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Guirgis FW, Black LP, DeVos E, et al. Lipid intensive drug therapy for sepsis pilot: A Bayesian phase I clinical trial. J Am Coll Emerg Physicians Open. 2020;1(6):1332-1340doi: 10.1002/emp2.12237.
Guirgis, F. W., Black, L. P., DeVos, E., Henson, M., Ferreira, J., Miller, T., Rosenthal, M., Leeuwenburgh, C., Kalynych, C., Moldawer, L., Jones, L., Crandall, M., Reddy, S. T., Gao, H., Wu, S., & Moore, F. (2020). Lipid intensive drug therapy for sepsis pilot: A Bayesian phase I clinical trial. Journal of the American College of Emergency Physicians open, 1(6), 1332-1340. https://doi.org/10.1002/emp2.12237
Guirgis, Faheem W, et al. "Lipid intensive drug therapy for sepsis pilot: A Bayesian phase I clinical trial." Journal of the American College of Emergency Physicians open vol. 1,6 (2020): 1332-1340. doi: https://doi.org/10.1002/emp2.12237
Guirgis FW, Black LP, DeVos E, Henson M, Ferreira J, Miller T, Rosenthal M, Leeuwenburgh C, Kalynych C, Moldawer L, Jones L, Crandall M, Reddy ST, Gao H, Wu S, Moore F. Lipid intensive drug therapy for sepsis pilot: A Bayesian phase I clinical trial. J Am Coll Emerg Physicians Open. 2020 Nov 18;1(6):1332-1340. doi: 10.1002/emp2.12237. eCollection 2020 Dec. PMID: 33392541; PMCID: PMC7771745.
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J Am Coll Emerg Physicians Open. 2020 Nov 18;1(6):1332-1340. doi: 10.1002/emp2.12237. eCollection 2020 Dec.

Lipid intensive drug therapy for sepsis pilot: A Bayesian phase I clinical trial.

Journal of the American College of Emergency Physicians open

Faheem W Guirgis, Lauren Page Black, Elizabeth DeVos, Morgan Henson, Jason Ferreira, Taylor Miller, Martin Rosenthal, Christiaan Leeuwenburgh, Colleen Kalynych, Lyle Moldawer, Lisa Jones, Marie Crandall, Srinivasa T Reddy, Hanzhi Gao, Sam Wu, Frederick Moore

Affiliations

  1. Department of Emergency Medicine University of Florida College of Medicine-Jacksonville Jacksonville Florida USA.
  2. Division of Pulmonary and Critical Care Medicine Department of Medicine University of Florida College of Medicine-Jacksonville Jacksonville Florida USA.
  3. Department of Surgery University of Florida College of Medicine Gainesville Florida USA.
  4. Department of Aging and Geriatric Research University of Florida College of Medicine Gainesville Florida USA.
  5. Department of Surgery University of Florida College of Medicine-Jacksonville Jacksonville Florida USA.
  6. Department of Medicine UCLA College of Medicine Los Angeles California USA.
  7. Department of Biostatistics College of Public Health & Health Professions College of Medicine University of Florida Gainesville Florida USA.

PMID: 33392541 PMCID: PMC7771745 DOI: 10.1002/emp2.12237

Abstract

OBJECTIVES: Cholesterol may be protective in sepsis. Patients with early sepsis may have critically low cholesterol levels that are associated with poor outcomes. The study objective was to test the safety of a fish oil-containing lipid injectable emulsion for stabilizing early cholesterol levels in sepsis.

METHODS: Phase I Bayesian optimal interval design trial of adult patients with septic shock (Sequential Organ Failure Assessment score ≥4 or vasopressor dependence). Using sequential dose escalation, participants received 2 doses of 1.0 to 1.6 g/kg of lipid emulsion (Smoflipid 20% lipid emulsion) within 48 hours of enrollment. Cholesterol levels, function, and organ failure were assessed serially during the first 7 days of hospital admission.

MEASUREMENTS AND MAIN RESULTS: A total of 10 patients with septic shock were enrolled. One patient withdrew for social reasons. Another patient had an unrelated medical complication and received 1 drug dose. Of 9 patients, mean age was 58 years (SD 16), median Sequential Organ Failure Assessment was 8, and 28-day mortality was 30%. No serious adverse events related to lipid infusion occurred. The six occurrences of non-serious adverse events possibly related to lipid infusion included hyperglycemia (1), elevated triglycerides (3), anemia (1), and vascular access redness/pain (1) for all doses. The mean change in total cholesterol levels from enrollment was -7 (SD 16.6) at 48 hours and 14 (SD 25.2) at 7 days.

CONCLUSIONS: Fish oil-containing lipid emulsion administration during early septic shock was safe. Further studies are needed to assess effects on cholesterol levels, function, and organ failure.

CLINICAL TRIAL REGISTRATION: NCT03405870.

© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.

Keywords: cholesterol; lipid emulsion; lipids; organ failure; parenteral nutrition; sepsis; septic shock

Conflict of interest statement

The authors have no conflicts of interest to disclose.

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