Viscoelastic Coagulation Monitoring for Early Identification of Sepsis: The VISION II Study (VISION II)
Viscoelastic Coagulation Monitor as an Early Index of Sepsis in Patients Admitted With Infection at the Emergency Department: The VISION II Study
The VISION II study is a prospective, multicenter, observational cohort study evaluating the diagnostic performance of Viscoelastic Coagulation Monitor (VCM) parameters for the early identification of sepsis in adults presenting to the Emergency Department with suspected infection.The previous single-center, proof-of-concept VISION study (NCT07073456) showed that shorter clotting time (CT) was independently associated with sepsis and that patients with sepsis accumulated a greater number of out-of-range VCM measurements during follow-up. Although CT demonstrated potential for distinguishing between patients with and without sepsis, its diagnostic performance was moderate, supporting further evaluation in a larger, multicenter cohort.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
Sepsis is frequently associated with hemostatic disturbances resulting from the close interaction between inflammation and coagulation. These alterations may occur early in the course of infection but may not be adequately detected by conventional coagulation tests. The Viscoelastic Coagulation Monitor (VCM) is a point-of-care device that provides a rapid bedside assessment of whole-blood clot formation and may therefore support the early identification of patients progressing to sepsis.
In the previous single-center, prospective, proof-of-concept VISION study, VCM parameters were evaluated in adults presenting to the Emergency Department with suspected infection. Shorter clotting time (CT) remained independently associated with sepsis after adjustment for established clinical scores and laboratory biomarkers. Patients with sepsis also accumulated a greater number of out-of-range VCM measurements during follow-up. However, the diagnostic performance of CT was moderate, indicating the need for validation in a larger, multicenter cohort. Moreover, patients receiving anticoagulant or antiplatelet therapy were excluded from the previous study, limiting the applicability of its findings to routine Emergency Department practice.
VISION II is a prospective, observational, multicenter study designed to evaluate the diagnostic performance of VCM parameters for the early identification of sepsis in approximately 400 adults presenting to the Emergency Department with suspected infection. Unlike the previous study, VISION II will include patients receiving chronic anticoagulant or antiplatelet therapy and will assess the potential effect of these treatments on VCM parameters and diagnostic performance.
VCM testing and clinical and laboratory assessments will be performed at enrollment and, for patients who remain hospitalized, at 24, 48, and 72 hours. Recorded assessments will include SOFA-2, qSOFA, NEWS2 scores, conventional coagulation parameters, inflammatory biomarkers, microbiological findings, administered antibiotic therapy, admission to the Intensive Care Unit, survival status, and major thromboembolic events.
The primary endpoint is the difference in VCM-derived parameters between patients who develop sepsis within the first 72 hours and those who do not. Sepsis will be defined according to the Sepsis-3 criteria. Sepsis status will be independently determined by two clinical adjudicators who will review the available clinical data from the 72-hour follow-up period while remaining blinded to the VCM results.
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Evangelos J. Giamarellos-Bourboulis, MD, PhD
- Numero di telefono: 00302105831994
- Email: egiamarel@med.uoa.gr
Luoghi di studio
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Attica
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Magoula, Attica, Grecia, 19600
- Thriasio Eleusis General Hospital, First Department of Internal Medicine
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Contatto:
- Styliani Sympardi, MD, PhD
- Numero di telefono: 00306971863078
- Email: lianasympa@hotmail.com
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Investigatore principale:
- Styliani Sympardi, MD, PhD
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Nikaia, Attica, Grecia, 18454
- Nikaia General Hospital of Piraeus "Agios Panteleimon" - West Attica General Hospital "Agia Varvara", Emergency Department (ED)
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Contatto:
- Dimitrios Tsiftsis, MD
- Numero di telefono: 00306945491406
- Email: deltatangogr@yahoo.com
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Investigatore principale:
- Dimitrios Tsiftis, MD, PhD
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Piraeus, Attica, Grecia, 18536
- Tzaneio General Hospital of Piraeus, Emergency Department
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Contatto:
- Styliani Gerakari, MD, PhD
- Numero di telefono: 00306973308684
- Email: sgerakari76@gmail.com
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Investigatore principale:
- Styliani Gerakari, MD, PhD
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Central Macedonia
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Exochí, Central Macedonia, Grecia, 57010
- G. Papanikolaou Thessaloniki General Hospital, Emergency Department
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Contatto:
- Eleni Peitsidou, MD, PhD
- Numero di telefono: 00306977227355
- Email: peitsidou@yahoo.gr
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Investigatore principale:
- Eleni Peitsidou, MD, PhD
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Thessaloniki, Central Macedonia, Grecia, 54636
- AHEPA Thessaloniki University General Hospital, Emergency Department
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Contatto:
- Varvara Fyntanidou, MD, PhD
- Numero di telefono: 00306977427336
- Email: bfyntan@yahoo.com
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Investigatore principale:
- Varvara Fyntanidou, MD, PhD
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Chaidari
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Athens, Chaidari, Grecia, 12462
- 4th Department of Internal Medicine, ATTIKON University General Hospital, General Hospital of West Attica H Agia Varvara, National and Kapodistrian University of Athens, Medical School
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Contatto:
- Evangelos J. Giamarellos-Bourboulis, MD, PhD
- Email: egiamarel@med.uoa.gr
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Investigatore principale:
- Evangelos J. Giamarellos-Bourboulis, MD, PhD
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Athens, Chaidari, Grecia, 12462
- Emergency Medicine Department, ATTIKON University General Hospital, General Hospital of West Attica H Agia Varvara, NKUA
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Contatto:
- Ioannis Parisis, MD, PhD
- Numero di telefono: +306944322627
- Email: iparissis@yahoo.com
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Investigatore principale:
- Ioannis Parisis, MD, PhD
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South Aegean
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Ermoupoli, South Aegean, Grecia, 84100
- Syros General Hospital "Vardakeio and Proio" Department of Internal Medicine
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Contatto:
- Georgios Giannikopoulos, MD
- Numero di telefono: 00306948889393
- Email: giannikopoulos69@gmail.com
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Investigatore principale:
- Georgios Giannikopoulos, MD
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Thessaly
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Larissa, Thessaly, Grecia, 41221
- General Hospital of Larissa "Koutlimpaneio and Triantafylleio"
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Contatto:
- Dimitrios Mpampalis, MD
- Numero di telefono: 00306932341149
- Email: dbabales@yahoo.com
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Investigatore principale:
- Dimitrios Mpampalis, MD
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Metodo di campionamento
Popolazione di studio
Adult patients presenting to the Emergency Departments of participating hospitals with suspected infection who meet all inclusion criteria and none of the exclusion criteria will be enrolled in the study.
Descrizione
Inclusion Criteria:
- Male or female adults aged 18 years or older.
- Written informed consent provided by the patient or, when the patient is unable to provide consent, by a legally authorized representative.
- Suspected infection based on the predefined diagnostic criteria for infection sources specified in the study protocol and derived from published international guidelines.
Exclusion Criteria:
- Age under 18 years.
- Written informed consent not provided by the patient or, when applicable, by a legally authorized representative.
- History of hemophilia or any other congenital coagulation disorder.
- Known hematologic malignancy, regardless of disease stage.
- Pregnancy or lactation.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Modelli osservazionali: COHORT
- Prospettive temporali: PROSPECTIVE
Numero di gruppi/coorti
Coorti e interventi
Gruppo / CoorteGruppo / Coorte |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Patients with suspected infection
Adult patients presenting to the Emergency Department with suspected infection, as determined by the treating physician's clinical judgment and according to the predefined infection criteria specified in the study protocol. |
Peripheral venous whole-blood samples will be collected for the assessment of eight parameters using the Viscoelastic Coagulation Monitor (VCM): clotting time (CT), clot formation time (CFT), alpha angle, amplitude at 10 minutes (A10), amplitude at 20 minutes (A20), maximum clot firmness (MCF), lysis index at 30 minutes (LI30), and lysis index at 45 minutes (LI45). Assessments will be performed at enrollment and, for patients who remain hospitalized, at 24, 48, and 72 hours. VCM results will not influence the patient's treatment or any other aspect of standard clinical care, which will remain entirely at the discretion of the treating physicians. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Differences in VCM parameters between patients who develop sepsis and those who do not
Lasso di tempo: From enrollment through 72 hours
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The eight VCM-derived parameters will be compared between patients who develop sepsis and those who do not. Sepsis will be defined according to the Sepsis-3 criteria as suspected or confirmed infection accompanied by an increase of ≥2 points in the Sequential Organ Failure Assessment (SOFA)-2 score or more from baseline. |
From enrollment through 72 hours
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Clotting Time in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: From enrollment to 72 hours
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Clotting time (CT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
From enrollment to 72 hours
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Clot Formation Time in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: At enrollment and at 24, 48, and 72 hours
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Clot formation time (CFT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared using the Mann-Whitney U test between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
At enrollment and at 24, 48, and 72 hours
|
|
Alpha Angle in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Alpha angle, measured in degrees using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
At enrollment and at 24, 48, and 72 hours.
|
|
Amplitude at 10 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Amplitude at 10 minutes (A10), measured in VCM units, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
At enrollment and at 24, 48, and 72 hours.
|
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Maximum Clot Firmness in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Maximum clot firmness (MCF), measured in VCM units, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
At enrollment and at 24, 48, and 72 hours.
|
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Lysis Index at 30 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Lysis index at 30 minutes (LI30), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
At enrollment and at 24, 48, and 72 hours.
|
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Lysis Index at 45 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Lysis index at 45 minutes (LI45), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
At enrollment and at 24, 48, and 72 hours.
|
|
Amplitude at 20 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Amplitude at 20 minutes (A20), measured in VCM units, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy. |
At enrollment and at 24, 48, and 72 hours.
|
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Use of chronic anticoagulant therapy or antiplatelet therapy
Lasso di tempo: At enrollment
|
Number and proportion of enrolled patients receiving chronic anticoagulant therapy and those not receiving anticoagulant therapy. |
At enrollment
|
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Clotting Time in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Clotting time (CT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared between participants who develop a major thromboembolic event and participants who do not develop such an event within the first 72 hours after enrollment. |
At enrollment and at 24, 48, and 72 hours.
|
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Clot Formation Time in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Clot formation time (CFT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared between participants who develop a major thromboembolic event and participants who do not develop such an event within the first 72 hours after enrollment. |
At enrollment and at 24, 48, and 72 hours.
|
|
Alpha Angle in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Alpha angle, measured in degrees using the VCM, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not. |
At enrollment and at 24, 48, and 72 hours.
|
|
Amplitude at 10 Minutes in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Amplitude at 10 minutes (A10), measured in VCM units, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not. |
At enrollment and at 24, 48, and 72 hours.
|
|
Amplitude at 20 Minutes in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Amplitude at 20 minutes (A20), measured in VCM units, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not. |
At enrollment and at 24, 48, and 72 hours.
|
|
Lysis Index at 30 Minutes in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Lysis index at 30 minutes (LI30), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not. |
At enrollment and at 24, 48, and 72 hours.
|
|
Lysis Index at 45 Minutes in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Lysis index at 45 minutes (LI45), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not. |
At enrollment and at 24, 48, and 72 hours.
|
|
Maximum Clot Firmness in Participants With and Without a Major Thromboembolic Event
Lasso di tempo: At enrollment and at 24, 48, and 72 hours.
|
Maximum clot firmness (MCF), measured in VCM units, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not. |
At enrollment and at 24, 48, and 72 hours.
|
|
Occurrence of sepsis among patients receiving chronic anticoagulant therapy
Lasso di tempo: From enrollment to 72 hours
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Number and proportion of patients receiving chronic anticoagulant therapy who develop sepsis, as defined by the Sepsis-3 criteria, during the study follow-up period. |
From enrollment to 72 hours
|
|
Cumulative number of out-of-range VCM parameters
Lasso di tempo: At enrollment and at 24, 48, and 72 hours
|
The cumulative number of VCM parameters outside their predefined reference ranges will be determined at enrollment and at 24, 48, and 72 hours and compared between patients who develop sepsis and those who do not. |
At enrollment and at 24, 48, and 72 hours
|
|
Correlation between VCM parameters and inflammatory mediators
Lasso di tempo: At enrollment
|
Correlations between the eight VCM-derived parameters and measured inflammatory mediators and biomarkers, including interleukin-6 (IL-6), tissue factor (CD142), procalcitonin (PCT), and C-reactive protein (CRP), will be assessed. |
At enrollment
|
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Correlation between VCM parameters and conventional coagulation parameters
Lasso di tempo: At enrollment and, for hospitalized patients, at 24, 48, and 72 hours
|
Correlations between the eight VCM-derived parameters and conventional coagulation parameters, including international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer levels, and platelet count, will be assessed. |
At enrollment and, for hospitalized patients, at 24, 48, and 72 hours
|
Collaboratori e investigatori
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Aggiornamenti dei record di studio
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- VISION II
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