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Septic ShockNCT05315557

Efficacy and Safety of Vasopressin Versus Terlipressin as a Second Vasopressor in Critically Ill Cirrhotics With Septic Shock- the VITEL-C Trial

A study testing Terlipressin and vasopressin in people with Septic Shock and Cirrhosis, Liver, run by Institute of Liver and Biliary Sciences, India at 1 site in India.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Sepsis is a life-threatening organ dysfunction caused by dysregulated host response. A Subset of sepsis is septic shock which has almost 4-6 times the mortality when compared to sepsis. Septic shock has underlying cellular and metabolic abnormalities in addition to circulatory dysfunction. Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Septic Shock, Cirrhosis, Liver
What is being tested?
Terlipressin and vasopressin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 siteIndia
Study dates
5 Apr 2022to 31 Mar 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-70yrs
  • An informed consent from the patient or relative

Who cannot join

  • Age <18 years and > 70 years
  • Stroke
  • Severe sepsis requiring higher dose of noradrenaline (>1mcg/Kg/min)
  • Myocardial dysfunction, Coronary artery disease, Arrhythmias
  • Peripheral Vascular disease
  • Gut Paralysis
Show all 20Show fewer
  • Acute on chronic liver failure (ACLF)
  • Hepato-cellular carcinoma (HCC), intrahepatic or extrahepatic malignancy
  • Complete portal vein thrombosis
  • Hepatic vein outflow tract obstruction (HVOTO)
  • Pregnancy
  • Patients with Pa02/FiO2 ratio <150
  • CKD
  • COPD
  • Severe coagulopathy - platelets <20,000 and INR > 4
  • Active Bleed or DIC
  • Patients already on terlipressin or vasopressin in the last 48 hours
  • Extremely moribund patients with an expected life expectancy of less than 24 hours
  • Failure to give informed consent from family members.
  • Patient enrolled in other clinical trial

Trial locations and contacts

1 site in 1 country.

Dr Vishnu Girish, MD contact

01146300000

vishnugirish@gmail.com

India1 site
  • Institute of Liver & Biliary Sciences

    New Delhi, National Capital Territory of Delhi, 110070

    Dr Vishnu Girish, MD, 01146300000, vishnugirish@gmail.com

Other trials in India

About this study

Official title: Efficacy and Safety of Vasopressin Versus Terlipressin as a Second Vasopressor in Critically Ill Cirrhotics With Septic Shock- the VITEL-C Trial.

Sepsis is a life-threatening organ dysfunction caused by dysregulated host response. A Subset of sepsis is septic shock which has almost 4-6 times the mortality when compared to sepsis. Septic shock has underlying cellular and metabolic abnormalities in addition to circulatory dysfunction. The circulatory dysfunction in sepsis is in the form of severe vasodilatation with high cardiac index. Cirrhosis is a state of hyperdynamic circulation. The mortality of septic shock in these group of patients is still higher.

At the onset of septic shock there is initially an increased secretion of Arginine vasopressin. However, this initial rise is short lasting, and the vasopressin levels come back to normal or low serum levels with continued hypotension. However, even normal levels are too low for the degree of hypotension in septic shock. This causes a relative deficiency of vasopressin in septic shock. The exact time when this fall happens is not known and it is likely to be variable. Vasopressin was therefore tried as an agent in septic shock. Terlipressin is a synthetic analogue of vasopressin. It has a greater selectivity for the V1 receptor. Terlipressin is also shown to be effective in septic shock in cirrhotics3. Other vasoactive agents are not preferred in cirrhotics - dopamine due to high risk of arrhythmias and dobutamine as baseline cardiac output of cirrhotics is high which further increases in sepsis and dobutamine would further add to it. However, it may be given in myocardial dysfunction. Noradrenaline is recommended as the first vasopressor to be started in general in septic shock population. No study has compared the effectiveness of vasopressin and Terlipressin when added to noradrenaline in patients with cirrhosis. Acute kidney injury is a very common complication of septic shock in cirrhotics.

Read the detailed description

Hypothesis: We hypothesise that vasopressin would be non-inferior to terlipressin as a second vasopressor in critically ill cirrhotics with septic shock and would have lesser adverse effects when compared to terlipressin.

Aim: To compare the efficacy of adding continuous infusion of terlipressin versus vasopressin to noradrenaline in causing improvement in systemic hemodynamics and microcirculation.

Methodology:

Study population:

  1. Critically ill cirrhotic - Defined as a cirrhotic patient who presents with at least one organ failure, defined by SOFA score WITH
  2. septic shock - Defined as a patient in septic shock after initial fluid resuscitation and antibiotic administration, requiring a noradrenaline of at least 2.6mcg/min to maintain a MAP more than 65mmHg.

Study design: Prospective open label randomised controlled study. The study will be conducted in Department of Hepatology ILBS- intensive care unit.

Study period: 1 year

Sample size: Based on the previous studies it is assumed that terlipressin + noradrenaline group would give a response rate of 93%, it was assumed that vasopressin and noradrenaline would give a response rate 15% less than the terlipressin and noradrenaline group and a response rate of 78% was assumed. Further considering an alpha error of 5% and power 95% with a non-inferiority margin of 10% we need to enroll 82 cases Assuming a 10% dropout rate we need to enroll 90 cases with 45 in each arm. However, we decided to enroll 100 cases randomized into 2 groups, 50 each by block randomization method by taking a block size of 10

Patients will be evaluated in the Emergency Room. Detailed history and clinical examination and investigation accordingly will be sent when septic shock is clinically suspected

Fluid Resuscitation Initially a 16G peripheral line will be placed. CVP line and arterial line preferably in the radial artery will be placed as soon as possible.

5% albumin will be used as the resuscitation fluids according to the FRISC protocol.

Fluid response will be assessed at the end of 1 hour

Antibiotics Antibiotics will be given according to the institutional policy

Vasopressors Noradrenaline will be started at a dose of 0.05mcg/kg/min and titrated. All the infusions will be given via central line placed in the jugular, subclavian or femoral vein by a critical care expert under USG guidance.

Intervention:Patients after screening for all exclusion criteria will be randomised into 2 arms (group-1, Terlipressin arm) and (group-2, Vasopressin arm) in a ratio 1:1

  • STATISTICAL ANALYSIS: Continuous data- Student's t test
  • Nonparametric analysis- Mann Whitney test
  • Survival outcome By Kaplan-Meier method curve.
  • For all tests, p≤ 0.05 will be considered statistically significant.
  • Analysis will be performed using SPSS.
  • The analysis will be done with intention to treat and per protocol analysis if applicable.

Stopping rule: Side effects or toxicities that are severe -arrhythmia, AMI, Cardiomyopathy (defined later) Cyanosis.

  • Suspicion or confirmed bowel ischemia.
  • Patient unwilling for further hospital stay.
  • Study unrelated complication here the drug effects could not be assessed (massive
  • GI bleed uncontrolled, bowel perforation or any surgical intervention).
Being tested
Terlipressin, vasopressin
Medical subject headings
Shock, Septic, Liver Cirrhosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TerlipressinDrug

    1mg/24 hour and titrate according to MAP

  • vasopressinDrug

    0.03 U/hour and titrate according to MAP

Study groups in NCT05315557
Study groupRoleWhat they receive
TerlipressinExperimentalTerlipressin 1mg/24 hours
Receives: Drug: Terlipressin
VasopressinActive comparatorVasopressin 0.03 U/hour
Receives: Drug: vasopressin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Improvement in systemic hemodynamics at 6 hours after randomization

    Improvement in systemic hemodynamics defined as discontinuation of noradrenaline infusion OR reversal of shock

    Measured: 6 hours after randomization

Secondary outcomes (30)
  1. Reduction in dose of noradrenaline at the end of 6 hours

    Measured: 6 hours

  2. Amount of noradrenaline requirements between in each arm at the end of 6 hours

    Measured: 6 hours

  3. Improvement in Systemic Vascular Resistance (SVR) by 10% or above 500 at 6 hours

    Systemic Vascular Resistance will be measured by using pulmonary thermodilution

    Measured: 6 hours

  4. Improvement in SVR by 10% or above 500 at 12 hours

    Measured: 12 hours

  5. Improvement in SVR by 10% or above 500 at 48 hours

    Measured: 48 hours

  6. Decrease in Cardiac output by 10% or less than 6L after 6 hours of randomization

    Cardiac output will be measured by using pulmonary thermodilution

    Measured: 6 hour of randomization

  7. KDIGO criteria - increase in urine output in 6 hours

    Measured: 6 hour

  8. KDIGO criteria - increase in urine output in 12 hours.

    Measured: 12 hour

  9. KDIGO criteria - increase in urine output in 24 hours

    Measured: 24 hour

  10. KDIGO criteria - increase in urine output in 48 hours.

    Measured: 48 hour

  11. improvement in serum creatinine in 24 (Improvement in KDIGO stage at 24)

    Measured: 24 hour

  12. Improvement in serum creatinine in 48 hours (Improvement in KDIGO stage at 48 hours)

    Measured: 48 hour

  13. Need of Renal Replacement Therapy

    Measured: Day 28

  14. Improvement in microcirculation as measured by improvement in lactate

    Measured: 6 hours

  15. Improvement in microcirculation as measured by improvement in capillary refill time at 6 hours

    Measured: 6 hours

  16. Improvement in microcirculation as measured by Near IR spectroscopy ina subset of patients whenever feasible

    Measured: 6 hours

  17. Improvement in microcirculation as measured by improvement in lactate

    Measured: 24 hours

  18. Improvement in microcirculation as measured by improvement in capillary refill time at 24 hours.

    Measured: 24 hours

  19. Improvement in microcirculation as measured by Near IR spectroscopy ina subset of patients whenever feasible

    Measured: 24 hours

  20. Improvement in microcirculation as measured by improvement in lactate

    Measured: 48 hours

  21. Improvement in microcirculation as measured by improvement in capillary refill time at 48 hours.

    Measured: 48 hours

  22. Improvement in microcirculation as measured by Near IR spectroscopy ina subset of patients whenever feasible

    Measured: 48 hours

  23. Improvement in renal resistive index at 24 hours

    Measured: 24 hours

  24. Improvement in renal resistive index at 48 hours

    Measured: 48 hours

  25. Incidence of adverse effects till 48 hours after randomization including incidence of rebound hypertension

    Measured: 48 hours

  26. Mortality at day 28

    Measured: Day 28

  27. Days of mechanical ventilation

    Measured: Day 28

  28. Days of Intensive Care Unit stay.

    Measured: Day 28

  29. Endothelial function will be measured in a subset of patients

    Endothelial function will be assessed from a change in endothelin-1 and von Willebrand Factor (vWF) levels in a subset of patients whereever feasible

    Measured: 48 hours

  30. Coagulation function will measure in a subset of patients

    Coagulation function will be measured by change in rotational thromboelastometry test

    Measured: 48 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Apr 2022
  2. Study start5 Apr 2022 (estimated)
  3. Primary completion31 Mar 2023 (estimated)
  4. Study completion31 Mar 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05315557
Sponsor's protocol ID
ILBS-Cirrhosis-48
Status last verified
Mar 2022
First submitted
7 Mar 2022
Last updated
7 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Terlipressin and vasopressin in people with Septic Shock and Cirrhosis, Liver, run by Institute of Liver and Biliary Sciences, India at 1 site in India.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 7 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in India. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Dr Vishnu Girish, MD (01146300000, vishnugirish@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Improvement in systemic hemodynamics at 6 hours after randomization (time frame: 6 hours after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Apr 2022; AzTrials last refreshed its copy on 8 Nov 2026.

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