In this single-center, randomized, single-blind, placebo-controlled pilot clinical trial. The effect of apigenin on the improvement of organ function will be investigated in elderly patients with sepsis. Researchers will screen patients admitted to the Department of Critical Care Medicine at Zhujiang Hospital to identify patients with sepsis based on including and excluding criteria and obtain informed consent and randomize them into groups. The treatment group will be given apigenin tablets 50mg ground with 5ml of sterilized water for intra-gastric tube injection; the control group will be given an equal volume of sterilized water for intra-gastric tube injection. The changes in SOFA score and other clinically meaningful outcomes in 4 days will be collected.
Investigational drug: Apigenin Study title: Improvement of Organ function by Apigenin in Elderly Patients With Sepsis: A Single-center, Single-blind, Randomized, Placebo-controlled, pilot Clinical Trial Principal Investigator: Zhanguo Liu, professor, Department of Critical Care Medicine, Zhujiang Hospital, Southern Medical University Study subjects: Elderly septic/septic shock patients who meet the diagnostic criteria of the 2016 International Sepsis Guidelines. Study objectives: The objective of the study is to determine whether apigenin, compared to placebo, improves organ dysfunction scores (SOFA scores) in elderly septic patients. Study design: A single-center, single-blind, randomized, placebo-controlled pilot Clinical Trial. Method: Apigenin group: Intragastric tube injection of ground apigenin tablet 50 mg with 5 ml of sterilized water + conventional standardized treatment, for 4 days or until ICU discharge. Placebo control group: Gastric tube injection of 5 ml of sterilized water for injection + conventional standardized treatment, for 4 days or ICU discharge. Course: 4 days Sample size: 20 The number of study center: 1 Study center: 1. Department of Critical Care Medicine of Zhujiang Hospital, Guangzhou, Guangdong, China Primary endpoint: 96-hour Sequential Organ Failure Assessment (SOFA) score Secondary endpoints: 2. The state of inflammatory response: the serum level of interleukin-6(IL-6) and C-reactive protein (CRP) at 96 h after randomization. 3. The state of liver function: the serum level of transaminase (AST#ALT) #total bilirubin at 96 h after randomization. 4. The state of lung function: oxygenation index (PaO2/FiO2) at 96h after Randomization. 5. The state of kidney function: the serum level of Creatinine (Cr)#blood urea nitrogen (BUN)# at 96 h after randomization. 6. The state of infection: the serum level of procalcitonin (PCT) at 96 h after randomization. 7. The state of circulation system: the serum level of lactate at 96 h after Randomization. 8. The duration of successful cessation of supportive therapies for organ dysfunction including vasoactive agents, mechanical ventilation. 9. The daily urine output#duration of continuous renal replacement therapy (CRRT) #fluid balance. 10. The length of stay in ICU. Safety endpoints: 1. adverse events 2. Serious adverse events
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
20
Intragastric tube injection of ground apigenin tablet 50 mg with 5 ml of sterilized water + conventional standardized treatment, for 4 consecutive days.
Intragastric tube injection of 5 ml of sterilized water + conventional standardized treatment, for 4 consecutive days.
Department of Critical Care Medicine of Zhujiang Hospital,Southern Medical University
Guanzhou, Guangdong, China
96-hour Sequential Organ Failure Assessment (SOFA) score
The SOFA score is the Sequential Organ Failure Score, which is used to assess a patient's prognosis by determining the degree of impairment of major organ function. The score is divided into 6 sections: respiratory, coagulation, hepatic, cardiovascular, central nervous system, and renal, and ranges from 0 to 4, with higher SOFA scores associated with a higher incidence of poor prognosis.
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
inflammatory response(1)
the serum level of C-reactive protein(CRP)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
inflammatory response(2)
the serum level of interleukin-6(IL-6)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
Duration of use of vasoactive drugs
The duration from the vasoactive drugs administration to the successful cessation in hours( The successful cessation is defined as the attainment of a clinician-prescribed mean arterial pressure target for more than 24-hours without the use of vasoactive drugs.This outcome measure is intended only for patients receiving vasoactive drugs)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
liver function(1)
the serum level of Alanine transaminase(ALT)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
liver function(2)
the serum level of Aspartate transaminase (AST)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
liver function(3)
the serum level of total bilirubin(TBil)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
lung function
oxygenation index(PaO2/FiO2),the patients treated with extracorporeal membrane oxygenation will not collect this indicator
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
kidney function(1)
serum level of Creatinine (Cr)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
kidney function(2)
serum level of blood urea nitrogen(BUN)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
Indicators of infection
the serum level of procalcitonin(PCT)
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
The level of lactate
the serum level of lactic acid
Time frame: The outcome will be assessed at the 0,1,2,3,4 day after enrollment
The Duration of use of mechanical ventilation (MV)
The duration from the MV administration to the successful cessation in hours( The successful cessation is defined as the termination of MV for more than 48-hours. This outcome measure is intended only for patients receiving MV)
Time frame: The outcome will be assessed at the 28 day after enrollment
The duration of CRRT
The duration of CRRT therapy in hours
Time frame: The outcome will be assessed at the 28 day after enrollment
Daily urine output
Daily urine output in milliliters from 0:00 - 24:00
Time frame: The outcome will be assessed at the 1,2,3,4 day after enrollment
fluid balance
Net fluid intake and output in 24 hours
Time frame: The outcome will be assessed at the 1,2,3,4 day after enrollment
The length of ICU stay
ICU length of ICU stay
Time frame: The outcome will be assessed at the 28 day after enrollment
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