Characterizing contemporary practices in the approach to elevated troponin I levels during sepsis

项目摘要/摘要 我提出了“在提高肌钙蛋白I水平的方法中的当代实践的特征” “脓毒症”研究为治疗升高的血清肌钙蛋白水平开发一种循证的方法 在脓毒症期间，并提高我在临床设计、数据科学方法论、统计编程方面的技能 和专业发展，以便成为一名独立的临床研究员。脓毒症是由 感染引起的危及生命的器官功能障碍，并与重大的长期心血管疾病有关 发病率。脓毒症时血清肌钙蛋白水平经常升高，可作为脓毒症后的预后指标。 心血管并发症。尽管它的预后意义和在脓毒症期间的规律性存在， 对于脓毒症期间血清肌钙蛋白水平升高的患者，没有标准化的管理方法。 关于心血管诊断测试和使用潜在的心脏保护药物的决定 在这些患者中，由治疗临床医生自行决定，导致了不同的实践方法 对患者结局的影响尚不清楚。我提出了两个必要的基本步骤来开发 脓毒症期间血清肌钙蛋白升高患者的标准化管理方法 使用大型观察性重症监护数据库：1)评估心血管诊断的当前做法 脓毒症期间血清肌钙蛋白水平升高的患者的治疗和管理，以及2)评估 使用抗血小板和抗凝血策略作为潜在的心力衰竭的风险和好处 保护性治疗药物，在相同的败血症队列中。第一个目标将通过以下方式实现 使用风险调整的分层模型进行实践差异分析，以确定患者、医生和 医院层面的因素导致心脏管理方法的差异。第二个目标将是 通过使用边际结构模型估计平均值的定向试验方法完成 每种治疗策略对临床疗效的影响。完成这项建议将填补知识 以及评估两类潜在的有氧运动的风险和收益。 脓毒症期间血清肌钙蛋白升高患者的保护性药物治疗。 这项工作通知我未来申请导师职业发展奖的目的是 潜在心脏保护药物的随机比较有效性研究，目标是 减少败血症住院后的心血管并发症。这项提案将作为 为我的职业生涯奠定了基础，成为危重病护理卫生服务和比较研究领域的领先内科科学家 非心源性心血管并发症管理的有效性研究 得了重病。

PROJECT SUMMARY/ABSTRACT I propose the “Characterizing contemporary practices in the approach to elevated troponin I levels during sepsis” study to develop an evidenced-based approach to the management of elevated serum troponin levels during sepsis and to advance my skillset in clinical design, data science methodology, statistical programming and professional development in order to become an independent clinical investigator. Sepsis is the result of life-threatening organ dysfunction due to infection and is associated with significant long-term cardiovascular morbidity. Serum troponin levels are frequently elevated during sepsis and are prognostic for post-sepsis cardiovascular complications. Despite its prognostic significance and regular presence during sepsis, there is no standardized management approach to patients with elevated serum troponin levels during sepsis. Decisions regarding cardiovascular diagnostic testing and use of potential cardio-protective medications among these patients are left to the discretion of the treating clinician, resulting in diverse practice approaches with unclear impact on patient outcomes. I propose two essential foundational steps needed to develop a standardized management approach to patients with elevated serum troponin levels during sepsis through the use of a large, observational critical care database: 1) evaluate current practices in cardiovascular diagnostic and therapeutic management of patients with elevated serum troponin levels during sepsis, and 2) assess the risks and benefits associated with use of anti-platelet and anticoagulation strategies as potential cardio- protective treatment agents, among the same sepsis cohort. The first objective will be achieved through practice variation analysis using risk-adjusted hierarchical models to identify the patient-, physician-, and hospital-level factors contributing to cardiac management approach variation. The second objective will be completed through a targeted trial approach using marginal structural models to estimate the average treatment effect of each treatment strategy on clinical outcomes. Completion of this proposal will fill knowledge gaps in current practice strategies as well as assess the risks and benefits of two classes of potential cardio- protective medications employed in management of patients with elevated serum troponin levels during sepsis. This work with inform my future application for a mentored Career Development Award geared toward randomized comparative effectiveness studies of potential cardio-protective medications with the goal of reducing cardiovascular complications following sepsis hospitalization. This proposal will serve as the foundation to my career as a leading physician-scientist in critical care health services and comparative effectiveness research with a focus on the management of the cardiovascular complications of non-cardiac critical illness.