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

脓毒症期间肌钙蛋白 I 水平升高方法的当代实践特征

• 批准号: 10314392
• 负责人: Michael Anthony Garcia
• 金额: $ 5.35万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2022-06-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10314392
• 关键词: Acute; Admission activity; Adrenergic beta-Antagonists; Anticoagulants; Anticoagulation; Antiplatelet Drugs; Aspirin; Automobile Driving; Award; Benefits and Risks; Big Data; Biological Markers; Cardiac; Cardiac Catheterization Procedures; Cardiology; Cardiovascular Diseases; Cardiovascular system; Career Choice; Clinical; Clinical Investigator; Comparative Effectiveness Research; Consultations; Coronary; Critical Care; Critical Illness; Data; Data Science; Databases; Development; Diagnostic; Diagnostic tests; Drug Prescriptions; Echocardiography; Electrocardiogram; Fellowship; Foundations; Functional disorder; Future; Goals; Health Services Research; Heart Injuries; Hemorrhage; Hospital Mortality; Hospitalization; Hospitals; Infection; Inflammation; Injury to Kidney; K-Series Research Career Programs; Knowledge; Left; Life; Measurement; Mentors; Methodology; Methods; Modeling; Morbidity - disease rate; Myocardial; Organ; Outcome; Oxygen; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Physicians; Randomized; Renal clearance function; Research; Research Methodology; Research Personnel; Risk; Rupture; Scientist; Sepsis; Serum; Standardization; Stress Tests; Structural Models; Therapeutic; Training; Troponin; Troponin I; Variant; Work; cardioprotection; cardiovascular risk factor; career; cohort; comparative effectiveness; comparative effectiveness study; design; endothelial dysfunction; evidence base; health care service; heart imaging; insight; large datasets; mortality; myocardial injury; novel; prognostic; prognostic significance; prognostic value; skills; thrombotic; treatment effect; treatment strategy

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.

项目概要/摘要 我建议“表征在期间提高肌钙蛋白 I 水平的方法的当代实践 脓毒症”研究旨在开发一种基于证据的方法来管理血清肌钙蛋白水平升高 在脓毒症期间，提高我在临床设计、数据科学方法、统计编程方面的技能 成为独立临床研究者的专业发展是脓毒症的结果。 由于感染而危及生命的器官功能障碍，并与严重的长期心血管疾病相关 脓毒症期间血清肌钙蛋白水平经常升高，并且是脓毒症后的预后。 尽管其具有预后意义并且在脓毒症期间经常出现，但仍存在心血管并发症。 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心脏保护药物的决定 这些患者中的哪些患者由治疗临床医生自行决定，从而导致不同的实践方法 对患者结果的影响尚不明确，我提出了开发一个必要的两个基本步骤。 脓毒症期间血清肌钙蛋白水平升高的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实践 脓毒症期间血清肌钙蛋白水平升高的患者的治疗管理，以及 2) 评估 使用抗血小板和抗凝策略作为潜在的心血管疾病相关的风险和益处 第一个目标将通过以下方式实现： 使用风险调整分层模型进行变异分析，以识别患者、医生和 第二个目标是导致心脏管理方法变化的医院层面因素。 通过有针对性的试验方法使用边际结构模型来估计平均值 每种治疗策略对临床结果的治疗效果 完成本提案将充实知识。 当前实践策略中的差距以及评估两类潜在有氧运动的风险和益处 用于治疗脓毒症期间血清肌钙蛋白水平升高的患者的保护性药物。 这项工作为我未来申请指导职业发展奖提供了信息 潜在心脏保护药物的随机比较有效性研究，目的是 减少脓毒症住院后的心血管并发症。 为我作为重症监护健康服务和比较领域领先的医师科学家的职业生涯奠定了基础 以非心脏病患者心血管并发症管理为重点的有效性研究 危重疾病。