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| Name | Class |
|---|---|
| National Heart, Lung, and Blood Institute (NHLBI) | NIH |
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The increasing rate of hospital-acquired infection and antibiotic resistance are major causes of prolonged ICU stay and death in hospitalized patients. The enormous impact of ICU-related infection demands the need for cost-effective therapies that can be rapidly implemented to improve patient immune response to control infection. Unfortunately, little high-quality comparative effectiveness research has been performed on micronutrient treatment regimens as methods to decrease hospital-acquired infection in critically ill patients. Critically ill medical and surgical patients have an extremely high prevalence of vitamin D insufficiency.
We will perform a rigorous, double-blind, randomized, controlled, pilot clinical trial in ventilator-dependent ICU patients to test the clinical/metabolic safety and efficacy of two doses of oral high-dose vitamin D3 therapy versus standard therapy (no supplemental vitamin D). The primary endpoint is to test whether high-dose regimens [either 50,000 or 100,000 international units (IU) of enteral vitamin D3 given daily for 5 consecutive days (total dose = 250,000 or 500,000 IU, respectively) increase plasma 25(OH)D concentrations into a desirable range (> 30 ng/mL).](streamdown:incomplete-link)
Study Design:
Enrollment goal is 36 patients. Once consent is obtained subjects will be randomly assigned to one of three study groups. Each group consists of 12 patients with enteral access ; a placebo arm, an arm where subjects receive 50,000 IU of Vitamin D for 5 days, and a third arm where subjects receive 100,000 IU of Vitamin D for 5 days.
Methods: Baseline blood samples (25-hydroxyvitamin D, vitamin D binding protein, ionized calcium, LL-37,and hBD-2) will be taken on study day 7,14,21,28,84 days. On study day 1 and 8, LL-37, hBD-2, cathelicidin from BAL fluid will also be analyzed. Patients will be given either placebo, Vitamin D3 50,000 IU x 5 days (total 250,000 IU) or Vitamin D3 100,000 IU x 5 days (total 500,000 IU) with an intention to treat model. Baseline data on the patients including demographic, laboratory, documented infections, severity illness score (APACHE II) and organ dysfunction score (SOFA) will be collected. ELISA assay on the serum and BAL will be performed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Enteral vitamin D3 50,000 IU | Experimental | An arm where subjects receive 50,000 IU of Vitamin D for 5 days. |
|
| Enteral Vitamin D3 100,000 IU | Experimental | Arm where subjects receive 100,000 IU of Vitamin D for 5 days |
|
| Inactive Substance | Placebo Comparator | Arm where patients receive inactive substance for 5 days. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Enteral Vitamin D3 50,000 IU | Drug | Enteral Vitamin D3 50,000IU x 5 days (total dose 250,000IU) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Baseline | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the baseline measurement. | Baseline |
| Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 7 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 7 measurement. | Day 7 |
| Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 14 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 14 measurement. | Day 14 |
| Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 21 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 21 measurement. | Day 21 |
| Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 28 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 28 measurement. | Day 28 |
| Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 84 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 84 measurement. | Day 84 |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Plasma LL-37 Levels | Plasma LL-37 was measured at Baseline, Day 7 and Day 14. | Baseline, Day 7, Day 14 |
| Duration of Time on Ventilator | The number of days spent on mechanical ventilation was collected for all study participants and the average number of days for each study arm is reported. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Greg Martin, MD, MSc | Emory University | Principal Investigator |
| Thomas Ziegler, MD | Emory University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Emory University Hospital Midtown | Atlanta | Georgia | 30308 | United States | ||
| Emory University Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11246310 | Background | Tejada Artigas A, Bello Dronda S, Chacon Valles E, Munoz Marco J, Villuendas Uson MC, Figueras P, Suarez FJ, Hernandez A. Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med. 2001 Feb;29(2):304-9. doi: 10.1097/00003246-200102000-00015. | |
| 9237723 | Background | Winther B, Greve JM, Gwaltney JM Jr, Innes DJ, Eastham JR, McClelland A, Hendley JO. Surface expression of intercellular adhesion molecule 1 on epithelial cells in the human adenoid. J Infect Dis. 1997 Aug;176(2):523-5. doi: 10.1086/517280. |
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Study participants were recruited from critical care units at three hospitals in Atlanta, Georgia. 658 patients were assessed for eligibility, of these 562 did not meet inclusion and exclusion criteria. 65 eligible patients declined to participate while 31 gave informed consent and were randomized to one of the three study arms.
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| ID | Title | Description |
|---|---|---|
| FG000 | Placebo | Participants randomized to receive an inactive substance administered enterally for 5 days |
| FG001 | 250,000 IU of Vitamin D3 | Participants randomized to receive 50,000 IU of Vitamin D3 per day for 5 days, for a total dose of 250,000 IU administered enterally |
| FG002 | 500,000 IU of Vitamin D3 | Participants randomized to receive 100,000 IU per day of Vitamin D3 for 5 days, for a total dose of 500,000 administered enterally |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
The participant randomized to the 250,000 IU of Vitamin D3 study arm, whose spouse withdrew consent to participate in the study, is not represented in the Baseline Analysis Population.
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| ID | Title | Description |
|---|---|---|
| BG000 | Placebo | Participants randomized to receive an inactive substance administered enterally for 5 days |
| BG001 | 250,000 IU of Vitamin D3 | Participants randomized to receive 50,000 IU of Vitamin D3 per day for 5 days, for a total dose of 250,000 IU administered enterally |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Baseline | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the baseline measurement. | Blood samples were obtained every 7 days while participants remained hospitalized. Follow up discontinued once the participant was discharged from the hospital. At the baseline time point, 10 patients were randomized to the placebo arm, 9 to the arm receiving 250,000 IU of Vitamin D3, and 11 to the arm receiving 500,000 of Vitamin D3. | Posted | Number | participants | Baseline |
|
Data regarding serious adverse events and non-serious adverse events were collected from the start of treatment until 30 days after study drug discontinuation (35 days in total). Ongoing events were monitored until resolution.
As critically ill study patients are known to have a high morbidity and mortality rate, no adverse events specifically due to the study drug were expected. The clinical course of every participant was monitored to record any unexpected adverse events and all serious adverse events (SAEs). SAEs were defined as death, rehospitalization or reoperation within 30 days, cardiopulmonary arrest, pulmonary aspiration during feeding tube administration, new cancer diagnosis, and congenital anomalies.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Placebo | Participants randomized to receive an inactive substance administered enterally for 5 days |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Re-hospitalization | General disorders | Non-systematic Assessment | Re-hospitalization within 30 days of study drug discontinuation |
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Limitations to generalizability of this pilot study include the small sample size and imbalances in chronic conditions between treatment arms at study entry.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Jenny Han, MD | Emory University | 404-616-0821 | jehan2@emory.edu |
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| ID | Term |
|---|---|
| D012131 | Respiratory Insufficiency |
| D003428 | Cross Infection |
| ID | Term |
|---|---|
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D007239 | Infections |
| D007049 | Iatrogenic Disease |
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| Enteral Vitamin D3 100,000IU | Drug | Enteral Vitamin D3 100,000IU over 5 days (total 500,000IU) |
|
| Inactive substance | Other | Inactive substance given enterally for 5 days. |
|
| 12 weeks |
| Duration of Time in Intensive Care Unit (ICU) | The number of days spent in the intensive care unit (ICU) was collected for each participant and the average number of days for each study arm is reported. | 12 weeks |
| Duration of Time in Hospital | The number of days that each participant spent in the hospital was collected and the average number of days for each study arm is reported. | 12 weeks |
| Change in Sequential Organ Failure Assessment (SOFA) Score | Change in Sequential Organ Failure Assessment (SOFA) score between Baseline and Day 7. The Sequential Organ Failure Assessment (SOFA) score is a mortality prediction score that is based on the degree of dysfunction of 6 organ systems (respiratory, nervous, cardiovascular, liver, coagulation, and kidneys). A score ranges from 0-24. 0 (normal) to 4 (high degree of dysfunction) is given for each organ system, with a higher score indicating greater severity. A score of 0-6 is associated with a mortality rate of less than 10% while a score between 16 and 24 is associated with a greater than 90% mortality rate. Scores decreasing between the Baseline and Day 7 measurements are represented as negative values for the change in SOFA score. | Baseline, Day 7 |
| Number of Hospital Acquired Infections | The number of study participants who had a hospital acquired infection. | 12 weeks |
| Number of Hospital Mortality Cases | The number of study participants who died while in the hospital was collected. | 12 weeks |
| Day 84 Mortality | The number of participants who died prior to the end of the study (Day 84) was collected. | Day 84 |
| Atlanta |
| Georgia |
| 30322 |
| United States |
| 20219962 | Background | Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010 May;91(5):1255-60. doi: 10.3945/ajcn.2009.29094. Epub 2010 Mar 10. |
| 20723187 | Background | Manaseki-Holland S, Qader G, Isaq Masher M, Bruce J, Zulf Mughal M, Chandramohan D, Walraven G. Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomised controlled trial. Trop Med Int Health. 2010 Oct;15(10):1148-55. doi: 10.1111/j.1365-3156.2010.02578.x. Epub 2010 Aug 17. |
| 17467345 | Background | Yim S, Dhawan P, Ragunath C, Christakos S, Diamond G. Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxyvitamin D(3). J Cyst Fibros. 2007 Nov 30;6(6):403-10. doi: 10.1016/j.jcf.2007.03.003. Epub 2007 Apr 27. |
| 16215847 | Background | De Smet K, Contreras R. Human antimicrobial peptides: defensins, cathelicidins and histatins. Biotechnol Lett. 2005 Sep;27(18):1337-47. doi: 10.1007/s10529-005-0936-5. |
| 20097832 | Background | Barlow PG, Beaumont PE, Cosseau C, Mackellar A, Wilkinson TS, Hancock RE, Haslett C, Govan JR, Simpson AJ, Davidson DJ. The human cathelicidin LL-37 preferentially promotes apoptosis of infected airway epithelium. Am J Respir Cell Mol Biol. 2010 Dec;43(6):692-702. doi: 10.1165/rcmb.2009-0250OC. Epub 2010 Jan 22. |
| 19389235 | Background | Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V. Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 2009 Apr 23;7:28. doi: 10.1186/1479-5876-7-28. |
| 27419080 | Derived | Han JE, Jones JL, Tangpricha V, Brown MA, Brown LAS, Hao L, Hebbar G, Lee MJ, Liu S, Ziegler TR, Martin GS. High Dose Vitamin D Administration in Ventilated Intensive Care Unit Patients: A Pilot Double Blind Randomized Controlled Trial. J Clin Transl Endocrinol. 2016 Jun;4:59-65. doi: 10.1016/j.jcte.2016.04.004. Epub 2016 May 5. |
| BG002 | 500,000 IU of Vitamin D3 | Participants randomized to receive 100,000 IU per day of Vitamin D3 for 5 days, for a total dose of 500,000 administered enterally |
| BG003 | Total | Total of all reporting groups |
| Participants |
|
| Gender | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Number | participants |
|
| Region of Enrollment | Number | participants |
|
| Vitamin D at baseline | Number | participants |
|
| Coronary Artery Disease | Number | participants |
|
| Congestive Heart Failure | Number | participants |
|
| Diabetes | Number | participants |
|
| Chronic Obstructive Pulmonary Disease (COPD) | Number | participants |
|
| Asthma | Number | participants |
|
Participants randomized to receive 50,000 IU of Vitamin D3 per day for 5 days, for a total dose of 250,000 IU administered enterally |
| OG002 | 500,000 IU of Vitamin D3 | Participants randomized to receive 100,000 IU per day of Vitamin D3 for 5 days, for a total dose of 500,000 administered enterally |
|
|
| Primary | Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 7 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 7 measurement. | Blood samples were obtained every 7 days while participants remained hospitalized. Follow up discontinued once the participant was discharged from the hospital. The number of participants analyzed at each time point decreased over the course of the study as participants were discharged from the hospital. | Posted | Number | participants | Day 7 |
|
|
|
| Primary | Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 14 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 14 measurement. | Blood samples were obtained every 7 days while participants remained hospitalized. Follow up discontinued once the participant was discharged from the hospital. The number of participants analyzed for each time point decreased over the course of the study as participants were discharged from the hospital. | Posted | Number | participants | Day 14 |
|
|
|
| Primary | Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 21 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 21 measurement. | Blood samples were obtained every 7 days while participants remained hospitalized. Follow up discontinued once the participant was discharged from the hospital. The number of participants analyzed at each time point decreased over the course of the study as participants were discharged from the hospital. | Posted | Number | participants | Day 21 |
|
|
|
| Primary | Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 28 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 28 measurement. | Blood samples were obtained every 7 days while participants remained hospitalized. Follow up discontinued once the participant was discharged from the hospital. The number of participants analyzed at each time point decreased over the course of the study as participants were discharged from the hospital. | Posted | Number | participants | Day 28 |
|
|
|
| Primary | Number of Participants With Plasma 25(OH)D Concentration >30ng/mL at Day 84 | The number of participants with a plasma 25(OH)D concentration in the desirable range (defined as greater than 30 ng/mL) at the Day 84 measurement. | Blood samples were obtained every 7 days while participants remained hospitalized. Follow up discontinued once the participant was discharged from the hospital. The number of participants analyzed at each time point decreased over the course of the study as participants were discharged from the hospital. | Posted | Number | participants | Day 84 |
|
|
|
| Secondary | Change in Plasma LL-37 Levels | Plasma LL-37 was measured at Baseline, Day 7 and Day 14. | For the Day 14 analysis there were 8 participants in the Placebo arm, 6 participants in the 250,000 of Vitamin D arm, and 5 participants in the 500,000 of Vitamin D arm. | Posted | Median | Inter-Quartile Range | ng/mL | Baseline, Day 7, Day 14 |
|
|
|
| Secondary | Duration of Time on Ventilator | The number of days spent on mechanical ventilation was collected for all study participants and the average number of days for each study arm is reported. | Posted | Mean | Standard Deviation | days | 12 weeks |
|
|
|
| Secondary | Duration of Time in Intensive Care Unit (ICU) | The number of days spent in the intensive care unit (ICU) was collected for each participant and the average number of days for each study arm is reported. | Posted | Mean | Standard Deviation | days | 12 weeks |
|
|
|
| Secondary | Duration of Time in Hospital | The number of days that each participant spent in the hospital was collected and the average number of days for each study arm is reported. | Posted | Mean | Standard Deviation | days | 12 weeks |
|
|
|
| Secondary | Change in Sequential Organ Failure Assessment (SOFA) Score | Change in Sequential Organ Failure Assessment (SOFA) score between Baseline and Day 7. The Sequential Organ Failure Assessment (SOFA) score is a mortality prediction score that is based on the degree of dysfunction of 6 organ systems (respiratory, nervous, cardiovascular, liver, coagulation, and kidneys). A score ranges from 0-24. 0 (normal) to 4 (high degree of dysfunction) is given for each organ system, with a higher score indicating greater severity. A score of 0-6 is associated with a mortality rate of less than 10% while a score between 16 and 24 is associated with a greater than 90% mortality rate. Scores decreasing between the Baseline and Day 7 measurements are represented as negative values for the change in SOFA score. | SOFA score obtained daily while in the ICU. The portion of the study participants included in the analysis of the change in SOFA score between Baseline and Day 7 is limited to participants having values for both time points.. | Posted | Mean | Standard Deviation | units on a scale | Baseline, Day 7 |
|
|
|
| Secondary | Number of Hospital Acquired Infections | The number of study participants who had a hospital acquired infection. | Posted | Number | participants | 12 weeks |
|
|
|
| Secondary | Number of Hospital Mortality Cases | The number of study participants who died while in the hospital was collected. | The number of participants in the hospital mortality analysis for the arm receiving 500,000 IU of Vitamin D3 was 10, rather than 11. | Posted | Number | participants | 12 weeks |
|
|
|
| Secondary | Day 84 Mortality | The number of participants who died prior to the end of the study (Day 84) was collected. | The number of participants in the hospital mortality analysis for the arm receiving 500,000 IU of Vitamin D3 was 10, rather than 11, as one participant withdrew. | Posted | Number | participants | Day 84 |
|
|
|
| 1 |
| 10 |
| 0 |
| 10 |
| EG001 | 250,000 IU of Vitamin D3 | Participants randomized to receive 50,000 IU of Vitamin D3 per day for 5 days, for a total dose of 250,000 IU administered enterally. | 1 | 9 | 0 | 9 |
| EG002 | 500,000 IU of Vitamin D3 | Participants randomized to receive 100,000 IU per day of Vitamin D3 for 5 days, for a total dose of 500,000 administered enterally. | 2 | 11 | 0 | 11 |
|
| Death | General disorders | Non-systematic Assessment | Death within 30 days of study drug discontinuation |
|
| Cardiopulmonary arrest | Cardiac disorders | Non-systematic Assessment | Cardiopulmonary arrest |
|
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| D020969 |
| Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
|