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

项目概要/摘要 最近对住院贫血患者采取限制性输血策略的实践转变 没有明确和令人信服的证据表明对疲劳和疲劳的潜在不利影响 功能结果。这很重要，因为贫血会增加任何时候变得疲劳的倾向。 给定的活动水平（疲劳性），增加疲劳并减少活动，这最终可能会损害 功能结果。鉴于此，输血的目标可能包括减少疲劳、尽量减少疲劳 以及增加活动，这应该会改善功能结果。因此，关于影响的数据 输血对疲劳、活动和易疲劳性的影响可以为新输血策略的设计提供信息，这些策略可能会 改善患者的治疗效果。一个例子是症状驱动的输血，其中患者将接受输血 根据他们的症状，例如疲劳。因此，该提案将1）为住院患者提供数据 输血对疲劳、活动水平和易疲劳性的影响，2) 创建并验证新的 疲劳度仪器可在未来的研究中用于测量患者的疲劳、活动和疲劳度， 并确定那些最有可能从输血中受益的人。通过本次 K23 提案获得的知识 将填补输血如何影响疲劳这一主要和最重要的认识方面的关键空白 贫血症状、活动作为重要的临床结果以及疲劳性作为影响的关键介质 疲劳和活动。这种理解可以改善输血实践并最终改善输血结果 通过提供证据帮助临床医生和患者更好地权衡贫血住院患者的病情 输血对疲劳、活动和易疲劳性的潜在益处，以及不必要输血的风险 住院期间。此外，该 K23 将支持高级生物统计学和 定量数据分析、研究方法以及检查、治疗和治疗方面的临床培训 贫血的管理。这些活动在强大的导师团队的指导和支持下，将 让我科学、专业地发展，这样在这个K23奖励期结束时我将成为 准备使用收集到的数据申请 RO1，以支持我将作为独立领导者领导的 RCT 调查员。这项计划中的随机对照试验将建立在作为该研究一部分而建立的数据和科学基础之上。 K23，并将症状驱动的输血与当前统一限制性输血的做法进行比较 仅基于 Hb 进行练习，使用疲劳、活动和易疲劳性作为结果。因此，通过 通过该奖项的培训、指导和研究经验，我将把自己定位为独立的 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 贫血住院患者。此外，我将把自己定位为未来的领导者，研究如何 新兴疗法影响并可以改善住院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.