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

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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).