The Effect of Red Blood Cell Transfusion on Fatigue, Activity and Fatigability in Hospitalized Patients with Anemia

项目摘要/摘要 最近在实践中对住院贫血患者采取限制性输血策略的转变 在没有明确和令人信服的证据表明对疲劳和 功能结果。这一点很重要，因为贫血会增加任何时候变得疲惫的倾向 给定的活动水平(疲劳性)，增加疲劳和减少活动，这最终可能会损害 功能结果。考虑到这一点，输血的目标可能包括减少疲劳性，最大限度地减少疲劳 以及增加活动，这应该会改善功能结果。因此，关于艾滋病影响的数据 对疲劳、活动性和疲劳性的输血可以为新的输血策略的设计提供信息，这些策略可能 改善患者的预后。一个例子是症状驱动的输血，在这种情况下，患者将被输血 根据他们的症状，如疲劳。因此，这项提案将1)为住院患者提供数据 疲劳性仪器，可在未来的研究中用于测量患者的疲劳性、活动性和疲劳性， 并确定那些最有可能从输血中受益的人。通过这份K23建议书获得的知识 将填补在理解输血如何影响疲劳方面的关键空白，作为主要和最重要的 贫血症状、作为重要临床结局的活动性和作为影响的关键中介的疲劳性 既疲惫又活跃。这种理解可以改善输血实践，并最终取得以下结果 通过提供证据帮助临床医生和患者更好地权衡 在住院期间。此外，这一K23将支持高级生物统计学和 量化数据分析、研究方法和临床培训中的检查、治疗和 贫血的管理。这些活动在一个强大的指导团队的指导和支持下，将 请允许我以科学和专业的方式发展，这样在K23获奖期结束时，我将成为 准备使用收集的数据来申请RO1，以支持我将作为独立人员领导的RCT 调查员。这项计划中的区域合作研究将建立在作为其一部分建立的数据和科学基础之上 K23，并将症状驱动输血与目前统一限制输血的做法进行比较 仅以Hb为基础进行练习，使用疲劳、活动和疲劳性作为结果。因此，通过 这个奖项的培训、指导和研究经验，我会把自己定位为一名独立的 输血如何影响重要的患者报告和临床结果的研究人员和领导者 因贫血住院的患者。此外，我将把自己设定为未来研究如何 新的和新兴的治疗方法影响并可以改善住院的贫血患者的健康结果。

PROJECT SUMMARY/ABSTRACT Recent shifts in practice towards restrictive transfusion strategies in hospitalized patients with anemia have been made without clear and convincing evidence concerning the potential adverse effects on fatigue and functional outcomes. This is important because anemia increases the tendency to become fatigued at any given level of activity (fatigability), increasing fatigue and decreasing activity, which may ultimately impair functional outcomes. Given this, the goals of transfusion may include reducing fatigability, minimizing fatigue and increasing activity, which should be expected to improve functional outcomes. Thus, data on the effects of transfusion on fatigue, activity, and fatigability could inform the design of new transfusion strategies that may improve patient outcomes. One example is symptom-driven transfusion, in which patients would be transfused based on their symptoms, such as fatigue. Therefore, this proposal will 1) provide data for hospitalized patients on the effects of transfusion on fatigue, activity levels, and fatigability, and 2) create and validate a new fatigability instrument that can be used in future studies to measure fatigue, activity, and fatigability in patients, and identify those most likely to benefit from a transfusion. The knowledge acquired through this K23 proposal will fill critical gaps in the understanding of how transfusion affects fatigue as the primary and most significant symptom of anemia, activity as an important clinical outcome, and fatigability as a key mediator of effects on both fatigue and activity. This understanding can improve transfusion practice and ultimately outcomes for hospitalized patients with anemia, by providing evidence that helps clinicians and patients better weigh the potential benefits of transfusion on fatigue, activity, and fatigability, against the risks of unnecessary transfusion during hospitalization. Moreover, this K23 will support additional training in advanced biostatistics and quantitative data analysis, research methodology, and clinical training in the workup, treatment, and management of anemia. These activities, under the guidance and support of a strong mentorship team, will allow me to develop scientifically and professionally, so that at the end of this K23 award period I will be prepared to use the data collected to apply for an RO1 to support an RCT that I would lead as an independent investigator. This planned RCT would build on the data and scientific foundation established as part of this K23, and would compare symptom-driven transfusion to the current practice of uniform restrictive transfusion practice based on Hb alone, using fatigue, activity, and fatigability as outcomes. Therefore, through the training, mentoring, and research experience of this award, I will position myself to become an independent researcher and a leader in how transfusion affects important patient-reported and clinical outcomes in hospitalized patients with anemia. Additionally, I will set myself up to be a leader in the future who studies how new and emerging therapies affect and can improve the health outcomes of hospitalized patients with anemia.