Characterizing contemporary practices in the approach to elevated troponin I levels during sepsis

脓毒症期间肌钙蛋白 I 水平升高方法的当代实践特征

• 批准号: 10314392
• 负责人: Michael Anthony Garcia
• 金额: $ 5.35万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2022-06-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10314392
• 关键词: Acute; Admission activity; Adrenergic beta-Antagonists; Anticoagulants; Anticoagulation; Antiplatelet Drugs; Aspirin; Automobile Driving; Award; Benefits and Risks; Big Data; Biological Markers; Cardiac; Cardiac Catheterization Procedures; Cardiology; Cardiovascular Diseases; Cardiovascular system; Career Choice; Clinical; Clinical Investigator; Comparative Effectiveness Research; Consultations; Coronary; Critical Care; Critical Illness; Data; Data Science; Databases; Development; Diagnostic; Diagnostic tests; Drug Prescriptions; Echocardiography; Electrocardiogram; Fellowship; Foundations; Functional disorder; Future; Goals; Health Services Research; Heart Injuries; Hemorrhage; Hospital Mortality; Hospitalization; Hospitals; Infection; Inflammation; Injury to Kidney; K-Series Research Career Programs; Knowledge; Left; Life; Measurement; Mentors; Methodology; Methods; Modeling; Morbidity - disease rate; Myocardial; Organ; Outcome; Oxygen; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Physicians; Randomized; Renal clearance function; Research; Research Methodology; Research Personnel; Risk; Rupture; Scientist; Sepsis; Serum; Standardization; Stress Tests; Structural Models; Therapeutic; Training; Troponin; Troponin I; Variant; Work; cardioprotection; cardiovascular risk factor; career; cohort; comparative effectiveness; comparative effectiveness study; design; endothelial dysfunction; evidence base; health care service; heart imaging; insight; large datasets; mortality; myocardial injury; novel; prognostic; prognostic significance; prognostic value; skills; thrombotic; treatment effect; treatment strategy

PROJECT SUMMARY/ABSTRACT I propose the “Characterizing contemporary practices in the approach to elevated troponin I levels during sepsis” study to develop an evidenced-based approach to the management of elevated serum troponin levels during sepsis and to advance my skillset in clinical design, data science methodology, statistical programming and professional development in order to become an independent clinical investigator. Sepsis is the result of life-threatening organ dysfunction due to infection and is associated with significant long-term cardiovascular morbidity. Serum troponin levels are frequently elevated during sepsis and are prognostic for post-sepsis cardiovascular complications. Despite its prognostic significance and regular presence during sepsis, there is no standardized management approach to patients with elevated serum troponin levels during sepsis. Decisions regarding cardiovascular diagnostic testing and use of potential cardio-protective medications among these patients are left to the discretion of the treating clinician, resulting in diverse practice approaches with unclear impact on patient outcomes. I propose two essential foundational steps needed to develop a standardized management approach to patients with elevated serum troponin levels during sepsis through the use of a large, observational critical care database: 1) evaluate current practices in cardiovascular diagnostic and therapeutic management of patients with elevated serum troponin levels during sepsis, and 2) assess the risks and benefits associated with use of anti-platelet and anticoagulation strategies as potential cardio- protective treatment agents, among the same sepsis cohort. The first objective will be achieved through practice variation analysis using risk-adjusted hierarchical models to identify the patient-, physician-, and hospital-level factors contributing to cardiac management approach variation. The second objective will be completed through a targeted trial approach using marginal structural models to estimate the average treatment effect of each treatment strategy on clinical outcomes. Completion of this proposal will fill knowledge gaps in current practice strategies as well as assess the risks and benefits of two classes of potential cardio- protective medications employed in management of patients with elevated serum troponin levels during sepsis. This work with inform my future application for a mentored Career Development Award geared toward randomized comparative effectiveness studies of potential cardio-protective medications with the goal of reducing cardiovascular complications following sepsis hospitalization. This proposal will serve as the foundation to my career as a leading physician-scientist in critical care health services and comparative effectiveness research with a focus on the management of the cardiovascular complications of non-cardiac critical illness.

项目总结/摘要 我提出“在治疗过程中肌钙蛋白I水平升高的方法中， 脓毒症”研究，以开发一种基于证据的方法来管理血清肌钙蛋白水平升高 并提高我在临床设计，数据科学方法，统计编程方面的技能 和专业发展，以成为一个独立的临床研究者。脓毒症是由于 由于感染导致危及生命的器官功能障碍，并与显著的长期心血管疾病相关。 发病率血清肌钙蛋白水平在脓毒症期间经常升高，并且是脓毒症后的预后指标 心血管并发症尽管它的预后意义和定期出现在脓毒症， 对脓毒症期间血清肌钙蛋白水平升高的患者没有标准化的管理方法。 关于心血管诊断测试和使用潜在心脏保护药物的决定 在这些患者中，由治疗临床医生自行决定，导致不同的实践方法 对患者结局的影响不明确。我提出了两个必要的基本步骤，需要制定一个 脓毒症期间血清肌钙蛋白水平升高患者的标准化管理方法 使用大型观察性重症监护数据库：1）评价心血管诊断的当前实践 脓毒症期间血清肌钙蛋白水平升高的患者的治疗管理，以及2）评估 与使用抗血小板和抗凝策略作为潜在心血管治疗相关的风险和获益 保护性治疗药物，在同一脓毒症队列中。第一个目标将通过 使用风险调整分层模型进行变异分析，以识别患者、医生和 导致心脏管理方法变化的医院层面因素。第二个目标是 通过有针对性的试验方法完成，使用边际结构模型估计平均值 每种治疗策略对临床结局的治疗效果。完成本提案将填补知识 当前实践策略的差距，以及评估两类潜在的心脏病的风险和益处， 在脓毒症期间血清肌钙蛋白水平升高的患者的管理中使用的保护性药物。 这项工作与通知我未来的申请辅导职业发展奖面向 潜在心脏保护药物的随机比较有效性研究，目的是 减少败血症住院后的心血管并发症。该提案将作为 作为一名重症监护健康服务和比较医学领域的领先医生-科学家， 有效性研究，重点关注非心血管并发症的管理 病危