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PneumoniaPhase 4NCT04778917

Observation and Treatment of Pulmonary Microthrombosis in Childhood Pneumonia With Elevated D-dimer

A Phase 4 study testing Low-Molecular-Weight Heparins Calcium Injection in people with Pneumonia, run by Capital Institute of Pediatrics, China at 1 site in China.

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

Objective 1. Master the clinical feathers, imaging features and laboratory diagnosis characteristics and economic costs of children pneumonia with higher D-dimer: 1. Compare the characteristics of different groups of children in the course of the disease,clinicalsymptoms and signs; 2. Read more about this study

Who is it for?
Ages 28 days to 18 years
Conditions the study is for
Pneumonia
What is being tested?
Low-Molecular-Weight Heparins Calcium Injection
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
124 participants
Where
1 siteChina
Study dates
Dec 2014to Feb 2018
Phase
Phase 4
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 28 days to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Clinical diagnosis of simple pneumonia
  • Age 28 days to 18 years

Who cannot join

  • With congenital heart disease
  • With kidney disease
  • With blood system diseases
  • With paralysis
  • With muscle tension
  • With fracture,
Show all 10Show fewer
  • With a family history of thrombotic disease
  • With indwelling central venous catheters
  • With parenteral nutrition, neoplastic disease
  • With primary immunodeficiency disease

Trial locations and contacts

1 site in 1 country.

China1 site
  • Capital Institute of Pediatrics

    Beijing

Other trials in China

About this study

Objective

  1. Master the clinical feathers, imaging features and laboratory diagnosis characteristics and economic costs of children pneumonia with higher D-dimer:
  2. Compare the characteristics of different groups of children in the course of the disease,clinicalsymptoms and signs;
  3. All the children in the study need to do enhanced CT, to observe if there were intrapulmonary vascular thrombosis and necrosis pneumonia signs;
  4. compared changes of coagulation index beside D-dimer.
  5. Compared with low molecular weight heparin prevention Disseminated intravascular coagulation(DIC) dose and instructions to the recommended dose in safety and effectiveness,and proposed elevated anticoagulation D-Dimer specification of the clinical treatment of children with pneumonia.
Read more

Background and rationale:

Pneumonia is the main cause of lung function injury and death in children. The high blood coagulation state can lead to the formation of pulmonary vascular thrombosis, local pulmonary ischemia and necrosis, which may be an important mechanism for the occurrence of necrotizing pneumonia and pulmonary embolism in children with pneumonia. Elevated D-dimer is an important predictor of pulmonary thrombosis and necrotizing pneumonia. At present, D-Dimer in many children with severe pneumonia is found to increase, the symptom is severe, the late stage of the performance of necrotizing pneumonia, seriously affect the children's lung function and quality of life.

Read the detailed description

This is a randomized, controlled, single blind trial(Researchers are not blind, patients are blind).

1.Patient population

  1. .Experience group We will recruit 93 cases in our trial.All of them are with simple pneumonia and are hospitalized in the respiratory department of our hospital, also D-dimer is higher than or equal to 500ug / L, 93 cases as the observation group, were randomly divided into A, B, C three sub group.
  2. .Control group We will recruit 31 cases in our control group.And children in this group are also with simple pneumonia,they will be similar with the experience group children at the age, the disease course but their D-Dimer is lower than 500 ug/L.

2.Randomized methods: A random number table was created by the statistical staff of the non-present research group using SAS to generate random numbers table before the start of the study. Selected children are in accordance with the A, B, C three groups of 1:1:1 ratio distribution.

3.Study method: Fasting venous blood was extracted from all the children from the second morning after admission to complete the coagulation function, blood routine, biochemical and related inflammatory indicators and complete chest CT examination。The above indicators were monitored dynamically during hospitalization.

4.Study protocal:

Study group:

Group A :Conventional treatment for children with pneumonia, without the use of low molecular weight heparin.

Group B :Group B with prevention of DIC amount: low molecular weight heparin calcium 50-100 units / kg, once or twice subcutaneous injection, 5-10 days of treatment or D-Dimer recovery normal. According to Huang Ke, disseminated intravascular coagulation, Huang Shaoliang, Zhou Dunhua, editor in chief of pediatric hematology clinical manual, Third Edition, 601-602.

Group C :Group C with anticoagulant therapy: low molecular weight heparin calcium 100 units /kg, subcutaneous injection, two times a day, treatment for 7 days orD-Dimer return to normal. Low molecular weight heparin calcium.

Control group :Conventional treatment for children with pneumonia, without the use of low molecular weight heparin.

5.Statistical methods

Statistical analysis system(SAS).2 software was used for statistical analysis . The continuous variables of the central tendency and the discrete trend are represented by the median and the four point spacing, and the categorical variables are described by the constituent ratio. Normal distribution of continuous variables between the 22 comparison using T test, multiple comparisons using ANOVA. Non normal distribution of continuous variables between the 22 comparison using Rank Sum Test Wilcoxon, multiple comparisons using Kruskal-Wallis method. Statistical testing methods used properly. All the tests were taken by alpha =0.05.

6.Study objection:

  1. .Compare the group A with the control group of the clinical features
  2. . Compare all of the patients in the observation group with the control group of the chest CT features
  3. .To observe the efficacy and safety of anticoagulant therapy to children with D-dimer increased pneumonia

7.Sample size estimation:

As there is no evaluation of the efficacy of children with pneumonia combined with elevated D-Dimer in China, studies have shown that severe pneumonia is often accompanied by elevated D-Dimer. Therefore, this study only estimates the sample size based on the effective rate of heparin in the treatment of severe pneumonia. According to Wang Xuanzhu's research [Wang Xuanzhu. The efficacy of heparin in the treatment of severe pneumonia in children and its effect on platelet parameters and D-dimers], the effective rate of conventional methods in the treatment of severe pneumonia is 76.6%, and the effective rate of low-dose heparin treatment is 95.8%. This study adopts a two-sided test, taking α=0.05, β=0.20, u0.05/2=1.96, u0.2=0.8, p1=0.766, p2=0.958.Considering the possible loss to follow-up rate in this study is 10%, the sample size of each group should be: 31.

  1. Reporting for adverse events

Liver function, coagulation function, and platelet monitoring were performed for each child in the group. If there is a tendency to bleeding, the test was immediately terminated and corresponding treatment was given.

Conditions
Pneumonia
Being tested
Low-Molecular-Weight Heparins Calcium Injection
Keywords
D-dimer,pneumonia,children
Medical subject headings
Pneumonia

What participants receive

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

  • Low-Molecular-Weight Heparins Calcium InjectionDrug

    We use different dose of low-molecular-weight heparins calcium injection to different interventions

Study groups in NCT04778917
Study groupRoleWhat they receive
Small dose low molecular weight heparinExperimentalLow molecular weight heparin calcium 100 units / kg/day, subcutaneous injection, 5-10 days of treatment or D-dimer recovery normal.
Receives: Drug: Low-Molecular-Weight Heparins Calcium Injection
High dose of low molecular weight heparinExperimentallow molecular weight heparin calcium 200 units /kg/day, subcutaneous injection, treatment for 7 days or D-dimer return to normal.
Receives: Drug: Low-Molecular-Weight Heparins Calcium Injection
Vacuity contrast groupPlacebo comparatorConventional treatment for children with pneumonia, without the use of low molecular weight heparin.
Receives: Drug: Low-Molecular-Weight Heparins Calcium Injection
contrast groupNo interventionConventional treatment for children with pneumonia, without the use of low molecular weight heparin.

What is being measured

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

  1. Lung imaging absorption improvement time after treatment

    The enrolled children were subjected to weekly imaging examinations to determine the time for the absorption of lung inflammation to improve.Criteria for evaluating the severity of CT changes (large lung shadows or dot shadows in CT images) : Criteria for improvement of lung imaging absorption: no obvious lesion absorption, no absorption or large patchy shadow; Partial absorption of lesions: there is absorption, but there is still patchy shadow or cloud flocculent shadow; Obvious absorption of lesions: no abnormalities or only a little light in the lung.

    Measured: Change from basline in lung imaging at 1 month

  2. Time to improve cough symptoms

    The clinician will judge the improvement time of the child's cough symptoms

    Measured: 2 weeks

  3. Heat retreat time

    The time required for temperature to drop below 37.3℃ after treatment.

    Measured: 2 weeks

  4. The time to disappear rhonchus in the lungs

    The clinician will judge the absorption time of dry and wet rhonchus in the lungs.

    Measured: 2 weeks

Secondary outcomes (3)
  1. Average hospital stay time

    The time required from the child's admission to the improvement and discharge

    Measured: 2weeks to 4weeks

  2. The degree of coagulation improvement

    Laboratory test indicators include: platelet count (PLT), prothrombin time, partial thromboplastin time Prothrombin time(PT)\Activated partial thromboplastin time(APTT), protein fiber, fiber protein degradation product Fibrinogen(FIB)\Fibrinogen degradation products(FDP), D-dimer, Antithrombin III(AT-III).Compare the improvement degree of the above indicators in each group before and after treatment.

    Measured: 2 weeks

  3. Differences in inflammation indicators in each group

    The inflammatory markers included CRP, ESR and WBC counts.

    Measured: basline

Timeline

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

  1. First posted3 Mar 2021
  2. Study startDec 2014
  3. Primary completionJul 2017
  4. Study completionFeb 2018

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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
124 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04778917
Sponsor's protocol ID
W12-1
Status last verified
Feb 2021
First submitted
19 Mar 2020
Last updated
3 Mar 2021
Results posted
No
Data monitoring committee
Yes

Publications

  • Esposito S, Cohen R, Domingo JD, Pecurariu OF, Greenberg D, Heininger U, Knuf M, Lutsar I, Principi N, Rodrigues F, Sharland M, Spoulou V, Syrogiannopoulos GA, Usonis V, Vergison A, Schaad UB. Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat? Pediatr Infect Dis J. 2012 Jun;31(6):e78-85. doi: 10.1097/INF.0b013e318255dc5b.

    PubMed 22466326
  • Schroeder JD, McKenzie AS, Zach JA, Wilson CG, Curran-Everett D, Stinson DS, Newell JD Jr, Lynch DA. Relationships between airflow obstruction and quantitative CT measurements of emphysema, air trapping, and airways in subjects with and without chronic obstructive pulmonary disease. AJR Am J Roentgenol. 2013 Sep;201(3):W460-70. doi: 10.2214/AJR.12.10102.

    PubMed 23971478
  • Litmanovich DE, Hartwick K, Silva M, Bankier AA. Multidetector computed tomographic imaging in chronic obstructive pulmonary disease: emphysema and airways assessment. Radiol Clin North Am. 2014 Jan;52(1):137-54. doi: 10.1016/j.rcl.2013.09.002.

    PubMed 24267715
  • Youn YS, Lee KY, Hwang JY, Rhim JW, Kang JH, Lee JS, Kim JC. Difference of clinical features in childhood Mycoplasma pneumoniae pneumonia. BMC Pediatr. 2010 Jul 6;10:48. doi: 10.1186/1471-2431-10-48.

    PubMed 20604923
  • Madzhuga AV, Somonova OV, Elizarova AL, Sviridova SP, Zubrikhin GN. [The clinical value of D-dimer in the diagnosis and treatment of thromboembolic complications and DIC syndrome in cancer patients]. Anesteziol Reanimatol. 2005 Sep-Oct;(5):55-7. Russian.

    PubMed 16318055
  • Zhao D, Ding R, Mao Y, Wang L, Zhang Z, Ma X. Heparin rescues sepsis-associated acute lung injury and lethality through the suppression of inflammatory responses. Inflammation. 2012 Dec;35(6):1825-32. doi: 10.1007/s10753-012-9503-0.

    PubMed 22782595
  • Lankisch P, Laws HJ, Wingen AM, Borkhardt A, Niehues T, Neubert J. Association of nephrotic syndrome with immune reconstitution inflammatory syndrome. Pediatr Nephrol. 2012 Apr;27(4):667-9. doi: 10.1007/s00467-011-2069-5. Epub 2011 Dec 29.

    PubMed 22203364
  • van der Poll T, de Boer JD, Levi M. The effect of inflammation on coagulation and vice versa. Curr Opin Infect Dis. 2011 Jun;24(3):273-8. doi: 10.1097/QCO.0b013e328344c078.

    PubMed 21330919

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Low-Molecular-Weight Heparins Calcium Injection in people with Pneumonia, run by Capital Institute of Pediatrics, China at 1 site in China.

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 10 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 3 Mar 2021. 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 China. 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. Some participants in this study may receive a placebo. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

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

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Lung imaging absorption improvement time after treatment (time frame: Change from basline in lung imaging at 1 month). The study lists 4 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 NCT04778917, which also lists 8 linked publications.

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 3 Mar 2021.

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