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Statins for Acutely Injured Lungs From Sepsis (SAILS)

This study has been terminated.
(stopped for futility)
Sponsor:
Information provided by (Responsible Party):
National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier:
NCT00979121
First received: September 16, 2009
Last updated: October 2, 2014
Last verified: August 2014
  Purpose

Objective: assess the efficacy and safety of oral rosuvastatin in patients with sepsis-induced Acute Lung Injury (ALI).

Hypothesis: Rosuvastatin therapy will improve mortality in patients with sepsis-induced ALI.


Condition Intervention Phase
Sepsis
Acute Lung Injury
Drug: Rosuvastatin
Drug: Placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title: Randomized Trial of Rosuvastatin for Acutely Injured Lungs From Sepsis

Resource links provided by NLM:


Further study details as provided by National Heart, Lung, and Blood Institute (NHLBI):

Primary Outcome Measures:
  • Hospital Mortality to Day 60. [ Time Frame: 60 days after randomization ] [ Designated as safety issue: No ]
    The percentage of subjects alive at study day 60. Those subjects discharged home prior to day 60 were counted as alive at day 60.


Secondary Outcome Measures:
  • Ventilator Free Days at Study Day 28 [ Time Frame: time of initiating unassisted breathing to day 28 after study randomization ] [ Designated as safety issue: No ]
    Ventilator Free Days (VFDs) to day 28 were defined as the number of days from the time of initiating unassisted breathing to day 28 after randomization, assuming survival for at least two consecutive calendar days after initiating unassisted breathing and continued unassisted breathing to day 28. If a subject received assisted breathing at day 27 or died prior to day 28, a value of zero VFDs was given.


Other Outcome Measures:
  • Organ Failure Free Days at Day 14 [ Time Frame: 14 days after randomization ] [ Designated as safety issue: No ]
    The number of days from randomization to day 14 without an organ failure. Four main organ systems were measured: cardiovascular, coagulation, hepatic function, and renal function.

  • ICU Free Days to Day 28 [ Time Frame: 28 days after randomization ] [ Designated as safety issue: No ]
  • Other Secondary Out-comes [ Time Frame: 28 days after randomization ] [ Designated as safety issue: No ]
    Percentage of subjects with Arrhythmia's, Bowel Ischemia, Myocardial Infarction, Ischemic Stroke, and Thromboembolism were measured.

  • Changes in Plasma Concentrations of C-reactive Protein (CRP) From Baseline to Day 6 and Day 14 [ Time Frame: 6 and 14 days after randomization ] [ Designated as safety issue: No ]
    CRP levels were collected on subjects at baseline and on-study. The change in concentration from baseline levels to levels on study days 6 and 14 was analyzed. Those subjects that were still alive and on study at day 6 and 14 with a measured CRP level were included in the analysis.


Enrollment: 745
Study Start Date: January 2010
Study Completion Date: November 2013
Primary Completion Date: November 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Rosuvastatin

Half of the subjects were randomized to the active drug (Rosuvastatin).

Dosage, Form, and Frequency: drug was provided as 10mg tablets and administered through an enteral feeding tube or orally (following extubation when patients were able to safely take oral medications). An initial 40mg loading dose was administered followed by a daily 20 mg maintenance dose. Maintenance dosing was adjusted for renal failure not compensated by renal replacement therapy.

Duration: drug was administered daily until:

  1. 28 days after randomization or 3 days after ICU discharge (whichever comes first),
  2. Discharge from study hospital,
  3. Death
Drug: Rosuvastatin
Subjects received an initial 40mg loading dose followed by 20 mg of study drug daily by mouth or feeding tube for 28 days or until discharged from the study hospital.
Other Name: Crestor
Placebo Comparator: Placebo

Half of the subjects were randomized to placebo.

10mg tablets identical to active drug were administered through an enteral feeding tube or orally (following extubation when patients were able to safely take oral medications). Dosage, frequency, and duration was provided in the same manner as the active drug.

Drug: Placebo
Subjects received placebo by mouth or feeding tube daily for 28 days or until discharged from study hospital.

Detailed Description:

Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) involves extensive inflammation in the lungs that can lead to rapid respiratory failure. These conditions are most commonly caused by pneumonia, generalized infection, or severe trauma to the lungs, but can also be less commonly caused by smoke or salt water inhalation, drug overdose, or shock.

For some people, ALI/ARDS resolves without treatment, but many severe cases result in hospitalization in the intensive care unit (ICU), where 30% to 40% of cases end in mortality. Current treatments for ALI/ARDS include assisted breathing with a ventilator, supportive care, and management of the underlying causes.

Upon admission to the ICU, Rosuvastatin or placebo was administered through an enteral feeding tube or administered orally following extubation when patients were able to safely take oral medications. The type and placement of the enteral feeding tube (nasogastric, nasoenteric, PEG, orogastric, oroenteric, etc.) and the ability to safely take oral medications was determined by the patient's primary team. Study drug was blinded with an identical appearing placebo. The first study drug dose (rosuvastatin or placebo) was administered within 4 hours of randomization as a loading dose of 40 mg.

Blood pressure, heart rate, ventilation settings, and various blood factors were measured during treatment. Phone-based follow-up assessments occurred at months 6 and 12 after ICU discharge and included measurements of health-related quality of life; psychological, neurocognitive, and physical activity outcomes; healthcare utilization; and mortality.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 1. Systemic inflammatory response syndrome (SIRS) defined as meeting at least criteria (a) or (b)for a systemic inflammatory response:

    1. White blood cell count >12,000 or <4,000 or >10% band forms
    2. Body temperature >38 degrees Celsius (C) (any route) or <36 degrees C (accepting core temperatures only; indwelling catheter, esophageal, rectal)
    3. Heart rate (> 90 beats/min) or receiving medications that slow heart rate or paced rhythm 2. Suspected or proven infection: Sites of infection include thorax, urinary tract, abdomen, skin, sinuses, central venous catheters, and bacterial meningitis (Appendix A).

      3. ALI as defined by acute onset of:

    1. PaO2 / FiO2 ≤ 300 (intubated). If altitude > 1000m, then PaO2 / FiO2 ≤ 300 x (PB/760), and
    2. Bilateral infiltrates consistent with pulmonary edema on frontal chest radiograph, and
    3. Requirement for positive pressure ventilation via an endotracheal tube, and
    4. No clinical evidence of left atrial hypertension, or if measured, a Pulmonary Arterial Wedge Pressure (PAOP) less than or equal to 18 mm Hg. If a patient has a PAOP > 18 mmHg, then the other criteria must persist for more than 12 hours after the PAOP has declined to ≤ 18 mmHg, and still be within the 48-hour enrollment window.

"Acute onset" is defined as follows: the duration of the hypoxemia criterion (#1) and the chest radiograph criterion (#2) must be ≤ 28 days at the time of randomization. Opacities considered "consistent with pulmonary edema" include any patchy or diffuse opacities not fully explained by mass, atelectasis, or effusion or opacities known to be chronic (> 28 days). The findings of vascular redistribution, indistinct vessels, and indistinct cardiac borders are not considered "consistent with pulmonary edema".

All ALI criteria (3a-d above) must occur within the same 24 hour period. The onset of ALI is when the last ALI criterion is met. Patients must be enrolled within 48 hours of ALI onset and no more than 7 days from the initiation of mechanical ventilation. SIRS criteria must occur within the 72 hours before or the 24 hours after ALI onset. Information for determining when these time window criteria were met may come from either the Network hospital or a referring hospital reports.

Exclusion Criteria:

  1. No consent/inability to obtain consent
  2. Age less than 18 years
  3. More than 7 days since initiation of mechanical ventilation
  4. More than 48 hours since meeting ALI inclusion criteria
  5. Patient, surrogate, or physician not committed to full support ).
  6. Unable to receive or unlikely to absorb enteral study drug
  7. Rosuvastatin specific exclusions

    • Receiving a statin medication within 48 hours of randomization
    • Allergy or intolerance to statins
    • Physician insistence for the use or avoidance of statins during the current hospitalization
    • Creatine Kinase (CK) , alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 5 times the upper limit of normal
    • Diagnosis of hypothyroidism and not on thyroid replacement therapy
    • Pregnancy or breast feeding
    • Receiving niacin, fenofibrate or cyclosporine, gemfibrozil, atazanavir, lopinavir, ritonavir, daptomycin
  8. Severe chronic liver disease
  9. Moribund patient not expected to survive 24 hours
  10. Chronic respiratory failure defined as PaCO2 > 60 mm Hg in the outpatient setting
  11. Home mechanical ventilation (noninvasive ventilation or via tracheotomy) except for CPAP/BIPAP (Continuous Positive Airway Pressure/BiLevel Positive Airway Pressure) used solely for sleep-disordered breathing
  12. Diffuse alveolar hemorrhage from vasculitis
  13. Burns > 40% total body surface
  14. Interstitial lung disease of severity sufficient to require continuous home oxygen therapy
  15. Unwillingness or inability to utilize the ARDS network 6 ml/kg Predicted Body Weight (PBW) ventilation protocol
  16. Cardiac disease classified as NYHA (New York Heart Association) class IV
  17. Myocardial infarction within past 6 months
  18. Intraparenchymal Central Nervous System (CNS) bleed within a month of randomization.
  19. Temperature >40.3 C in the 6 hours before randomization
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00979121

  Hide Study Locations
Locations
United States, California
University of San Francisco-Fresno Medical Center
Fresno, California, United States
University of California, Davis Medical Center
Sacramento, California, United States
UCSF-Moffitt Hospital
San Francisco, California, United States
University of California, San Francisco (UCSF)-Moffitt Hospital
San Francisco, California, United States
United States, Colorado
Centura St. Anthony Central Hospital
Denver, Colorado, United States
Denver Health Medical Center
Denver, Colorado, United States
Rose Medical Center
Denver, Colorado, United States
University of Colorado Health Sciences Center
Denver, Colorado, United States
United States, District of Columbia
Washington Hospital Center
Washington DC, District of Columbia, United States
United States, Louisiana
Baton Rouge General Hospital-Blue Bonnet
Baton Rouge, Louisiana, United States
Baton Rouge General Hospital-Midcity
Baton Rouge, Louisiana, United States
Earl K. Long Medical Center
Baton Rouge, Louisiana, United States
Our Lady of the Lake Regional Medical Center
Baton Rouge, Louisiana, United States
Medical Center of Louisiana
New Orleans, Louisiana, United States
Ochsner Clinic Foundation
New Orleans, Louisiana, United States
Tulane University Health Sciences Center
New Orleans, Louisiana, United States
United States, Maryland
Johns Hopkins Hospital
Baltimore, Maryland, United States
University of Maryland Shock Trauma Center
Baltimore, Maryland, United States
Johns Hopkins Bayview Medical Center
Baltimore, Maryland, United States
United States, Massachusetts
Baystate Medical Center
Springfield, Massachusetts, United States
United States, Minnesota
Rochester Methodist Hospital
Rochester, Minnesota, United States
St. Mary's Hospital, Mayo Clinic
Rochester, Minnesota, United States
United States, North Carolina
Durham Regional Medical Center
Durham, North Carolina, United States
Duke University Medical Center
Durham, North Carolina, United States
Wesley Long Community Hospital
Greensboro, North Carolina, United States
Moses Cone Health System
Greensboro, North Carolina, United States
Wake Forest University Baptist Medical Center
Winston Salem, North Carolina, United States
United States, Ohio
Cleveland Clinic Foundation
Cleveland, Ohio, United States
MetroHealth Medical Center
Cleveland, Ohio, United States
University Hospitals of Cleveland
Cleveland, Ohio, United States
United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States
United States, Texas
Baylor College of Medicine
Houston, Texas, United States
United States, Utah
Intermountain Medical Center
Murray, Utah, United States
McKay-Dee Hospital
Ogden, Utah, United States
Utah Valley Regional Medical Center
Provo, Utah, United States
LDS Hospital
Salt Lake City, Utah, United States
United States, Virginia
University of Virginia Medical Center
Charlottesville, Virginia, United States
United States, Washington
Providence Hospital
Everett, Washington, United States, 98201
Harborview Medical Center
Seattle, Washington, United States
University of Washington
Seattle, Washington, United States
Sponsors and Collaborators
Investigators
Study Chair: Jonathon Truwit, MD University of Virginia, Medical Center
  More Information

Additional Information:
No publications provided by National Heart, Lung, and Blood Institute (NHLBI)

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier: NCT00979121     History of Changes
Other Study ID Numbers: 670, N01HR056179
Study First Received: September 16, 2009
Results First Received: August 22, 2014
Last Updated: October 2, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by National Heart, Lung, and Blood Institute (NHLBI):
ALI
Sepsis
statin

Additional relevant MeSH terms:
Rosuvastatin
Acute Lung Injury
Lung Injury
Respiratory Distress Syndrome, Adult
Sepsis
Toxemia
Infection
Inflammation
Lung Diseases
Pathologic Processes
Respiration Disorders
Respiratory Tract Diseases
Systemic Inflammatory Response Syndrome
Thoracic Injuries
Wounds and Injuries
Anticholesteremic Agents
Antimetabolites
Enzyme Inhibitors
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypolipidemic Agents
Lipid Regulating Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on November 27, 2014