Attenuation of Anemia for the Optimization of Post-Hospitalization Functional Recovery in Survivors of Critical Illness

项目总结/摘要 贫血是一种常见但未被充分认识的危重病并发症。同时增加对贫血的耐受性 与死亡率等负面短期结果无关， 功能结果（身体功能、认知、心理健康、生活质量）仍然未知。障碍 在这些功能领域是非常普遍和衰弱的幸存者的严重疾病， 确定可改变的风险因素已被认为是危重病研究的一个关键优先事项。 申请人的长期目标是成为一名成功的独立翻译临床科学家 领导一个多学科团队，以优化危重病患者的康复。的科学目标 本申请的目的是：1）识别在严重贫血后处于贫血恢复受损的最高风险的患者， 2）评估住院后持续性贫血与功能结局之间的关系; 和3）测试一种新的贫血预防和治疗干预措施对术后贫血的可行性和影响。 住院功能结局。申请人的培训目标是获得以下方面的培训和专业知识： 生物统计学和数据科学，多维功能结局评估和实用临床试验 设计和实施科学。 目标1.评估危重病后第一年贫血恢复的模式和后果 ·危重病后贫血的恢复仍不完全表征。为此，流行病学 来自ICU幸存者的大队列数据将用于评估重症监护室（ICU）后血红蛋白恢复情况。 病将使用先进的统计和数据科学方法来确定 血红蛋白恢复，预测患者恢复受损的高风险，并评估 血红蛋白恢复与住院后第一年的功能结局之间的关系。 目标2.进行一项试验性实用临床试验，测试多方面的贫血干预（优化） 静脉切开术实践、临床决策支持、针对性药物性贫血治疗）， 贫血发展和促进功能恢复的设置危重病 ·贫血治疗干预对危重病后功能结局的影响尚未得到证实。 定义了这一目标将采用试点临床试验测试的可行性和有效性，一种新的多方面 贫血干预旨在减轻和治疗危重病期间的贫血， 血红蛋白水平和住院后功能结局（即住院后3个月和6个月）。

Project Summary/Abstract Anemia is a common but underappreciated complication of critical illness. While increased tolerance of anemia has not been associated with negative short-term outcomes such as mortality, the impact on long-term functional outcomes (physical function, cognition, mental health, quality of life) remains unknown. Impairments in these functional domains are highly prevalent and debilitating in survivors of critical illness, and the identification of modifiable risk factors has been recognized as a key priority in critical illness research. The long-range goal of the applicant is to become a successful independent translational clinician-scientist leading a multidisciplinary team to optimize patient recovery after critical illness. The scientific objectives of this application are to: 1) identify patients at highest risk for impaired recovery from anemia after critical illness; 2) assess the relationships between persistent post-hospitalization anemia and functional outcomes; and 3) to test the feasibility and impact of a novel anemia prevention and treatment intervention on post- hospitalization functional outcomes. The training goals of the applicant are to obtain training and expertise in biostatistics and data science, multi-dimensional functional outcome assessment, and pragmatic clinical trial design and implementation science. Aim 1. To assess patterns and consequences of anemia recovery in the first year after critical illness • Recovery from anemia after critical illness remains incompletely characterized. In this aim, epidemiologic data from a large cohort of ICU survivors will be utilized to evaluate hemoglobin recovery after critical illness. Advanced statistical and data science approaches will be used to identify unique profiles of hemoglobin recovery, predict patients at high risk for impaired recovery, and assess the relationships between hemoglobin recovery and functional outcomes in the first year after hospitalization. Aim 2. To perform a pilot pragmatic clinical trial testing a multi-faceted anemia intervention (optimized phlebotomy practice, clinical-decision support, targeted pharmacologic anemia treatment) to attenuate anemia development and promote functional recovery in the setting of critical illness • The impact of anemia treatment interventions on functional outcomes after critical illness has not been defined. This aim will employ a pilot clinical trial testing the feasibility and efficacy of a novel multi-faceted anemia intervention aimed at attenuating and treating anemia during critical illness for the modification of hemoglobin levels and post-hospitalization functional outcomes (i.e. 3 and 6 months after hospitalization).