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Evaluation of Intestinal Brush Border Enzyme Function in Critically Ill Patients

28 augusti 2017 uppdaterad av: Ulrike Holzinger, Medical University of Vienna

Evaluation of Intestinal Brush Border Enzyme Function in Patients With SIRS and Septic Shock Compared to Control Patients

The purpose of this study is to evaluate the role of several enzymes of the gut mucosa in preventing invasion of gastrointestinal bacteria.

Studieöversikt

Status

Avslutad

Intervention / Behandling

Detaljerad beskrivning

Systemic Inflammatory Response Syndrome (SIRS), sepsis, septic shock and concomitant multiorgan failure are major causes of morbidity and mortality in intensive care units. During SIRS and septic shock the role of the gut seems to be uncertain. As it serves as an intestinal barrier which allows the symbiotic relationship between man and enteric bacteria, increased gut permeability during critical illness is accused to promote sepsis. Brush border enzymes have the ability to detoxify lipopolysaccharides and prevent bacterial invasion across the gut mucosal barrier. A reduced brush border enzyme function could contribute to the gastrointestinal intolerance in critically ill patients, which is frequently observed. The aim of this study is to assess the influence of SIRS and septic shock on brush border enzyme morphology and function in men.

Studietyp

Interventionell

Inskrivning (Faktisk)

39

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

      • Vienna, Österrike, 1090
        • Medical University Vienna

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år till 80 år (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Septic Shock:

Recruitment and inclusion criteria

  • 15 mechanically ventilated critically ill patients fulfilling criteria of SIRS (2 symptoms: RR > 20/min, HR > 90/min, Temp. > 38°/< 36°, 12G/l< WBC < 4G/l; assumed or proven infection, persistent hypotension refractory to fluid therapy and need for vasopressors.
  • Time window for inclusion: up to 72h after onset of symptoms

Exclusion criteria

  • PLT < 50G/l,
  • PT < 50%,
  • Continuous therapeutic anticoagulation,
  • DIC, st. p. MCI within 14 days,
  • Gastrointestinal perforation,
  • Age < 18 years,
  • Age > 80 Years

SIRS:

Recruitment and inclusion criteria

  • 15 mechanically ventilated critically ill patients fulfilling criteria of SIRS (2 symptoms: RR > 20/min, HR > 90/min, Temp. > 38°/< 36°, 12G/l < WBC < 4G/l; assumed or proven infection
  • Time window for inclusion: up to 72h after onset of symptoms

Exclusion criteria:

  • PLT < 50G/l,
  • PT < 50%, continuous therapeutic anticoagulation,
  • DIC, st. p. MCI within 14 days,
  • Gastrointestinal perforation,
  • Age < 18 years,
  • Age > 80 Years

Healthy/controls:

  • 15 control subjects will be recruited from the outpatient ward referred to the endoscopy of the Department of Medicine III - Division of Gastroenterology and Hepatology for upper GI-endoscopy because of epigastric pain or reflux symptoms.

Inclusion criteria:

  • Signed informed consent

Exclusion criteria:

  • Patients with diarrhea of unknown origin, IBD or known celiac disease
  • Age < 18 years
  • Age > 80 Years
  • PLT < 50G/l, PT < 50%
  • Therapeutic oral anticoagulation

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Diagnostisk
  • Tilldelning: Icke-randomiserad
  • Interventionsmodell: Enskild gruppuppgift
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Övrig: Septic Shock
Activity of the brush border membrane enzymes intestinal alkaline phosphatase, maltase and lactase, as well as brush border morphology determined from duodenal biopsies in patients with septic shock
When gastroscopy is indicated for clinical reasons, duodenal biopsies to determine the activity of the brush border membrane enzymes intestinal alkaline phosphatase, maltase and lactase, as well as assessing brush border morphology are taken
Övrig: SIRS
Activity of the brush border membrane enzymes intestinal alkaline phosphatase, maltase and lactase, as well as brush border morphology determined from duodenal biopsies in patients with SIRS
When gastroscopy is indicated for clinical reasons, duodenal biopsies to determine the activity of the brush border membrane enzymes intestinal alkaline phosphatase, maltase and lactase, as well as assessing brush border morphology are taken
Övrig: healthy/controls
Activity of the brush border membrane enzymes intestinal alkaline phosphatase, maltase and lactase, as well as brush border morphology determined from duodenal biopsies in patients without SIRS/septic shock
When gastroscopy is indicated for clinical reasons, duodenal biopsies to determine the activity of the brush border membrane enzymes intestinal alkaline phosphatase, maltase and lactase, as well as assessing brush border morphology are taken

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
activity of the brush border membrane enzyme intestinal alkaline phosphatase
Tidsram: at inclusion
Duodenal biopsies will be taken on day 0 (at inclusion) and will be subsequently frozen. Determination of enzyme activity will be done within 28 days.
at inclusion

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
activity of the brush border membrane enzyme maltase
Tidsram: at inclusion
Duodenal biopsies will be taken on day 0 (at inclusion) and will be subsequently frozen. Determination of enzyme activity will be done within 28 days.
at inclusion
activity of the brush border membrane enzyme lactase
Tidsram: at inclusion
Duodenal biopsies will be taken on day 0 (at inclusion) and will be subsequently frozen. Determination of enzyme activity will be done within 28 days.
at inclusion
Brush border morphology
Tidsram: at inclusion
Duodenal biopsies will be taken on day 0 (at inclusion) and will be subsequently frozen. Determination of enzyme activity will be done within 28 days.
at inclusion
ICU mortality
Tidsram: at ICU discharge
only for groups "septic shock" and "SIRS"
at ICU discharge
hospital mortality
Tidsram: at hospital discharge
only for groups "septic shock" and "SIRS"
at hospital discharge
mortality (6 months)
Tidsram: 6 months after inclusion
6 months after inclusion

Samarbetspartners och utredare

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Utredare

  • Huvudutredare: Ulrike Holzinger, MD, Medical University of Vienna

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 juli 2011

Primärt slutförande (Faktisk)

1 februari 2015

Avslutad studie (Faktisk)

1 september 2015

Studieregistreringsdatum

Först inskickad

12 april 2012

Först inskickad som uppfyllde QC-kriterierna

24 april 2012

Första postat (Uppskatta)

26 april 2012

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

29 augusti 2017

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

28 augusti 2017

Senast verifierad

1 augusti 2017

Mer information

Termer relaterade till denna studie

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