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

减轻贫血以优化危重疾病幸存者的出院后功能恢复

• 批准号: 10415166
• 负责人: Matthew A Warner
• 金额: $ 19.06万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10415166
• 关键词: Acute; Admission activity; Adoption; Anemia; Applications Grants; Attenuated; Biometry; Clinical Trials; Clinical Trials Design; Cognition; Complication; Critical Care; Critical Illness; Data; Data Science; Development; Erythrocyte Transfusion; Future; Goals; Hemoglobin; Hemoglobin concentration result; Hospitalization; Hospitals; Illness impact; Impairment; Intensive Care Units; Intervention; Knowledge; Mental Health; Methodology; Modification; Outcome; Outcome Assessment; Outcomes Research; Patient Outcomes Assessments; Patients; Pattern; Pharmacology; Physical Function; Pragmatic clinical trial; Predictive Factor; Prevention; Quality of life; Recovery; Recovery of Function; Research; Research Priority; Risk Factors; Scientist; Survivors; Techniques; Testing; Training; United States; Venous blood sampling; attenuation; clinical decision support; clinical predictors; cohort; epidemiologic data; experience; feasibility testing; functional outcomes; high risk; implementation science; improved; modifiable risk; mortality; multi-component intervention; multidisciplinary; novel; patient oriented; patient population; prevent; success; therapy design; translational physician

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).

项目概要/摘要 贫血是一种常见但未被充分认识的危重疾病并发症。同时增加对贫血的耐受力 与死亡率、对长期影响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。减值 这些功能领域的疾病在危重疾病的幸存者中非常普遍且使人衰弱，并且 识别可改变的风险因素已被认为是危重疾病研究的首要任务。 申请人的长期目标是成为一名成功的独立转化临床医生科学家 领导多学科团队优化危重病后患者的康复。科学目标 该应用程序的目的是：1) 识别危重症后贫血恢复受损风险最高的患者 疾病; 2）评估持续性住院后贫血与功能结果之间的关系； 3) 测试新型贫血预防和治疗干预措施的可行性和对术后贫血的影响 住院功能结果。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、多维功能结果评估、实用临床试验 设计和实施科学。 目标 1. 评估危重疾病后第一年贫血恢复的模式和后果 • 危重病后贫血的恢复特征仍不完全。为实现这一目标，流行病学 来自大量 ICU 幸存者的数据将用于评估危重患者后血红蛋白的恢复情况 疾病。将使用先进的统计和数据科学方法来确定 血红蛋白恢复，预测恢复受损高风险的患者，并评估关系 住院后第一年血红蛋白恢复和功能结果之间的关系。 目标 2. 进行试点实用临床试验，测试多方面的贫血干预措施（优化 放血实践、临床决策支持、靶向药物性贫血治疗）以减弱 严重疾病情况下贫血的发生和促进功能恢复 • 贫血治疗干预措施对危重病后功能结果的影响尚未得到研究。 定义的。这一目标将采用试点临床试验来测试一种新型多方面的可行性和有效性。 贫血干预旨在减轻和治疗危重疾病期间的贫血，以改变 血红蛋白水平和住院后功能结果（即住院后 3 个月和 6 个月）。