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Cholinesterase Activity and DeliriUm During Critical Illness Study (CADUCeuS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03098472
Recruitment Status : Active, not recruiting
First Posted : March 31, 2017
Last Update Posted : February 6, 2020
Sponsor:
Collaborator:
DR. FRANZ KOHLER CHEMIE GMBH
Information provided by (Responsible Party):
Christopher Hughes, Vanderbilt University Medical Center

Brief Summary:
Delirium is a syndrome of acute brain dysfunction involving attention and cognition that affects up to half of older hospitalized patients and 50%-75% of critically ill ICU patients, such that millions of patients worldwide experience this acute threat to their health and well being every year. One-third to half of critical illness survivors struggle with a dementia-like disorder similar in severity to moderate-to-severe traumatic brain injury or Alzheimer's Disease, and the only proven risk factor that is potentially modifiable is delirium in the ICU. Despite the frequency and impact of delirium in the ICU, little is known regarding the biological mechanisms that lead to this form of organ dysfunction during critical illness. A widely held hypothesis proposes that inflammation is regulated by the cholinergic system, and that this interaction plays a pivotal role whether delirium developments in the setting of acute illness. Acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) are enzymes that hydrolyze the neurotransmitter acetylcholine. Changes in the activity of these enzymes, which can be measured in whole blood, reflect altered regulation of circulating acetylcholine. AChE and BuChE activities have promise as both predictors of delirium (when found to be low at admission) and biomarkers of delirium (when low during serial measurement). Neither of these biomarkers, however, have been studied in the ICU setting where delirium risk is the highest. The current investigation, therefore will be the first to determine the validity of circulating AChE and BuChE activities as biomarkers of delirium during critical illness and subsequent cognitive impairment after discharge. This study will measure whole blood AChE and butyrylcholinesterase BuChE activities within the framework of the ICU Delirium and Cognitive Impairment Study Group's ongoing clinical trials in critically ill patients.

Condition or disease
Delirium Cognitive Impairment

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Study Type : Observational
Actual Enrollment : 279 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Cholinesterase Activity and Delirium During Critical Illness Study
Actual Study Start Date : May 8, 2017
Actual Primary Completion Date : January 1, 2020
Estimated Study Completion Date : January 1, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Delirium




Primary Outcome Measures :
  1. Delirium [ Time Frame: During hospital stay until death or hospital discharge, whichever comes first, up to 30 days ]
    Confusion Assessment Method for the ICU


Secondary Outcome Measures :
  1. Global cognition [ Time Frame: At 3, 6, and/or 12 months after hospital discharge up to 18 months after discharge ]
    Neuropsychological battery


Other Outcome Measures:
  1. Activities of daily living [ Time Frame: At 3, 6, and/or 12 months after hospital discharge up to 18 months after discharge ]
    Katz Index of Independence in Activities of Daily Living

  2. Instrumental activities of daily living [ Time Frame: At 3, 6, and/or 12 months after hospital discharge up to 18 months after discharge ]
    Functional activities questionnaire

  3. Quality of life and generic health status [ Time Frame: At 3, 6, and/or 12 months after hospital discharge up to 18 months after discharge ]
    EQ-5D

  4. Coma [ Time Frame: During hospital stay until death or hospital discharge, whichever comes first, up to 30 days ]
    Richmond Agitation Sedation Scale



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
The study will include all patients in the ICU Delirium and Cognitive Impairment Study Group's ongoing clinical trials over a two-year period of time.
Criteria

Inclusion Criteria:

  • English-speaking adults (>18 years of age) treated for acute respiratory failure (with mechanical ventilation or non-invasive positive pressure ventilation [NIPPV]) and/or shock (with vasopressors) in a medical and/or surgical ICU at Vanderbilt University Medical Center enrolled in an ICU Delirium and Cognitive Impairment Study Group's clinical trials. Exclusion criteria for the parent studies are summarized below. No additional exclusion criteria are required for this investigation.

Exclusion Criteria:

  • Expected death within 24 hours of enrollment or lack of commitment to aggressive treatment by family or the medical team (e.g., likely withdrawal of life support measures within 24 hours of screening)
  • Active substance abuse, psychotic disorder, or homelessness without a secondary contact person (which would make long-term follow-up difficult)
  • Blindness or deafness (which would prevent assessment of the study's outcomes)
  • Inability to obtain informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03098472


Locations
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United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States, 37212
Sponsors and Collaborators
Vanderbilt University Medical Center
DR. FRANZ KOHLER CHEMIE GMBH
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Responsible Party: Christopher Hughes, Associate Professor of Anesthesiology, Vanderbilt University Medical Center
ClinicalTrials.gov Identifier: NCT03098472    
Other Study ID Numbers: CADUCeuS
First Posted: March 31, 2017    Key Record Dates
Last Update Posted: February 6, 2020
Last Verified: February 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Additional relevant MeSH terms:
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Delirium
Critical Illness
Neurocognitive Disorders
Mental Disorders
Confusion
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Disease Attributes
Pathologic Processes