Using lactate testing to improve maternal sepsis identification: a multi-country test accuracy study and feasibility assessment

使用乳酸检测提高孕产妇败血症识别：多国检测准确性研究和可行性评估

• 批准号: MR/T039353/1
• 负责人: David Lissauer
• 金额: $ 117.57万
• 依托单位: University of Liverpool
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT039353%2F1
• 关键词: Using; lactate; testing; improve; maternal

"Maternal sepsis" is a medical problem caused by infection during or after pregnancy or childbirth. It occurs when the body's response to infection starts to cause damage to its own organs and tissues. It can be life-threatening if not identified and treated quickly after it has developed. In fact, worldwide it is the 3rd most common cause of death related to pregnancy and childbirth. Internationally, organisations such as the World Health Organisation and United Nations are committed to reducing the numbers of women who die from preventable causes related to their pregnancies. Tackling maternal sepsis is an important part of this effort.In high income countries research has shown that groups of key treatments given together at the same time can help reduce bad outcomes and deaths from sepsis. These groups of treatments are sometimes called "treatment bundles". Because of this research, and the importance of tackling maternal sepsis worldwide, a treatment bundle was developed specifically for maternal sepsis. This treatment bundle is called FAST-M and was developed to be used in resource-poor settings and been tested in lots of facilities so we know it can be used to improve care. The next important research question our team would like to answer is in which women the FAST-M treatment bundle should be started. In high income settings and the general adult population, a blood test is commonly used to help gauge which patients are most unwell from sepsis and at risk of poor outcomes. This blood test measures an acid in the blood called Lactate, which is a helpful test to identify people who need the most urgent treatment. A small hand-held machine can now be used to measure Lactate which means it could be used even in placed that don't have proper laboratory facilities.However, it is not currently known what happens to lactate when a pregnant or recently pregnant adult has an infection, or if the test works as well if used in low resource setting. Changes in the body around pregnancy and childbirth alter how the body responds to infection which may also alter how the test works. Our team wants to find out if using a rapid lactate test is better than routine observations in identifying women most likely have maternal sepsis and to suffer poor outcomes. We intend to conduct this research in 3 countries; Malawi, Pakistan and Uganda. We will identify cases of maternal infection within the hospital sites. After gaining the permission of these women we will add taking a blood sample for lactate testing. We will not change the usual treatment but follow what happens to these women till they are discharged from hospital. We will look at the results of the lactate test, compared to usual observations to see how it compares in diagnosing maternal sepsis, and in predicting poor outcomes. In the second part of the study we want to find out if using this lactate test as part of maternal sepsis care, linked to the FAST-M bundle is possible in low resource settings, and what makes this easier or more difficult. To do this we will use sites in Uganda and Pakistan and see how it Lactate testing works when used. We will look carefully at how staff find using it by measuring what happens to patients and if it has been used correctly and reliably. We will also give questionnaires to staff and talk in detail to healthcare workers and others in the facility to find out their opinions about the test.This research will help us to know if using the lactate blood test is useful to diagnose cases of maternal sepsis and how the testing can be used in resource limited facilities to improve care. We hope this information will help reduce deaths and poor outcomes from cases of maternal sepsis worldwide.

“产妇败血症”是由怀孕或分娩期间或之后的感染引起的医学问题。当身体对感染的反应开始对自身器官和组织造成损害时，就会发生这种情况。它可以是危及生命的，如果没有发现和治疗后，它已经发展迅速。事实上，在世界范围内，它是与怀孕和分娩有关的第三大常见死亡原因。在国际上，世界卫生组织和联合国等组织致力于减少死于与怀孕有关的可预防原因的妇女人数。解决孕产妇败血症是这一努力的重要组成部分。在高收入国家，研究表明，同时给予几组关键治疗可以帮助减少败血症的不良后果和死亡。这些治疗组有时被称为“治疗包”。由于这项研究，以及在全球范围内解决孕产妇败血症的重要性，专门为孕产妇败血症开发了一种治疗包。这种治疗包被称为FAST-M，是为在资源匮乏的环境中使用而开发的，并在许多设施中进行了测试，因此我们知道它可以用来改善护理。我们团队想要回答的下一个重要研究问题是，FAST-M治疗包应该从哪些女性开始。在高收入环境和一般成年人群中，血液检测通常用于帮助衡量哪些患者因败血症而最不适，并有不良结局的风险。这种血液测试测量血液中的一种叫做乳酸盐的酸，这是一种有助于识别需要紧急治疗的人的测试。一台小型手持式仪器现在可以用来测量乳酸，这意味着它甚至可以在没有适当实验室设施的地方使用。然而，目前还不知道当怀孕或最近怀孕的成年人感染时乳酸会发生什么，或者如果在低资源环境中使用该测试是否也有效。怀孕和分娩前后身体的变化会改变身体对感染的反应，这也可能改变测试的工作方式。我们的团队想知道使用快速乳酸盐测试是否比常规观察更好，以确定最有可能患有孕产妇败血症并遭受不良后果的女性。我们计划在三个国家进行这项研究：马拉维、巴基斯坦和乌干达。我们将查明医院内的产妇感染病例。在获得这些妇女的许可后，我们将增加一个乳酸盐测试的血液样本。我们不会改变通常的治疗，但会关注这些妇女的情况，直到她们出院。我们将研究乳酸盐试验的结果，与通常的观察结果进行比较，以了解它在诊断母体败血症和预测不良结局方面的比较情况。在研究的第二部分，我们想知道在低资源环境下，是否可以使用这种乳酸盐测试作为孕产妇败血症护理的一部分，与FAST-M捆绑在一起，以及是什么让这更容易或更困难。为此，我们将使用乌干达和巴基斯坦的网站，看看乳酸盐测试是如何工作的。我们将仔细研究工作人员如何通过测量患者发生的情况以及是否正确可靠地使用它来发现使用它。我们还将向工作人员发放问卷，并与医疗工作者和其他机构的人员进行详细交谈，以了解他们对该测试的意见。这项研究将帮助我们了解使用乳酸血测试是否有助于诊断孕产妇败血症病例，以及如何在资源有限的机构中使用该测试来改善护理。我们希望这些信息将有助于减少全球孕产妇败血症病例的死亡和不良结局。

项目成果

Avoidable Factors Associated with Maternal Death from Postpartum Haemorrhage: A National Malawian Surveillance Study

与产后出血导致孕产妇死亡相关的可避免因素：马拉维全国监测研究

• DOI: 10.2139/ssrn.4726184
• 发表时间: 2024
• 作者: Riches J