Informing best practices for evaluation and treatment of myocardial injury during sepsis

摘要/项目摘要 脓毒症是一种危及生命的疾病，诊断时，器官功能障碍的结果，严重感染。 脓毒症每年影响美国约100万患者。大约一半的患者 脓毒症有证据表明心肌损伤，称为"心肌损伤"。多种途径可导致 脓毒症时心肌损伤。尽管脓毒症期间心肌损伤的患者 结果，目前几乎没有信息可以告知评估这些患者的最佳方法， 可能导致个体患者心肌损伤的途径，或指导最佳治疗方案的选择 治疗。我们提出了"为评估和治疗心肌损伤提供信息的最佳实践， 脓毒症"研究，以提供临床可操作的信息，基准和指导患者的护理 脓毒症心肌损伤我们将使用现有的纵向电子健康记录数据从两个大的 美国的综合医疗保健系统，以有效地确定测试和治疗模式， 以及预测患者最有可能对涉及冠状动脉通路的治疗有反应的因素 动脉疾病我们还将评估常用的血液稀释剂对心肌损伤的有效性， 败血症我们组建了一支在电子医疗使用方面拥有合作记录和专业知识的团队 记录数据以研究脓毒症结局、心肌损伤的机制和生物标志物， 研究方法我们提案的结果将为当前的诊断和治疗策略提供信息， 指导未来研究患者最佳临床路径的随机试验的设计和实施 败血症时心肌损伤

ABSTRACT / PROJECT SUMMARY Sepsis is a life-threatening condition diagnosed when dysfunction of organs results from severe infection. Sepsis affects approximately 1 million patients in the United States each year. About one-half of patients with sepsis have evidence of injury to the heart muscle called ‘myocardial injury’. Multiple pathways can lead to myocardial injury during sepsis. Even though patients with myocardial injury during sepsis have worse outcomes, there is currently little information to inform the best approach to evaluate these patients, to inform the likely pathways leading to myocardial injury in individual patients, or to guide the selection of optimal treatments. We propose the “Informing best practices for evaluation and treatment of myocardial injury during sepsis” study to provide clinically actionable information to benchmark and guide the care of patients with myocardial injury in sepsis. We will use existing longitudinal electronic health record data from two large integrated healthcare systems in the United States to efficiently determine the patterns of testing and treatment and the factors that predict the patients most likely to respond to treatments for pathways involving coronary artery disease. We will also assess the effectiveness of commonly used blood thinners for myocardial injury in sepsis. We have assembled a team with a record of collaboration and expertise in the use of electronic health record data to study sepsis outcomes, mechanisms and biomarkers of myocardial injury, and observational research methodology. Results from our proposal will inform current diagnostic and therapeutic strategies and guide the design and conduct of future randomized trials investigating optimal clinical pathways for patients with myocardial injury in sepsis.