Using lactate testing to improve maternal sepsis identification: a multi-country test accuracy study and feasibility assessment

使用乳酸检测提高孕产妇败血症识别：多国检测准确性研究和可行性评估

• 批准号: MR/T039353/1
• 负责人: David Lissauer
• 金额: $ 117.57万
• 依托单位: University of Liverpool
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT039353%2F1
• 关键词: Using; lactate; testing; improve; maternal

"Maternal sepsis" is a medical problem caused by infection during or after pregnancy or childbirth. It occurs when the body's response to infection starts to cause damage to its own organs and tissues. It can be life-threatening if not identified and treated quickly after it has developed. In fact, worldwide it is the 3rd most common cause of death related to pregnancy and childbirth. Internationally, organisations such as the World Health Organisation and United Nations are committed to reducing the numbers of women who die from preventable causes related to their pregnancies. Tackling maternal sepsis is an important part of this effort.In high income countries research has shown that groups of key treatments given together at the same time can help reduce bad outcomes and deaths from sepsis. These groups of treatments are sometimes called "treatment bundles". Because of this research, and the importance of tackling maternal sepsis worldwide, a treatment bundle was developed specifically for maternal sepsis. This treatment bundle is called FAST-M and was developed to be used in resource-poor settings and been tested in lots of facilities so we know it can be used to improve care. The next important research question our team would like to answer is in which women the FAST-M treatment bundle should be started. In high income settings and the general adult population, a blood test is commonly used to help gauge which patients are most unwell from sepsis and at risk of poor outcomes. This blood test measures an acid in the blood called Lactate, which is a helpful test to identify people who need the most urgent treatment. A small hand-held machine can now be used to measure Lactate which means it could be used even in placed that don't have proper laboratory facilities.However, it is not currently known what happens to lactate when a pregnant or recently pregnant adult has an infection, or if the test works as well if used in low resource setting. Changes in the body around pregnancy and childbirth alter how the body responds to infection which may also alter how the test works. Our team wants to find out if using a rapid lactate test is better than routine observations in identifying women most likely have maternal sepsis and to suffer poor outcomes. We intend to conduct this research in 3 countries; Malawi, Pakistan and Uganda. We will identify cases of maternal infection within the hospital sites. After gaining the permission of these women we will add taking a blood sample for lactate testing. We will not change the usual treatment but follow what happens to these women till they are discharged from hospital. We will look at the results of the lactate test, compared to usual observations to see how it compares in diagnosing maternal sepsis, and in predicting poor outcomes. In the second part of the study we want to find out if using this lactate test as part of maternal sepsis care, linked to the FAST-M bundle is possible in low resource settings, and what makes this easier or more difficult. To do this we will use sites in Uganda and Pakistan and see how it Lactate testing works when used. We will look carefully at how staff find using it by measuring what happens to patients and if it has been used correctly and reliably. We will also give questionnaires to staff and talk in detail to healthcare workers and others in the facility to find out their opinions about the test.This research will help us to know if using the lactate blood test is useful to diagnose cases of maternal sepsis and how the testing can be used in resource limited facilities to improve care. We hope this information will help reduce deaths and poor outcomes from cases of maternal sepsis worldwide.

“孕产妇败血症”是怀孕或分娩后感染引起的医疗问题。当人体对感染的反应开始损害其自身器官和组织时，就会发生这种情况。如果未识别并在开发后迅速治疗，它可能会威胁生命。实际上，在全球范围内，这是与怀孕和分娩有关的第三大死亡原因。在国际上，世界卫生组织和联合国等组织致力于减少死于与怀孕有关的可预防原因的妇女人数。应对孕产妇败血症是这项工作的重要组成部分。在高收入国家的研究中表明，同时进行的关键治疗组可以帮助减少败血症的不良结果和死亡。这些治疗组有时称为“治疗束”。由于这项研究以及在全球范围内应对孕产妇败血症的重要性，专门为孕产妇败血症而开发了一个治疗捆绑包。该处理捆绑包称为Fast-M，并开发用于资源贫乏的设置，并在许多设施中进行了测试，因此我们知道它可以用于改善护理。我们的团队想回答的下一个重要研究问题是，应该在哪个女性开始快速治疗捆绑包。在高收入环境和一般成年人口中，通常使用血液检查来帮助衡量哪些患者最不适，并且患有败血症的风险不佳。该血液测试测量称为乳酸的血液中的酸，这是一个有用的测试，可确定需要最紧急治疗的人。现在可以使用一台小型手持机器来测量乳酸，这意味着即使在没有适当的实验室设施的位置也可以使用它。怀孕和分娩周围身体的变化改变了身体对感染的反应方式，这也可能改变了测试的工作方式。我们的团队想找出在识别女性最有可能患有孕妇败血症并遭受较差的结果时，使用快速乳酸测试是否比常规观察更好。我们打算在3个国家进行这项研究；马拉维，巴基斯坦和乌干达。我们将确定医院现场内的孕产妇感染病例。获得这些妇女的许可后，我们将添加取血样品进行乳酸测试。我们不会更改通常的治疗方法，而要遵循这些妇女从医院出院之前发生的事情。与通常的观察结果相比，我们将研究乳酸测试的结果，以查看其在诊断孕产妇败血症和预测不良预后的比较。在研究的第二部分中，我们想找出是否将这种乳酸测试作为母体败血症护理的一部分，在低资源设置中可能与快速M捆绑在一起，以及使它更容易或更困难的原因。为此，我们将使用乌干达和巴基斯坦的网站，并查看其使用时乳酸测试的工作原理。我们将仔细研究员工如何通过测量患者发生的情况以及是否正确使用，如何找到使用它。我们还将向工作人员提供问卷调查，并详细介绍医疗保健工作者和设施中的其他人，以了解他们对测试的看法。这项研究将帮助我们知道使用乳酸血液测试是否有助于诊断孕产妇脓毒症病例以及如何在资源有限设施中使用测试来改善护理。我们希望这些信息将有助于减少全世界母亲败血症病例的死亡和不良结果。

项目成果

Avoidable Factors Associated with Maternal Death from Postpartum Haemorrhage: A National Malawian Surveillance Study

与产后出血导致孕产妇死亡相关的可避免因素：马拉维全国监测研究

• DOI: 10.2139/ssrn.4726184
• 发表时间: 2024
• 作者: Riches J