A multivariate predictive model for long-term disability post subarachnoid hemorrhage in Caucasian and African American populations

白种人和非裔美国人蛛网膜下腔出血后长期残疾的多变量预测模型

• 批准号: 9759999
• 负责人: Ansley Stanfill
• 金额: $ 50.36万
• 依托单位: UNIVERSITY OF TENNESSEE HEALTH SCI CTR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-08 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9759999
• 关键词: Admission activity; Affect; Affective Symptoms; African American; Age; Aneurysmal Subarachnoid Hemorrhages; Automobile Driving; Categories; Caucasians; Clinic; Clinical; Clinical Data; Collection; DNA Repository; Data; Data Set; Databases; Development; Fostering; Foundations; Gender; Genes; Genetic; Genomics; Genotype; Glasgow Coma Scale; Glasgow Outcome Scale; Goals; Individual; Intervention; Knowledge; Marital Status; Measures; Medical Genetics; Methods; Modeling; Neurobehavioral Manifestations; Outcome; Pathway interactions; Patients; Phase; Population; Predictive Factor; Public Health; Quality of life; Race; Rehabilitation therapy; Research; Risk; Saliva; Sampling; Site; Stroke; Subarachnoid Hemorrhage; Testing; Universities; Validation; Variant; Work; base; caucasian American; clinical practice; clinical translation; cohort; disability; effective intervention; experience; genetic association; improved; improved outcome; innovation; insight; model development; mortality; novel; outcome prediction; physical symptom; post stroke; precision medicine; predictive modeling; premature; programs; racial difference; racial disparity; racial diversity; recruit; response; social; symptom science

Aneurysmal subarachnoid hemorrhage (aSAH) strikes relatively young individuals and carries high rates of mortality and severe disability. While social, clinical, and genetic factors have each independently been shown to be associated with disability, there remains a large portion of unexplained variability as well as great disparities in outcome for African American patients as compared to Caucasian patients. Thus, there is a gap in knowledge relating to: 1) accurate prediction of those most at risk for long-term disability outcomes and 2) the relative contributions of these multivariate factors for the observed disparities in outcome seen for African Americans. These gaps currently present a critical barrier toward the goal of developing an individualized intervention to reduce disability and increase quality of life after aSAH. The objective of this current proposal is to lay the foundation for such an intervention by accurately identifying individuals most at risk and identifying the factors contributing to the racial disparities seen for these populations. Our central hypothesis is that multivariate models encompassing selected social, clinical, and genetic factors will provide a sensitive and specific prediction of 12-month disability outcomes for Caucasian and African American populations. Guided by our strong pilot data and leveraging the power of two existing databases, this hypothesis will be tested by two specific aims: 1) Using social, clinical, and genetic data, we propose to develop a predictive model for disability 12 months post aSAH in a Caucasian cohort; and 2) Using social, clinical, and genetic data, we propose to develop a predictive model for disability 12 months post aSAH in an African American cohort. After validation and cross-validation, the uniformity of the two models will be compared for insights into factors driving the disparities in outcome between these groups. This project is innovative for its multivariate predictive model that incorporates the collection and addition of genetic data and also for the racial diversity seen when comparing these two unique longitudinal aSAH datasets. This project is significant, as it will inform precisely targeted interventions aimed at reducing disability and disparity in outcomes post aSAH, which will allow a better quality of life for these patients.

动脉瘤性蛛网膜下腔出血（ASAH）罢工相对较年轻，率高 死亡率和严重的残疾率。虽然社会，临床和遗传因素已经独立 被证明与残疾相关，仍然有很大一部分无法解释的变异性 与高加索患者相比，非裔美国人患者的结果差异。因此，存在差距 与以下方面有关的知识：1）准确预测长期残疾结果风险的人和2） 这些多元因素对观察到的非洲结果差异的相对贡献 美国人。这些差距目前为开发个性化的目标带来了关键的障碍 干预措施以减少残疾并增加ASAH之后的生活质量。当前建议的目的是 通过准确识别最有风险的人并确定的个人来为这种干预奠定基础 导致这些人群的种族差异的因素。我们的中心假设是 涵盖选定的社会，临床和遗传因素的多元模型将提供敏感和敏感的 对高加索和非裔美国人人口的12个月残疾结果的具体预测。指导 我们强大的试点数据并利用两个现有数据库的功能，该假设将由两个测试 具体目的：1）使用社会，临床和遗传数据，我们建议开发一个残疾预测模型 在白人队列中的阿萨后12个月； 2）使用社会，临床和遗传数据，我们建议 在非洲裔美国人群中，ASAH后12个月开发一个残疾预测模型。验证后 和交叉验证，将比较这两个模型的统一性，以洞悉推动驱动的因素 这些群体之间的结果差异。该项目对其多元预测模型具有创新性 将遗传数据的收集和添加以及在比较时看到的种族多样性 这两个独特的纵向ASAH数据集。该项目很重要，因为它将确切地为目标提供信息 旨在减少ASAH后结果的残疾和差异的干预措施，这将允许更好的质量 这些患者的生命。