Value of Biomarkers of Brain Injury for Predicting Psycho-cognitive Sequelae Secondary to Sepsis: a Prospective Multicenter Study (SEPSYM)
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Sepsis is a major cause of admission to intensive care units and is responsible for approximately 11 million deaths worldwide each year. It may be complicated by an acute brain dysfunction known as sepsis-associated encephalopathy (SAE), which affects about 50% of patients and typically manifests as delirium or coma. The diagnosis of SAE is primarily clinical, with EEG and brain MRI providing supportive information. Risk factors for SAE are mainly related to patient characteristics, including advanced age, chronic kidney disease, and pre-existing neurodegenerative or cognitive disorders. The pathophysiology of SAE involves three major mechanisms: neuroinflammation, endothelial dysfunction with blood-brain barrier disruption, and mitochondrial dysfunction leading to neuronal injury. These mechanisms likely explain both acute neurological symptoms and long-term psycho-cognitive sequelae. Following sepsis, 30-60% of patients develop psychiatric disorders and cognitive impairments comparable to those observed after moderate traumatic brain injury or early Alzheimer's disease. These sequelae are part of post-intensive care syndrome (PICS), supporting the need for structured post-ICU follow-up. However, the optimal target population and organization of such follow-up remain unclear, as some studies have reported reduced quality of life in patients receiving long-term follow-up. Identifying early biomarkers predictive of psycho-cognitive outcomes is therefore crucial, as current data on neuronal and glial biomarkers remain limited. Such biomarkers could improve prognostication, guide cognitive rehabilitation and psychological support, and contribute to the development of future neuroprotective strategies.
Primary objective:
To evaluate the value of biomarkers of brain injury for predicting cognitive impairment (memory impairment assessed by a MoCA score < 26/30) at 3 months.
Secondary objectives:
- To evaluate the value of brain injury biomarkers for predicting delirium in the ICU, including hypoactive, hyperactive, and mixed phenotypes
- To assess the association between brain injury biomarkers and the duration of delirium in the ICU
- To evaluate the value of brain injury biomarkers for predicting psychological sequelae (anxiety, post-traumatic stress disorder, and depression) at 3 months
- To evaluate the value of brain injury biomarkers for predicting functional neurological outcomes using the Glasgow Outcome Scale-Extended at ICU discharge and at 3 months
- To assess the association between brain injury biomarkers and Post-Intensive Care Syndrome (PICS)
- To assess the association between brain injury biomarkers and EEG abnormalities in the ICU
- To assess the association between brain injury biomarkers and MRI abnormalities at 3 months
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Adèle BELLINO
- Telefonnummer: +33 01 71 76 07 57
- E-mail: adele.bellino@aphp.fr
Undersøgelse Kontakt Backup
- Navn: Sarah BENGHANEM, Dr
- Telefonnummer: +33 01 58 41 25 25
- E-mail: sarah.benghanem@aphp.fr
Studiesteder
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-
Île-de-France Region
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Paris, Île-de-France Region, Frankrig, 75014
- Hôpital Cochin - APHP Centre
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Kontakt:
- Sarah BENGHANEM, Dr
- Telefonnummer: +33 01 58 41 25 25
- E-mail: sarah.benghanem@aphp.fr
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Adults aged 18-80 years.
- Admission to a medical or mixed ICU.
- Sepsis or septic shock according to Sepsis-3 criteria.
- ICU admission for less than 24 hours.
- Need for invasive or non-invasive mechanical ventilation and/or vasopressor support.
- Informed consent obtained from the patient or legal representative.
Exclusion Criteria:
- Moribund patients.
- Age >80 years.
- Patients under legal guardianship.
- History of schizophrenia or bipolar disorder.
- Pregnancy.
- No health insurance coverage.
- Previous inclusion in the study.
- Refusal to participate.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Diagnostisk
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Cognitive function impairment assessed by the Montreal Cognitive Assessment (MoCA) score at 3 months
Tidsramme: 3 months
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Montreal Cognitive Assessment (MoCA) ranges from 0 to 30 points, with higher scores indicating better cognitive performance.
Cognitive impairment will be defined as a MoCA score <26/30.
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3 months
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Coma- and/or delirium-free days
Tidsramme: Day 10 after inclusion
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Day 10 after inclusion
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Duration of delirium in the intensive care unit (ICU)
Tidsramme: 3 months
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3 months
|
|
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Type of ICU delirium: hypoactive, hyperactive, or mixed
Tidsramme: 3 months
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3 months
|
|
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Psychiatric disorders (anxiety, depression : ( 0 =min; 21 =max) , or PTSD)
Tidsramme: 3 months
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3 months
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Glasgow Outcome Scale-Extended (GOSE)
Tidsramme: 3 months
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3 months
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Delirium duration
Tidsramme: 3 months
|
Number of ICU days with delirium assessed using the Confusion Assessment Method for the ICU (CAM-ICU).
Delirium duration will be reported as the cumulative number of ICU days with at least one positive CAM-ICU assessment.
Higher values indicate longer delirium duration.
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3 months
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Delirium phenotype
Tidsramme: 3 months
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ICU delirium phenotype classified as hypoactive, hyperactive or mixed according to CAM-ICU and RASS assessments.
Results will be reported as the proportion of patients in each category.
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3 months
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Psychiatric outcomes
Tidsramme: 3 months
|
Symptoms of anxiety and depression assessed using the Hospital Anxiety and Depression Scale (HADS; higher scores indicate greater symptom severity).
PTSD assessed using the PTSD Checklist (PCL-5).
Results will be reported as continuous scores and proportions of patients above validated thresholds
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3 months
|
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Functional outcome
Tidsramme: 3 months
|
Functional neurological outcome assessed using the Glasgow Outcome Scale-Extended (GOSE; range 1-8, higher scores indicate better functional recovery).
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3 months
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PICS : Post-Intensive Care Syndrome (PICS)
Tidsramme: 3 months
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PICS is defined by the presence of cognitive impairment, psychiatric symptoms and/or physical disability at 3 months.
Results will be reported as the proportion of patients fulfilling at least one PICS domain.
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3 months
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Neurological, psychiatric, or rehabilitation follow-up proposed to the patient
Tidsramme: 3 months
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Referral for specialized follow-up after ICU discharge.
This outcome will be reported as the proportion of patients referred to neurological consultation, psychiatric consultation, cognitive rehabilitation, physical rehabilitation and/or a multidisciplinary post-ICU clinic.
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3 months
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Sarah BENGHANEM, Dr, Assistance Publique - Hôpitaux de Paris
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Neurologiske manifestationer
- Sygdomme i nervesystemet
- Psykiske lidelser
- Patologiske processer
- Infektioner
- Forvirring
- Neuroadfærdsmæssige manifestationer
- Neurokognitive lidelser
- Systemisk inflammatorisk responssyndrom
- Betændelse
- Stød
- Patologiske tilstande, tegn og symptomer
- Tegn og symptomer
- Delirium
- Sepsis
- Chok, septisk
- Syndrom efter efterintativ pleje
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- APHP251947
- IDRCB (Anden identifikator: 2025-A02589-40)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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