Grifols, S.A.Grifols Biologicals, LLCCompletedAlzheimer's DiseaseSpain, United States