Table 1.
TIME POINTS | Study Period | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Days | Days | Months | |||||||||||
Enrolment/Allocation | Post-Allocation | ||||||||||||
1 | 2 | 3 | 4 | 5–6 | 7 | 8–9 | 10 | 11–13 | 14 | 15–27 | 28 | 6 months | |
ENROLMENT: | |||||||||||||
Eligibility screen | x | ||||||||||||
Informed consent | x | ||||||||||||
Allocation | x | ||||||||||||
INTERVENTION: | |||||||||||||
Vitamin C or placebo | x | x | x | x | |||||||||
ASSESSMENTS: | |||||||||||||
Baseline variables | |||||||||||||
Source of infection | x | ||||||||||||
Severity of illness (APACHE II score) | x | ||||||||||||
Pre-existing comorbidities (Charlson comorbidity index, Clinical Frailty Score) | x | ||||||||||||
Vitamin C levela | x | ||||||||||||
Primary outcome | |||||||||||||
Death or persistent organ dysfunctionb | x | ||||||||||||
Secondary outcomes | |||||||||||||
Persistent organ dysfunction-free days in ICU, up to day 28b | x | x | x | x | x | x | x | x | x | x | x | x | |
Mortality at 6 months | x | ||||||||||||
HRQoL (EQ-5D-5 L) | x | ||||||||||||
Global tissue dysoxia (serum lactate concentration) | x | x | x | ||||||||||
Organ function including renal function (SOFA score) | x | x | x | x | x | x | x | x | |||||
Inflammation biomarkers (IL-1ß, TNF-α, CRP) | x | x | x | ||||||||||
Infection biomarkers (PCT) | x | x | x | ||||||||||
Endothelial injury biomarkers (TM, ANG-2) | x | x | x | ||||||||||
Occurrence of stage 3 AKIc | x | x | x | x | x | x | x | x | x | x | x | x | |
Acute hemolysis | x | x | x | x | x | x | x | x | x | x | x | x | |
Hypoglycemiad | x | x | x | x | x | x | x | x | x | ||||
Other variables | |||||||||||||
Protocol adherencee | x | x | x | x | |||||||||
Co-interventionsf | x | x | x | x | x | x | x | x | x | x | x |
AKI acute kidney injury, ANG-2 angiopoietin-2, APACHE II score Acute Physiology and Chronic Health Evaluation II score, CRP C-reactive protein, EQ-5D-5 L questionnaire EuroQol-5D (EQ-5D), HRQoL: health-related quality of life, ICU intensive care unit, IL-1ß interleukin-1 beta, PCT procalcitonin, SOFA score Sequential Organ Failure Assessment score, TM thrombomodulin, TNF-α tumor necrosis factor-alpha
aMust be collected before the first dose of investigational product
bDependency on mechanical ventilation, RRT, or vasopressors
cAs defined by KDIGO (Kidney Disease: Improving Global Outcomes) criteria22
dAssessed by core lab (during the time participants receive the 16 doses of the investigational product and the 7 days following the last dose)
eReceipt of every planned dose according to schedule until completion of 96-h treatment protocol, samples collected per protocol instructions, vitamin C baseline collected before the first dose of investigational product
fAdministration of mechanical ventilation, RRT, vasopressors, corticosteroids, thiamine, intravenous fluids, blood products, sedatives, and antimicrobials. Daily data until ICU discharge or 28 days (whichever comes first)