RecruitingNCT05110937

Dysfunctional Myelopoiesis and Myeloid-Derived Suppressor Cells in Sepsis

Dysfunctional Myelopoiesis and Myeloid-Derived Suppressor Cells in Sepsis Pathobiology Subtitle: Pathological Myeloid Activation After Sepsis and Trauma

Sponsor

University of Florida

Enrollment

450 participants

Start Date

Jan 4, 2022

Study Type

OBSERVATIONAL

Conditions

Sepsis Trauma Injury

Summary

Adverse outcomes in surgical sepsis patients are secondary to dysregulated emergency myelopoiesis, and expansion of myeloid-derived suppressor cells. Here we propose to determine the underlying mechanisms behind the increased expansion of these leukocyte populations and the underlying mechanisms that drive inflammation and immune suppression.

Eligibility

Min Age: 18 YearsMax Age: 100 Years

Inclusion Criteria7

Sepsis participant:
age ≥18 years
meets criteria for sepsis/septic shock by Sepsis-3 consensus criteria.
All adults age ≥ 18 years
Blunt trauma patient with a. Injury Severity Score (ISS) greater than or equal to 25 b. ISS > 15 and one of the following: i. > 4 units of PRBC or >3 units of whole blood or >1500 ml of autogenous blood product in the first 24 hours of admission ii. AIS (acute injury score) > 2 spine iii. Shock on arrival (Systolic blood pressure (SBP) < 90)
OR
c. ISS > 15 and two of the following: i. Age > 55 ii. AIS > 2 chest iii. +ETOH (ethyl alcohol) on arrival iv. Any red blood cell transfusion in first 24 hours

Exclusion Criteria18

have disease states that predispose to significant immune system dysfunction
have comorbidity burden or goals of care that preclude recovery after sepsis. These criteria include:
a. irreversible shock (death <12 hours) b. uncontrollable surgical source of sepsis c. patients deemed to be futile care or have advanced directives limiting resuscitative efforts d. alternative diagnoses causing shock state (e.g., hemorrhage, myocardial infarction or pulmonary embolus) e. known HIV infection with CD4+ count <200 cells/mm3 g. severe traumatic brain injury with unencumbered assessment of GCS equaling 3 on admission to the intensive care unit.
known pregnancy
enrollment >96 hours after suspected sepsis onset
pre-hospitalization bedridden performance status (WHO/Zubrod score ≥4)
subsequent clinical adjudication diagnosis not consistent with sepsis/septic shock by Sepsis-3 criteria.
Burn injury greater than 20% total body surface area (tBSA)
Trauma Participant:
Patients not expected to survive greater than 48 hours.
Prisoners.
Pregnancy.
Previous bone marrow transplantation.
Patients with End Stage Renal Disease.
Patients with any pre-existing hematological disease.
Patients deemed to be futile care or have advanced directives limiting resuscitative efforts.
Known HIV infection with CD4+ count <200 cells/mm3
Burn injury greater than 20% tBSA