The Effect of Red Blood Cell Transfusion on Fatigue, Activity and Fatigability in Hospitalized Patients with Anemia

红细胞输注对住院贫血患者疲劳、活动和易疲劳性的影响

• 批准号: 10094071
• 负责人: Micah Thomas Prochaska
• 金额: $ 16万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10094071
• 关键词: Activities of Daily Living; Address; Adverse effects; Affect; Age; Anemia; Award; Biometry; Chicago; Clinical; Clinical Data; Clinical Trials; Data; Data Analyses; Data Mart; Development; Erythrocyte Transfusion; Fatigue; Foundations; Future; Gender; Goals; Health; Hemoglobin; Hemoglobin concentration result; Hospitalization; Hospitals; K-Series Research Career Programs; Knowledge; Lead; Measurement; Measures; Mediator of activation protein; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Modeling; Monitor; Outcome; Outcome Measure; Pathway interactions; Patient Self-Report; Patient-Focused Outcomes; Patients; Physical Function; Policies; Positioning Attribute; Questionnaires; Reporting; Research; Research Methodology; Research Personnel; Risk; Role; Symptoms; Testing; Time; Training; Transfusion; Universities; Walking; Work; actigraphy; base; career development; clinical predictors; clinically relevant; comorbidity; design; disability; experience; functional disability; functional outcomes; improved; insight; instructor; instrument; mortality; patient subsets; research and development; response; theories

PROJECT SUMMARY/ABSTRACT Recent shifts in practice towards restrictive transfusion strategies in hospitalized patients with anemia have been made without clear and convincing evidence concerning the potential adverse effects on fatigue and functional outcomes. This is important because anemia increases the tendency to become fatigued at any given level of activity (fatigability), increasing fatigue and decreasing activity, which may ultimately impair functional outcomes. Given this, the goals of transfusion may include reducing fatigability, minimizing fatigue and increasing activity, which should be expected to improve functional outcomes. Thus, data on the effects of transfusion on fatigue, activity, and fatigability could inform the design of new transfusion strategies that may improve patient outcomes. One example is symptom-driven transfusion, in which patients would be transfused based on their symptoms, such as fatigue. Therefore, this proposal will 1) provide data for hospitalized patients on the effects of transfusion on fatigue, activity levels, and fatigability, and 2) create and validate a new fatigability instrument that can be used in future studies to measure fatigue, activity, and fatigability in patients, and identify those most likely to benefit from a transfusion. The knowledge acquired through this K23 proposal will fill critical gaps in the understanding of how transfusion affects fatigue as the primary and most significant symptom of anemia, activity as an important clinical outcome, and fatigability as a key mediator of effects on both fatigue and activity. This understanding can improve transfusion practice and ultimately outcomes for hospitalized patients with anemia, by providing evidence that helps clinicians and patients better weigh the potential benefits of transfusion on fatigue, activity, and fatigability, against the risks of unnecessary transfusion during hospitalization. Moreover, this K23 will support additional training in advanced biostatistics and quantitative data analysis, research methodology, and clinical training in the workup, treatment, and management of anemia. These activities, under the guidance and support of a strong mentorship team, will allow me to develop scientifically and professionally, so that at the end of this K23 award period I will be prepared to use the data collected to apply for an RO1 to support an RCT that I would lead as an independent investigator. This planned RCT would build on the data and scientific foundation established as part of this K23, and would compare symptom-driven transfusion to the current practice of uniform restrictive transfusion practice based on Hb alone, using fatigue, activity, and fatigability as outcomes. Therefore, through the training, mentoring, and research experience of this award, I will position myself to become an independent researcher and a leader in how transfusion affects important patient-reported and clinical outcomes in hospitalized patients with anemia. Additionally, I will set myself up to be a leader in the future who studies how new and emerging therapies affect and can improve the health outcomes of hospitalized patients with anemia.

项目总结/摘要 最近在贫血住院患者中限制性输血策略的实践转变， 没有明确和令人信服的证据表明对疲劳的潜在不利影响， 功能性成果。这一点很重要，因为贫血会增加在任何情况下疲劳的倾向。 给定的活动水平（疲劳），增加疲劳和减少活动，这可能最终损害 功能性成果。鉴于此，输血的目标可能包括减少疲劳， 以及增加活动，这应该有望改善功能结果。因此，关于 输血对疲劳、活动和易疲劳性的影响可以为设计新的输血策略提供信息， 改善患者结果。其中一个例子是血液驱动的输血， 根据他们的症状，比如疲劳。因此，本提案将1）提供住院患者的数据 关于输血对疲劳、活动水平和易疲劳性的影响，2）创建并验证新的 可用于未来研究的疲劳性仪器，以测量患者的疲劳、活动和疲劳性， 找出最有可能从输血中受益的人通过K23提案获得的知识 将填补关键的空白，了解输血如何影响疲劳作为主要和最重要的 贫血症状，活动作为重要临床结果，以及疲劳作为影响 疲劳和活动。这种理解可以改善输血实践和最终结果， 贫血住院患者，通过提供证据，帮助临床医生和患者更好地权衡 输血对疲劳、活动和易疲劳的潜在益处，以及不必要输血的风险 在住院期间。此外，K23将支持高级生物统计学方面的额外培训， 定量数据分析，研究方法和临床培训，在检查，治疗， 贫血的管理这些活动在强大的导师团队的指导和支持下，将 让我在科学和专业上发展，这样在K23奖结束时，我将 我准备使用收集到的数据申请RO 1，以支持我将作为独立研究者领导的RCT 调查员这项计划中的随机对照试验将建立在作为其一部分而建立的数据和科学基础之上。 K23，并将比较血液透析驱动的输血与目前统一限制性输血的做法 仅基于Hb的练习，使用疲劳、活动和易疲劳性作为结果。因此通过 培训，指导，和研究经验的这个奖项，我将定位自己成为一个独立的 输血如何影响重要的患者报告和临床结局的研究者和领导者， 贫血住院患者。此外，我将把自己设定为未来的领导者， 新的和正在出现的疗法影响并可以改善贫血住院患者的健康结果。