Epidemiology of Chronic Critical Illness in Surgical ICU Patients After Sepsis

脓毒症后外科 ICU 患者慢性危重疾病的流行病学

• 批准号: 8740719
• 负责人: FREDERICK A MOORE
• 金额: $ 17.85万
• 依托单位: UNIVERSITY OF FLORIDA
• 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 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8740719
• 关键词: Acute; Adult; Age; Biological Markers; Cachexia; Caring; Catabolism; Cessation of life; Chronic; Clinical; Clinical Trials; Cognitive; Coin; Computerized Medical Record; Critical Care; Critical Illness; Dependency; Development; Early Diagnosis; Early Intervention; Early treatment; Elderly; Enrollment; Epidemic; Epidemiology; Event; Functional disorder; Future; Goals; Healthcare; Healthcare Systems; Hospitals; Hour; Immunosuppression; Indolent; Inflammation; Integration Host Factors; Intensive Care Units; Intervention; Life; Longitudinal Studies; Modeling; Multiple Organ Failure; Newly Diagnosed; Nosocomial Infections; Operative Surgical Procedures; Organ; Outcome; Patients; Phenotype; Plant Roots; Population; Procedures; Process; Quality of life; Recovery; Recurrence; Resuscitation; Risk; Sampling; Sepsis; Severities; Site; Societies; Surgical Intensive Care; Survivors; Syndrome; Testing; Time; Trauma; Wound Healing; computerized; design; evidence based guidelines; experience; functional outcomes; high risk; improved; indexing; insight; mortality; novel; older patient; prospective; response; screening; septic; standard of care; standardized care

PROJECT ABSTRACT With sepsis screening and increased compliance with evidence based, guidelines-driven standard operating procedures for early diagnosis and treatment of sepsis in surgical intensive care unit (ICU) patients, early mortality has been dramatically reduced and late-onset fulminant multiple organ failure has virtually disappeared. A new phenotype of chronic critical illness (CCI), however, has emerged in surgical ICU patients characterized by prolonged ICU stays, recurrent nosocomial infections, poor wound healing, progressive cachexia and manageable organ dysfunctions. We have coined the term persistent inflammation, immunosuppression and catabolism syndrome (PICS) to reflect the pathophysiologic hallmarks of this growing epidemic. Many of these patients (especially the elderly) are discharged to long-term acute care facilities where they often suffer an indolent death. We hypothesize that CCI characterized by morbid long-term outcomes is now a predominant clinical trajectory of surgical ICU patients who survive sepsis. The overall objective of Project #1 is to characterize the epidemiology of CCI in surgical ICU patients who develop sepsis and to determine its long-term consequences. The challenge is to return those surgical ICU patients who survive sepsis to a functional, productive life, and to reduce their burden to the healthcare system and to society through early interventions. We need to identify early, however, which patients are at highest risk for morbid long-term outcomes and might benefit from novel interventions. Project #1's main functions will be the following: * Define the epidemiology and long-term consequences of sepsis in surgical ICU patients. Clearly, there is a compelling need to better understand the long-term consequences of sepsis in surgical ICU patients, especially those who progress into CCI who are at high risk for PICS. * Identify clinical indices and biomarkers that can predict CCI in surgical ICU patients early (within 48 hours) after sepsis. These prediction models could help provide insight into underlying pathophysiology and design entry criteria in future trials. * Identify clinical indices and biomarkers on day 14 in patients with CCI after sepsis that predict morbid outcome (defined as death or full functional dependency at 1 year). These findings could be used to gain insight into underlying pathophysiology by comparing novel biomarkers at earlier time points in patients at highest risk for morbid long-term outcomes versus those patients at lowest risk. A CCI score could then be developed as a composite endpoint in future interventional trials. To accomplish the above goals, Project #1 will perform, over 5 years, a single-site, prospective, longitudinal study of 400 adult surgery and trauma ICU patients who develop sepsis.

项目摘要 随着败血症的筛查并增加了基于证据的，指南驱动的标准操作 早期诊断和治疗败血症的手术重症监护病房（ICU）患者的程序，早期 死亡率已大大降低，并且迟发性暴发多器官衰竭实际上已经 消失了。然而，手术ICU患者出现了一种新的慢性疾病表型（CCI） 以ICU停留时间长时间，复发性医院感染，伤口愈合不良，进行性进行性特征 缓存和可管理的器官功能障碍。我们已经创造了一词持续的炎症， 免疫抑制和分解代谢综合征（图片）反映了这种增长的病理生理标志 流行性。这些患者中的许多（尤其是老年人）已出院到长期的急性护理设施中 他们经常遭受懒惰的死亡。我们假设以病态长期为特征的CCI 结果现在是败血症生存的手术ICU患者的主要临床轨迹。总体 项目＃1的目标是表征患败血症的手术ICU患者CCI的流行病学 并确定其长期后果。挑战是退还那些手术ICU患者 生存败血症，使其具有功能性，富有成效的生活，并减轻对医疗保健系统的负担 通过早期干预的社会。但是，我们需要尽早确定哪些患者面临的风险最高 病态的长期结果，可能会受益于新颖的干预措施。 项目＃1的主要功能将如下： *定义手术ICU患者败血症的流行病学和长期后果。显然，有一个 迫切需要更好地了解手术ICU患者败血症的长期后果， 尤其是那些进入CCI高风险的CCI的人。 *确定可以早日（在48小时内）预测手术ICU患者CCI的临床指数和生物标志物 败血症后。这些预测模型可以帮助您深入了解潜在的病理生理学和 在以后的试验中设计进入标准。 *败血症患者的CCI患者在第14天确定临床指数和生物标志物，以预测病态 结果（定义为1年的死亡或功能依赖性）。这些发现可用于获得 通过比较早期的患者的新生物标志物来洞悉潜在的病理生理学 与风险最低的患者相比，病态长期结局的最高风险。 CCI得分可能是 在将来的介入试验中开发为复合端点。 为了实现上述目标，项目＃1将在5年以上的单一站点，前瞻性，纵向执行 研究400名成人手术和创伤性ICU患者的研究。