The Role and Consequences of Anemia in Children with Pneumonia

贫血在肺炎儿童中的作用和后果

• 批准号: 8976080
• 负责人: PETER P MOSCHOVIS
• 金额: $ 6.87万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8976080
• 关键词: Admission activity; Affect; Africa South of the Sahara; Age; Altitude; Anemia; Antibiotics; Blood; Blood Transfusion; Carrying Capacities; Cause of Death; Cessation of life; Child; Child health care; Childhood; Clinical; Clinical Research; Clinical Trials; Country; Critical Care; Data; Development; Diagnosis; Disease; Environmental air flow; Erythrocyte Transfusion; Future; Goals; Health; Hemoglobin; Hospital Referrals; Hospitalized Child; Hypoxemia; Hypoxia; Income; Infectious Disease Epidemiology; Institution; Journals; K-Series Research Career Programs; Lead; Low income; Lung diseases; Malaria; Measures; Mentors; Mentorship; Observational Study; Outcome; Oxygen; Patients; Pediatrics; Perfusion; Pneumonia; Prevention; Public Health; Randomized Clinical Trials; Recovery; Regimen; Research; Research Methodology; Research Training; Resolution; Respiratory Failure; Respiratory Tract Infections; Respiratory distress; Risk; Risk Factors; Role; Safety; Science; Southeastern Asia; Technology; Testing; Time; Tissues; Training; Training Programs; Transfusion; Translational Research; Uganda; Universities; Work; adverse outcome; burden of illness; global health; improved; modifiable risk; mortality; nutrition; patient oriented; phase 4 study; prospective; skills; targeted treatment; treatment trial

DESCRIPTION (provided by applicant): Pneumonia is the leading cause of death among young children worldwide, primarily in low and middle-income countries (LMIC). Since children with pneumonia ultimately die of respiratory failure, factors such as anemia that affect delivery of oxygen to the tissues may affect patient outcomes. Anemia is very common in LMIC, affecting two-thirds of children in Sub-Saharan Africa and Southeast Asia, and it may be a target for therapy in some patients with pneumonia. The overarching goal of this research is to describe the outcomes of children hospitalized with the combination of severe pneumonia and moderate/severe anemia in order to obtain preliminary data that will inform a future prospective treatment trial. In our prior work, we found that the combination of anemia and high altitude is particularly harmful among children with severe pneumonia. This study did not include many children with severe anemia; by extension, I hypothesize that severe anemia will be associated with poor outcomes in pneumonia, even at low altitude. I will test this hypothesis through an observational study of children admitted with severe pneumonia and moderate/severe anemia to Mbarara Regional Referral Hospital, our collaborating institution in Southwest Uganda. In Aim 1, I will measure the effect of hemoglobin on time to recovery from severe pneumonia. In Aim 2, I will evaluate the effect of low hemoglobin on tissue hypoxia, as measured by blood lactate. Correcting severe anemia will in some cases require red blood cell (RBC) transfusion, and Aim 3 will evaluate the safety of RBC transfusions among patients with severe pneumonia by measuring the risk of transfusion-associated circulatory overload (TACO) in patients receiving transfusions. The larger research goal is to identify modifiable risk factors that influence outcomes in children with pneumonia. I have already received clinical training in pulmonary disease and critical care. As part of the F32 training program, I will develop skills in clinical ad translational research through mentorship by Dr. Patricia Hibberd, an established expert in respiratory infections, global child health, and patient-oriented clinical research who has conducted translational through Phase IV studies on the prevention and treatment of childhood pneumonia in the US and in low-income countries. The training will be augmented by coursework in global health, research methods, infectious disease epidemiology, nutrition, and advanced biostatics. I anticipate that the findings from this research will inform global public health efforts to reduce pneumonia mortality among children.

描述（由申请人提供）：肺炎是全球幼儿死亡的主要原因，主要在低收入和中等收入国家（LMIC）。由于肺炎的儿童最终死于呼吸衰竭，因此影响氧气向组织递送的贫血等因素可能会影响患者的预后。贫血在LMIC中很常见，影响撒哈拉以南非洲和东南亚的三分之二的儿童，对于某些肺炎患者来说，这可能是治疗的靶标。这项研究的总体目的是描述与严重肺炎和中度/严重贫血相结合住院的儿童的结果，以获取将为未来的前瞻性治疗试验提供的初步数据。在我们先前的工作中，我们发现贫血患者贫血和高海拔的结合尤其有害。这项研究不包括许多严重贫血的儿童。从延长的情况下，我假设严重的贫血与肺炎的不良预后有关，即使在低海拔处也是如此。我将通过对患有严重肺炎和中度/严重贫血的儿童的观察性研究来检验这一假设，这是我们在西南乌干达的合作机构Mbarara Regional Recotral Hospital。在AIM 1中，我将测量血红蛋白对从严重肺炎恢复的时间的影响。在AIM 2中，我将评估低血红蛋白对组织缺氧的影响，如血液乳酸测量。在某些情况下，纠正严重的贫血需要红细胞（RBC）输血，AIM 3将通过测量接受输血患者的输血相关循环超负荷（Taco）的风险来评估严重肺炎患者的RBC输血的安全性。更大的研究目标是确定影响肺炎儿童结果的可修改风险因素。我已经接受了肺部疾病和重症监护的临床培训。作为F32培训计划的一部分，我将通过Patricia Hibberd博士的指导发展临床AD转化研究的技能，Patricia Hibberd博士是呼吸道感染，全球儿童健康和以患者为导向的临床研究专家，他通过IV阶段的预防和治疗我们和低收入国家的肺炎肺炎进行了IV研究。全球健康，研究方法，传染病流行病学，营养和先进的生物统计学的课程将增加培训。我预计这项研究的发现将为全球公共卫生努力降低儿童的肺炎死亡率。