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| Name | Class |
|---|---|
| Region Skane | OTHER |
| Lund University | OTHER |
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Blood samples are collected and stored in a biobank for later analysis of circulating substances in peripheral blood and genetic variations in patients with severe critical illness and risk of death. The aim is to analyze stored samples in order to identify substances that can help predict the outcome of critically ill patients, but also to optimize treatment and possibly prevent serious illness and death in the future.
SWECRIT is a regional, multicenter study with prospective collection of blood samples and background information from critically ill patients, admitted to an Intensive Care Unit (ICU) in Region Skåne, Sweden. Patients were originally categorized into four study cohorts a) cardiac arrest, b) sepsis, c) influenza, and d) trauma. In April of 2020, a fifth study cohort, covid19, was added to the original ones. In addition, a control group of healthy controls has been enrolled.
Diagnoses, disease course, treatment results and survival are prospectively collected from all critically ill patients in the Patient Administrative System for Intensive Care Units (PASIVA). PASIVA is the portal by which collected laboratory and physiological data are entered into the Swedish Intensive Care Register (SIR). Further data are collected retrospectively from other health-related registers, such as the Swedish Population Register, the International Cardiac Arrest Registry (INTCAR), The Swedish CPR Registry, the Swedish Trauma Registry (SweTrau), and the Regional quality register Covid-IR (covid19 disease).
Specifically for the covid19-cohort, detailed face-to-face follow-up will be performed of all survivors at 3 & 12 months and a telephone interview after 3 years. Questionnaires (see below) will be sent to patients prior to the follow-up. Questions about well-being in general, quality-of-life, sleeping disorders, psychological and psychiatric problems will be addressed.
Collected blood samples in the ICU are processed by clinical chemistry at each participating hospital and frozen specimens of whole blood, serum, and plasma (200 ul aliquots) are sent to the biobank BD-47 in Region Skane for long-term storage (maximum 20 years).
The circulating substances and genetic markers, i.e. biomarkers that will be analyzed are: proteins (markers of inflammation, stress, infection, neurologic injury, myocardial injury and endothelial function) and other circulating substances in the blood (metabolomics), genes (DNA) from the entire genome, epigenetic changes (eg methylation status of DNA), gene fragments (eg secretory DNA), various forms of RNA such as micro-RNA & longcoding RNA.
Research questions for future analyzes of collected samples are specified but subject to change, depending on progress and development in the specific research field of each study cohort.
Inquiries to access the sample collection for research purpose can be sent to the central contacts listed below.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Critically Ill | Critically ill patients and patients in need of post-operative intensive care. |
| |
| Cardiac Arrest | Cardiac Arrest according to the ICD-10 I469 diagnosis. |
| |
| Sepsis | Sepsis according to the sepsis-3 criteria. |
| |
| Covid-19 | Critically ill patients with a positive Covid-19 test. |
| |
| Influenza | Critically ill patients with a positive influenza test. |
| |
| Trauma | Critically ill patients after a severe traumatic event. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Blood collection | Diagnostic Test | Sampling on admission to ICU (all patients) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Mortality (all) | Primary outcome when functional outcome cannot be assessed. | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients with good neurological outcome 1 (all) | Neurological outcome assessed using Cerebral Performance Category 1-5 (CPC 1-5), CPC 1 representing the best and CPC 5 the worst outcome. Good outcome is defined as CPC 1-2, poor outcome as CPC 3-5. | 3-6 months |
| Proportion of patients with good neurological outcome 2 (all) |
| Measure | Description | Time Frame |
|---|---|---|
| Severity of the Acute Respiratory Distress Syndrome (ARDS) (covid19) | Patients fulfilling the ARDS criteria are categorized into mild, moderate or severe, depending on the ratio of arterial oxygen partial pressure (mmHg) to fractional inspired oxygen (FiO2). Mild: < 300, Moderate: < 200, Severe: < 100. | On ICU admission |
Inclusion Criteria:
Exclusion Criteria:
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All critically ill patients admitted to the participating ICUs in Region Skane (2015-2018), and a healthy control group.
Starting in May 2020, critically ill Covid-19 patients admitted to an ICU in the Skane Region are prospectively included.
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| Name | Affiliation | Role |
|---|---|---|
| Hans Friberg, MD, PhD | Skane University Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Helsingborg Hospital | Helsingborg | Sweden | ||||
| Kristianstad Central Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32463121 | Background | Lengquist M, Lundberg OHM, Spangfors M, Annborn M, Levin H, Friberg H, Frigyesi A. Sepsis is underreported in Swedish intensive care units: A retrospective observational multicentre study. Acta Anaesthesiol Scand. 2020 Sep;64(8):1167-1176. doi: 10.1111/aas.13647. Epub 2020 Jun 18. | |
| 33148300 | Background | Lundberg OHM, Lengquist M, Spangfors M, Annborn M, Bergmann D, Schulte J, Levin H, Melander O, Frigyesi A, Friberg H. Circulating bioactive adrenomedullin as a marker of sepsis, septic shock and critical illness. Crit Care. 2020 Nov 4;24(1):636. doi: 10.1186/s13054-020-03351-1. |
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| ID | Term |
|---|---|
| D016638 | Critical Illness |
| D006323 | Heart Arrest |
| D018805 | Sepsis |
| D007251 | Influenza, Human |
| D000086382 | COVID-19 |
| D014947 | Wounds and Injuries |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006331 | Heart Diseases |
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| ID | Term |
|---|---|
| D001800 | Blood Specimen Collection |
| ID | Term |
|---|---|
| D013048 | Specimen Handling |
| D019411 | Clinical Laboratory Techniques |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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Whole blood, plasma, and serum are stored at -80°C in the biobank BD-47 at IDEON, Lund, Sweden.
| Healthy controls | Healthy at the time of blood sampling |
|
| Blood collection, serial sampling | Diagnostic Test | Additional sampling to admission samples in
|
|
Modified Rankin Score 0-6 (mRS 0-6), mRS 0 representing the best and mRS 6 representing the worst outcome. Good outcome is defined as mRS 0-3, poor outcome as mRS 3-6. |
| 3-6 months |
| Neurological outcome 3 (covid19) | Glasgow Outcome Scale Extended 1-8 (GOSE 1-8), GOSE 1 representing the worst outcome and GOSE 8 the best outcome. | 3-6 months |
| Proportion of patients with pathological Pulmonary Function Testing (PFT) |
A composite of Total Lung Capacity (TLC) & Diffusion capacity (DLCO) compared to a population norm. Less than 80 % of the (age-adjusted) population norm is considered pathological. |
| 3 and 12 months |
| Subjective respiratory function (covid19) | Saint George's Respiratory Questionnaire 0-100 (SGRQ 0-100), lower values representing better function and higher values representing worse function. 8.41 (SD 11.33) is considered a normative value (Spanish population). | 3, 12 and 36 months |
| Physical problems (covid19) | Short form Health Survey, version 2, physical function 10 (SF-36 v.2 PF-10), 10 items, higher score for each item represents better function. Scores are transformed to T-scores based on norm-based values. A T-score of 50 indicates the norm mean for each item. At a group level scores <47 and individual scores <45 indicate low physical function. | 3, 12 and 36 months |
| Proportion of patients with significant Fatigue (covid19) | Modified fatigue impact scale 0-84 (MFIS 0-84), higher values representing more fatigue and lower numbers representing less fatigue. A value >38 discriminates significant fatigue. | 3, 12 and 36 months |
| Hospital Anxiety and Depression Scale (covid19) | Anxiety and depression. Two sub-scales with 7 items in each, higher values represent more anxiety and depression, >8 points in each sub-scale indicates significant symptoms of anxiety and depression. | 3, 12 and 36 months |
| Kristianstad |
| Sweden |
| Skane University Hospital | Lund | Sweden |
| Skane University Hospital | Malmö | Sweden |
| 33930500 | Background | Thorgeirsdottir B, Levin H, Spangfors M, Annborn M, Cronberg T, Nielsen N, Lybeck A, Friberg H, Frigyesi A. Plasma proenkephalin A 119-159 and dipeptidyl peptidase 3 on admission after cardiac arrest help predict long-term neurological outcome. Resuscitation. 2021 Jun;163:108-115. doi: 10.1016/j.resuscitation.2021.04.021. Epub 2021 Apr 27. |
| 32731878 | Background | Johnsson J, Bjornsson O, Andersson P, Jakobsson A, Cronberg T, Lilja G, Friberg H, Hassager C, Kjaergard J, Wise M, Nielsen N, Frigyesi A. Artificial neural networks improve early outcome prediction and risk classification in out-of-hospital cardiac arrest patients admitted to intensive care. Crit Care. 2020 Jul 30;24(1):474. doi: 10.1186/s13054-020-03103-1. |
| 41706661 | Derived | Didriksson I, Toniste D, Hultgren M, Spangfors M, Gobel Andertun S, Nelderup M, Reepalu A, Frigyesi A, Friberg H, Lilja G. Three-year functional, physical, and mental health outcomes after critical COVID-19: A prospective multicentre cohort study. PLoS One. 2026 Feb 18;21(2):e0341319. doi: 10.1371/journal.pone.0341319. eCollection 2026. |
| 40836345 | Derived | Arctaedius I, Wasselius J, Lang M, Drake M, Johnsson M, Friberg H, Leithner C, Kenda M, Lybeck A, Moseby-Knappe M. The semi-quantitative cardiac arrest brain ischemia (CABI) score for magnetic resonance imaging predicts functional outcome after cardiac arrest. Crit Care. 2025 Aug 20;29(1):373. doi: 10.1186/s13054-025-05595-1. |
| 39540322 | Derived | Didriksson I, Frigyesi A, Spangfors M, Leffler M, Reepalu A, Nilsson AC, Annborn M, Lybeck A, Friberg H, Lilja G. Long-term recovery in critically ill COVID-19 survivors: A prospective cohort study. Acta Anaesthesiol Scand. 2025 Jan;69(1):e14550. doi: 10.1111/aas.14550. |
| 38982551 | Derived | Didriksson I, Lengquist M, Spangfors M, Leffler M, Sievert T, Lilja G, Frigyesi A, Friberg H, Schiopu A. Increasing plasma calprotectin (S100A8/A9) is associated with 12-month mortality and unfavourable functional outcome in critically ill COVID-19 patients. J Intensive Care. 2024 Jul 9;12(1):26. doi: 10.1186/s40560-024-00740-4. |
| 38059722 | Derived | Arctaedius I, Levin H, Larsson M, Friberg H, Cronberg T, Nielsen N, Moseby-Knappe M, Lybeck A. 2021 European Resuscitation Council/European Society of Intensive Care Medicine Algorithm for Prognostication of Poor Neurological Outcome After Cardiac Arrest-Can Entry Criteria Be Broadened? Crit Care Med. 2024 Apr 1;52(4):531-541. doi: 10.1097/CCM.0000000000006113. Epub 2023 Dec 7. |
| D002318 | Cardiovascular Diseases |
| D007239 | Infections |
| D018746 | Systemic Inflammatory Response Syndrome |
| D007249 | Inflammation |
| D012141 | Respiratory Tract Infections |
| D009976 | Orthomyxoviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D012140 | Respiratory Tract Diseases |
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D008171 | Lung Diseases |
| D011677 | Punctures |
| D013514 | Surgical Procedures, Operative |
| D008919 | Investigative Techniques |