Impact of Alcohol Misuse on Cognitive and Respiratory Outcomes in COVID-19-associated Acute Respiratory Failure

滥用酒精对 COVID-19 相关急性呼吸衰竭患者认知和呼吸结果的影响

基本信息

批准号：
10391807
负责人：
ELLEN L BURNHAM
金额：
$ 21.7万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-22 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10391807
关键词：
Accounting Acute Acute respiratory failure Address Admission activity Adult Adult Respiratory Distress Syndrome Alcohol consumption Alcohols Automobile Driving Brain COVID-19 COVID-19 pandemic COVID-19 patient COVID-19/ARDS Characteristics Clinic Cognition Cognitive Colorado Consumption Convalescence Coronavirus Critical Illness Data Delirium Development Diagnosis Enrollment Functional disorder Funding Goals Health Health system High Prevalence Hospitalization Hospitals Hypoxemia Impaired cognition Impairment Infection Intensive Care Units Intervention Investigation Long COVID Lung Mechanical Ventilators Mechanical ventilation Mental Health Monoclonal Antibody R24 Morbidity - disease rate National Institute on Alcohol Abuse and Alcoholism Neurocognitive Outcome Patients Predisposition Recording of previous events Recovery Reporting Research Residual state Resources Respiration Disorders Respiratory Failure Respiratory physiology Retrospective cohort Risk Risk Factors Role Services Severities Severity of illness Subgroup Survivors Universities Waxes Work alcohol misuse alcohol research brain abnormalities cohort health assessment improved lung development lung injury mental state mortality multidisciplinary pandemic disease prospective pulmonary function respiratory respiratory health response

项目摘要

Project Summary/Abstract During the Coronavirus (COVID)-19 pandemic, the number of patients diagnosed with the acute respiratory distress syndrome (ARDS) has increased dramatically in the US. COVID-19-associated ARDS is characterized by high morbidity, including a requirement for protracted mechanical ventilator support. In a substantial percentage of patients who survive hospitalization, deficits including neurocognitive dysfunction and residual pulmonary impairment have been reported as so-called Post-Acute Sequelae of COVID-19 (PASC). Therefore, it is imperative to urgently establish addressable factors that drive poor outcomes. Prior to the COVID-19 pandemic, investigations by our research group demonstrated that alcohol misuse is associated with an increased severity of ARDS, which may contribute to residual pulmonary dysfunction in survivors. Alcohol misuse can also propagate development of delirium that may increase risk for cognitive impairment in recovery. Notably, delirium has been reported in half of all COVID-19 patients in the ICU, and alcohol misuse appears to increase odds for its development. Although reports of increasing alcohol misuse during the pandemic are widespread and might be one modifiable factor driving severity of illness and outcomes, its impact on the trajectory of illness in COVID-19 has not been fully evaluated. The goal of this proposal is to determine if alcohol misuse promotes ICU delirium that in turn increases requirements for mechanical ventilation among patients with COVID-19-associated ARDS. Also, we wish to establish if alcohol misuse contributes to persistent cognitive and respiratory PASC in COVID-19 survivors. To address these questions, two aims are proposed. Aim 1: In hospitalized patients with COVID-19-associated ARDS, determine if alcohol misuse is associated with increased mechanical ventilation requirements, and if delirium further influences this relationship. Investigations will be conducted in a prospectively enrolled cohort of patients with COVID-19- associated ARDS, who are in the ICU at the University of Colorado Hospital (Aim 1a), and in a retrospective cohort of hospitalized patients with COVID-19, previously admitted in the University of Colorado Health system (Aim 1b). Aim 2: Among patients recovering from COVID-19, determine the impact of alcohol misuse on cognition and respiratory function in recovery, accounting for characteristics of acute illness that include requirements for mechanical ventilation and ICU delirium. Investigations will be conducted in patients followed in a multidisciplinary COVID-19 Recovery Clinic, who will have cognitive, mental, and respiratory health evaluated over the year following hospital discharge. Our proposed research will help determine if patients with alcohol misuse warrant targeted strategies to identify and treat delirium in the setting of COVID-19-associated respiratory failure, and it will clarify if hospitalized patients with COVID-19 and alcohol misuse represent a unique subgroup at risk for PASC who may merit specific services or interventions.

项目概要/摘要在冠状病毒 (COVID)-19 大流行期间，诊断出患有急性呼吸道疾病的患者人数窘迫综合症（ARDS）在美国急剧增加。 COVID-19 相关 ARDS 的特征发病率高，包括需要长期机械呼吸机支持。在实质性的住院患者存活率、神经认知功能障碍和残留缺陷等缺陷据报道，肺损伤被称为所谓的 COVID-19 急性后遗症 (PASC)。所以，迫切需要找出导致不良结果的可解决因素。在 COVID-19 之前大流行期间，我们研究小组的调查表明，滥用酒精与 ARDS 严重程度增加，可能导致幸存者残留肺功能障碍。酒精误用还会导致谵妄的发生，从而增加认知障碍的风险恢复。值得注意的是，ICU 中一半的 COVID-19 患者报告出现谵妄，并且酗酒似乎增加了其发展的可能性。尽管有报道称，疫情期间酗酒现象有所增加大流行病很普遍，可能是导致疾病严重程度和结果的一个可改变的因素，其对 COVID-19 疾病轨迹的影响尚未得到充分评估。该提案的目标是确定酒精滥用是否会导致 ICU 谵妄，进而增加对机械的要求 COVID-19 相关 ARDS 患者的通气。此外，我们希望确定是否滥用酒精有助于 COVID-19 幸存者的持续认知和呼吸 PASC。为了解决这些问题，提出了两个目标。目标 1：在患有 COVID-19 相关 ARDS 的住院患者中，确定是否饮酒误用与机械通气需求增加有关，如果谵妄进一步影响这一点关系。调查将在前瞻性招募的 COVID-19 患者队列中进行相关的 ARDS，他们在科罗拉多大学医院的 ICU 中（目标 1a），并且在一项回顾性研究中科罗拉多大学卫生系统先前收治的 COVID-19 住院患者队列（目标 1b）。目标 2：在从 COVID-19 中康复的患者中，确定滥用酒精对健康的影响恢复中的认知和呼吸功能，考虑到急性疾病的特征，包括机械通气和 ICU 谵妄的要求。将对患者进行调查在多学科 COVID-19 康复诊所中，患者将获得认知、心理和呼吸系统健康出院后一年内进行评估。我们提出的研究将有助于确定患者是否患有酒精滥用需要采取有针对性的策略来识别和治疗与 COVID-19 相关的谵妄呼吸衰竭，它将澄清住院的 COVID-19 患者和酗酒患者是否代表了呼吸衰竭面临 PASC 风险的独特亚群，可能需要特定的服务或干预措施。