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SepsisPhase 3ABC SepsisNCT04540094

Feasibility of 5% Albumin Compared With Balanced Crystalloid, as Intravenous Fluid Resuscitation in Adult Patients With Sepsis, Presenting as an Emergency to Hospital

A Phase 3 study testing Human albumin and Balanced crystalloid solution in people with Sepsis, run by University of Edinburgh at 15 sites in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The aim of this research study is to compare two different fluids (Human Albumin Solution (HAS) and Balanced Crystalloid that are given via a drip to patients with severe infection (sepsis). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Sepsis
What is being tested?
Human albumin and Balanced crystalloid solution
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
300 participants
Where
15 sitesUnited Kingdom
Study dates
1 Jun 2021to 30 Apr 2023
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult patients (18 years or older) who present to UK NHS hospitals with community acquired sepsis meeting all of the 4 criteria:
  • Clinically suspected or proven infection resulting in principal reason for acute illness;
  • NEWS score ≥5 (or NEWS2 if adopted in recruitment site);
  • Hospital presentation within last 12hrs; and
  • Clinician decision has been made that immediate (within 1 hour) intravenous fluid resuscitation is needed.

Who cannot join

  • >1 litre of intravenous crystalloid fluid or any intravenous HAS administered prior to eligibility assessment;
  • Requirement for immediate surgery (within one hour of eligibility assessment);
  • Chronic renal replacement therapy;
  • Known allergy/adverse reaction to HAS;
  • Balanced crystalloid or HAS not available;
  • Known adverse reaction to blood products;
Show all 12Show fewer
  • Palliation/end of life care (explicit decision by patient/family/carers in conjunction with clinical team that any active treatment beyond symptomatic relief is not appropriate);
  • Religious beliefs precluding HAS administration;
  • Previous recruitment in the trial;
  • Known recent severe traumatic brain injury (within 3 months);
  • Patients with permanent incapacity;
  • Known recruitment in another CTIMP studies within the last 30 days where co-enrolment has not been agreed.

Trial locations and contacts

15 sites in 1 country.

15 sites in 1 country

United Kingdom15 sites
  • Aberdeen Royal Infirmary

    Aberdeen

  • Addenbrookes Hospital

    Cambridge

  • Derby Teaching Hosptial NHS Foundation Trust

    Derby

  • Royal Infirmary Edinburgh

    Edinburgh

  • Royal Devon and Exeter Hospital

    Exeter

  • Glasgow Royal Infirmary

    Glasgow

  • Queen Elizabeth University Hospital

    Glasgow

  • St Johns

    Livingston

  • St Georges Hospital

    London

  • University College London Hospital

    London

  • John Radcliffe Hospital

    Oxford

  • Royal Alexandra Hospital

    Paisley

  • Derriford Hospital Plymouth

    Plymouth

  • Salford Royal NHS Foundation Trust

    Salford

  • Musgrove Park Hospital

    Taunton

Other trials in United Kingdom

About this study

Official title: Feasibility of 5% Albumin Compared With Balanced Crystalloid, as Intravenous Fluid Resuscitation in Adult Patients With Sepsis, Presenting as an Emergency to Hospital: ABC Sepsis Trial

The aim of this research study is to compare two different fluids (Human Albumin Solution (HAS) and Balanced Crystalloid that are given via a drip to patients with severe infection (sepsis). The investigators plan to see which fluid is better, and to see if they have a role in improving a patient's recovery time, reducing complications and the length of time they stay in hospital. This study plans to find out if there is evidence that one fluid is better overall to determine the need for a subsequent definitive trial.

Read the detailed description

This trial will be an open label two-arm, multicentre, pragmatic, parallel group randomised trial of adult patients with community acquired sepsis recruited from the Emergency Department and Medical and Surgical Assessment Units across ~10 UK NHS Hospitals. The treatment phase will be the first 6 hours following randomisation. 30-day and 90-day follow up will be conducted using routine data only. The exception to this will be the first 50 patients enrolled in the study, Health Related Quality of Life (HRQoL) will be measured using the EQ-5D-5L at baseline, 7 days and at 180 days. At baseline, the participant or their relative will be asked to recall the quality of life 4 weeks prior to the index hospital admission. Questionnaires will be administered by direct patient completion or, postal or email survey with telephone follow up for non-responders after two mailings two weeks apart.

Conditions
Sepsis
Being tested
Human albumin, Balanced crystalloid solution
Keywords
Sepsis, Emergency Care, Albumin, Crystalloid, Fluid, Resuscitation
Medical subject headings
Sepsis

What participants receive

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

  • Human albuminDrug

    Any preparation of 5% Human Albumin Solution which has marketing authorisation in the UK to be used for this indication and is stocked by local hospital pharmacies at the participating sites, may be prescribed in this study

  • Balanced crystalloid solutionDrug

    Any preparation of intravenous "balanced" crystalloid which has marketing authorisation in the UK to be used for this indication and is stocked by local hospital pharmacies at the participating sites, may be prescribed in this study.

Study groups in NCT04540094
Study groupRoleWhat they receive
5% Human Albumin SolutionExperimentalParticipants allocated to the treatment arm will receive intravenous 5% Human Albumin Solution (HAS) administered as the sole intravenous fluid during the initial 6-hour resuscitation period. The clinician can deliver up to 10ml/kg in the first 3 hours using 250ml boluses of HAS based on clinical judgement, using clinical assessment supplemented by technology if that is their usual practice. This will be followed by repeat clinical assessment after each bolus (including vital signs; lactate testing). After 3 hours further HAS boluses up to 6 hours post-randomisation will be at clinical discretion and will be documented in the CRF. Patients in the albumin arm should not receive balanced crystalloid as a resuscitation fluid in the first 6 hours.
Receives: Drug: Human albumin
Intravenous balanced crystalloidActive comparatorParticipant allocated to the usual care arm will receive intravenous balanced crystalloid administered as the sole intravenous fluid during the initial 6 hour resuscitation period. The clinician can deliver up to 30ml/kg in the first 3 hours using 250ml boluses of balanced crystalloid based on clinical judgement, using clinical assessment supplemented by technology if that is their usual practice. This will be followed by repeat clinical assessment after each bolus (including vital signs; lactate testing). Thereafter, further crystalloid boluses up to 6 hours will be at the discretion of the clinical team and will be documented in the CRF. Patients in the balanced crystalloid arm should not receive albumin as a resuscitation fluid in the first 6 hours.
Receives: Drug: Balanced crystalloid solution

What is being measured

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

  1. Recruitment Rate

    We measured the recruitment rate to assess deliverability. We aimed to recruit 300 participants in approximately 1 year in a 1:1 ratio into each treatment arm.

    Measured: Approx 1 year

  2. 30-day Mortality

    Assessment of how many participants in each arm died after 30 days to determine the effect size between the treatment groups.

    Measured: 30 days

Secondary outcomes (22)
  1. Data Completeness of Primary Outcome

    Feasibility Outcome assessing the number of participants who provided data for clinical primary outcome (30 day mortality)

    Measured: 180 days

  2. Withdrawal From Study

    Feasibility Outcomes assessing the number of participants who withdraw from study intervention and/or data collection

    Measured: Approx 1 year

  3. Number of Patients Who Receive Any Other Fluid Apart From Intervention or Control in First 6 Hrs After Recruitment

    Feasibility Outcome- number of patients who receive any other fluid apart from intervention or control in first 6 hrs after recruitment

    Measured: 6 hours

  4. Time to Start of In-hospital Intravenous Fluids

    Feasibility Outcome- Time to start of in-hospital intravenous fluids

    Measured: From time of Randomisation until fluid first being administered measured up to 6 hours.

  5. In-hospital Mortality

    Secondary Clinical Outcome

    Measured: From time of Randomisation until time of hospital discharge or death, whichever is first measured up to 90 days

  6. 90-day Mortality

    Secondary Clinical Outcome

    Measured: 90 days

  7. Volume of Randomised Fluid Delivered in Each Arm in the First 6hrs

    Secondary Clinical Outcome- Volume of randomised fluid delivered in each arm in the first 6hrs

    Measured: 6 hours

  8. Length of Hospital Stay

    Secondary Clinical Outcome

    Measured: 90 days

  9. Proportion of Patients Admitted to Critical Care (HDU/ICU)

    Secondary Clinical Outcome- Proportion of patients admitted to critical care (HDU/ICU)

    Measured: 90 days

  10. Length of Stay in Critical Care (HDU/ICU)

    Secondary Clinical Outcome- Length of stay in critical care (HDU/ICU)

    Measured: 90 days

  11. Number of Participants Needing Intravenous Vasopressors

    Secondary Clinical Outcome-number of participants needing intravenous vasopressors

    Measured: From time of Randomisation until time of hospital discharge, measured up to 90 days.

  12. Number of Participants Needing Renal Replacement

    Secondary Clinical Outcome- Number of participants needing renal replacement

    Measured: From time of Randomisation until time of hospital discharge, measured up to 90 days.

  13. Number of Participants Needing Invasive Ventilation

    Secondary Clinical Outcome- Number of participants needing invasive ventilation

    Measured: From time of Randomisation until time of hospital discharge, measured up to 90 days.

  14. Number of Patients Readmitted in First 90 Days After Discharge

    Secondary Clinical Outcome- Number of patients readmitted in first 90 days after discharge

    Measured: 90 days

  15. Number of Patients Developing Acute Kidney Injury (AKI)

    AKI Defined using National Institute for Health and Care Excellence (NICE) criteria:

    A diagnosis of AKI may be made if there is one of the following:

    A rise in serum creatinine of 26 micromol/L or greater within 48 hours. A 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days.

    A fall in urine output to less than 0.5 mL/kg/hour for more than 6 hours.

    Measured: 7 days

  16. Number of Patients Developing Pulmonary Oedema

    Safety Radiology diagnosis or requirement for rescue management (new diuretic use)

    Measured: 7 days

  17. Number of Patients Developing Allergy or Anaphylaxis

    Requirement for rescue management (antihistamines, adrenaline, intravenous fluids, steroid)

    Measured: 7 days

  18. Health Related Quality of Life (EQ-5D-5L Questionnaire)

    Health Economic Outcomes are measured using the the 5-level EQ-5D version (EQ-5D-5L). The EQ-5D-5L descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. A high score indicates a worse outcome. The patient is asked to indicate their health state by ticking the box next to the most appropriate statement in each of the five dimensions. The digits for the five dimensions can be combined into a 5-digit number (profile) that describes the patient's health state. The EQ-5D profile can be converted to a single number between 0-1 called the EQ-5D value. These EQ-5D values to lie on between 0-1 to indicate health where 0 represents the minimum score (dead) and 1 is full health. Values less than 0 are possible for health states considered worse than dead.

    Measured: baseline

  19. Secondary Care Costs

    Costs will be estimated by assigning national standard unit costs to inpatient stays (critical care and general ward level), readmissions and additional high costs activities observed in the study. Baseline (pre-admission) HQoL will be estimated using age/sex matched population reference data.

    Measured: 30 days

  20. Volume of Randomised Fluid Delivered in Each Arm in the First 24hrs

    Secondary Clinical Outcome-Volume of randomised fluid delivered in each arm in the first 24hrs

    Measured: 24 hours

  21. Health Related Quality of Life (EQ-5D-5L Questionnaire)

    Health Economic Outcomes are measured using the the 5-level EQ-5D version (EQ-5D-5L). The EQ-5D-5L descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. A high score indicates a worse outcome. The patient is asked to indicate their health state by ticking the box next to the most appropriate statement in each of the five dimensions. The digits for the five dimensions can be combined into a 5-digit number (profile) that describes the patient's health state. The EQ-5D profile can be converted to a single number between 0-1 called the EQ-5D value. These EQ-5D values to lie on between 0-1 to indicate health where 0 represents the minimum score (dead) and 1 is full health. Values less than 0 are possible for health states considered worse than dead.

    Measured: 7 Days

  22. Health Related Quality of Life (EQ-5D-5L Questionnaire)

    Health Economic Outcomes are measured using the the 5-level EQ-5D version (EQ-5D-5L). The EQ-5D-5L descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. A high score indicates a worse outcome. The patient is asked to indicate their health state by ticking the box next to the most appropriate statement in each of the five dimensions. The digits for the five dimensions can be combined into a 5-digit number (profile) that describes the patient's health state. The EQ-5D profile can be converted to a single number between 0-1 called the EQ-5D value. These EQ-5D values to lie on between 0-1 to indicate health where 0 represents the minimum score (dead) and 1 is full health. Values less than 0 are possible for health states considered worse than dead.

    Measured: 180 Days

Timeline

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

  1. First posted7 Sep 2020
  2. Study start1 Jun 2021
  3. Primary completion12 Sep 2022
  4. Study completion30 Apr 2023

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Open label two-arm, multicentre, pragmatic, parallel group randomised trial
Masking
None (open label)
Enrolment
300 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04540094
Sponsor's protocol ID
AC20043
Acronym
ABC Sepsis
Status last verified
Aug 2023
First submitted
19 Aug 2020
Last updated
4 Oct 2024
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The intention is to share anonymised data with external collaborators and scientists one year after the primary publication has been published (anticipated Jun 2022).

Publications

  • Gray AJ, Oatey K, Grahamslaw J, Irvine S, Cafferkey J, Kennel T, Norrie J, Walsh T, Lone N, Horner D, Appelboam A, Hall P, Skipworth RJE, Bell D, Rooney K, Shankar-Hari M, Corfield AR; Albumin, Balanced, and Crystalloid-Sepsis (ABC-Sepsis) Investigators. Albumin Versus Balanced Crystalloid for the Early Resuscitation of Sepsis: An Open Parallel-Group Randomized Feasibility Trial- The ABC-Sepsis Trial. Crit Care Med. 2024 Oct 1;52(10):1520-1532. doi: 10.1097/CCM.0000000000006348. Epub 2024 Jun 24.

    PubMed 38912884

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Human albumin and Balanced crystalloid solution in people with Sepsis, run by University of Edinburgh at 15 sites in United Kingdom.

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 5 inclusion and 12 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: finished, as of the sponsor's last update on 4 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 15 sites in United Kingdom. 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.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 4 Oct 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recruitment Rate (time frame: Approx 1 year). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04540094, which also lists 1 linked publication.

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 4 Oct 2024.

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