The purpose of this study is to learn how blood clotting substances respond in children with septic shock, low platelet counts, and multiple organ failure (MOF) treated at different institutions.

Multiple organ failure can be related to an infection producing “septic shock,” in which substances released in the blood cause poor blood flow to the organs. The number of platelets circulating in your child’s blood stream is also decreased (this is called “thrombocytopenia”) as a result of this condition. Research has shown that certain substances in the part of the blood known as plasma (the clear liquid part of the blood not including the red blood cells but holding blood clotting factors) can cause the organs to work poorly. The investigators would like to compare these blood responses in children with this condition, receiving a variety of different treatments, for multiple organ failure in other medical centers around the world. The investigators hope to enroll 80 patients into the study.

Condition
Septic Shock Thrombocytopenia Multiple Organ Failure

Further Study Details: 

Expected Total Enrollment:  80

Researchers have defined a subgroup of pediatric patients with critical illness who have a specific coagulation profile associated with thrombocytopenia. This distinct entity, defined as thrombocytopenia-associated multiple organ failure (TAMOF), has been demonstrated to predispose affected children to worsening organ failure and increased risk of death. A preliminary single-center study performed at Children’s Hospital of Pittsburgh (CHP) suggested significant improvement in organ system dysfunction in TAMOF patients using a plasma exchange protocol compared to standard therapy alone. The investigators desire to further evaluate plasma profiles and clinical outcomes in pediatric TAMOF in a broader geographic setting. The investigators propose to perform a prospective multi-center observational cohort study to evaluate plasma response and clinical outcomes in pediatric patients with TAMOF due to critical illness associated with systemic infection, sepsis, organ transplant, chemotherapy or cardiopulmonary bypass. Plasma samples will be obtained from all patients for measurement of markers of coagulation and inflammation. The primary clinical endpoints measured will be organ failure index scores, pediatric logistic organ dysfunction (PELOD) scores, and days until resolution of organ failures. Cohort outcome analysis will also be performed by pairing patients at different centers receiving standard therapy with those receiving plasma exchange as an additional therapy.

Ages Eligible for Study:  6 Months   -   18 Years,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

All pediatric Intensive Care Unit (ICU) patients with the following inclusion criteria are eligible for enrollment:

• Weight > 5 kilograms (minimum weight required due to technical limits of exchange equipment)
• Multiple organ failure, defined as organ failure index (OFI) score > 3 present for < 30 hours
• Patients must have new (not present prior to admission) organ failure in at least 3 of the 5 organ systems.
• Thrombocytopenia (platelet count < 100,000 per ul), or in patients with a baseline platelet count < 100,000 per ul, a minimum 50% decrease in platelet count
• Etiology of MOF due to systemic infection, shock, transplantation, chemotherapy, or cardiopulmonary bypass

Exclusion Criteria:

• Treatment prior to study entry with any form of plasma exchange therapy within 30 days not for TAMOF
• Thrombocytopenia secondary to diagnosed thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS)
• Patients with terminal illness (i.e. not expected to live > 60 days even if they survive this acute illness) or in which withdrawal of therapy is being considered (do-not-resuscitate [DNR]/comfort measures only, limited therapy etc.)

Please refer to this study by ClinicalTrials.gov identifier  NCT00118664

Kristine M Rogers, RN      404-785-1215    kristine.rogers@choa.org
James D Fortenberry, MD      404-785-1600    james.fortenberry@choa.org

Georgia
      Children''''s Healthcare of Atlanta at Egleston and Scottish Rite, Atlanta,  Georgia,  30322,  United States; Recruiting
Louisiana
      LSU Health Sciences Center, Shreveport,  Louisiana,  71130,  United States; Not yet recruiting
Minnesota
      Children''''s Hospitals and Clinics of Minnesota, Minneapolis,  Minnesota,  55404,  United States; Not yet recruiting
Ohio
      Columbus Childrens Hospital, Columbus,  Ohio,  43205,  United States; Recruiting
      Cincinnati Children''''s Hospital Medical Center, Cincinnati,  Ohio,  45229,  United States; Not yet recruiting
Pennsylvania
      Children''''s Hospital of Pittsburgh, Pittsburgh,  Pennsylvania,  15213,  United States; Recruiting
Tennessee
      Vanderbilt Children''''s Hospital, Nashville,  Tennessee,  37232,  United States; Not yet recruiting
Texas
      Methodist Children''''s Hospital of San Antonio, San Antonio,  Texas,  78229,  United States; Not yet recruiting
      Cook Children''''s Hospital, Fort Worth,  Texas,  76104,  United States; Recruiting
      Texas Children''''s Hospital, Houston,  Texas,  77030,  United States; Not yet recruiting

Study chairs or principal investigators

James D. Fortenberry, MD,  Principal Investigator,  Children''''s Healthcare of Atlanta   

Study ID Numbers:  05-004
Record last reviewed:  July 2005
Last Updated:  July 21, 2005
Record first received:  July 11, 2005
ClinicalTrials.gov Identifier:  NCT00118664
Health Authority: United States: Institutional Review Board
ClinicalTrials.gov processed this record on 2005-07-26