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: 10214153
• 负责人: Matthew A Warner
• 金额: $ 16.9万
• 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/10214153
• 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).

项目摘要/摘要 贫血是危重疾病中一种常见但未得到充分认识的并发症。虽然提高了对贫血的耐受性 与死亡率等短期负面结果无关，对长期的影响 功能结果(身体功能、认知、心理健康、生活质量)仍不清楚。减值 这些功能领域的疾病在危重疾病幸存者中非常普遍和虚弱，而且 识别可改变的危险因素已被认为是危重疾病研究的关键优先事项。 申请者的长期目标是成为一名成功的独立翻译临床医生-科学家 领导一个多学科团队，以优化危重疾病患者的康复。的科学目标 此应用程序用于：1)确定危重后贫血恢复受损的最高风险患者 2)评估持续性住院后贫血与功能结局的关系； 3)检验一种新的贫血防治干预措施的可行性和对患者的影响。 住院功能结局。申请者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、多维功能结果评估和实用临床试验 设计和实施科学。 目的1.评估危重疾病后第一年贫血恢复的模式和后果 ·危重疾病后从贫血中恢复的特征仍然不完全。在这一目标中，流行病学 来自一大批ICU幸存者的数据将被用于评估危重事件后血红蛋白的恢复情况 生病了。将使用先进的统计和数据科学方法来确定 血红蛋白恢复，预测高危患者恢复受损，并评估两者之间的关系 入院后第一年的血红蛋白恢复与功能结果之间的关系。 目的2.进行先导性实用临床试验，测试多方面的贫血干预(优化 静脉采血实践、临床决策支持、有针对性的药物性贫血治疗)以减轻 危重病背景下贫血的发生和促进功能恢复 ·贫血治疗干预措施对危重疾病后功能结局的影响尚未得到 已定义。这一目标将采用先导性临床试验来测试新的多方面的可行性和有效性 旨在减轻和治疗危重病期间贫血的贫血干预措施 血红蛋白水平和入院后功能转归(即入院后3个月和6个月)。