Quantifying the Cardiovascular and Immunologic Changes after Spinal Cord Injury to Aid Diagnosis of Clinically Meaningful Infections

量化脊髓损伤后的心血管和免疫变化，以帮助诊断有临床意义的感染

• 批准号: 10577881
• 负责人: Felicia Skelton
• 金额: $ 16万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10577881
• 关键词: APACHE II; Acute Disease; Address; Admission activity; Age; Antibiotics; Autonomic nervous system; Bacteria; Bacteriuria; Bladder; Blood Pressure; Cardiovascular Abnormalities; Cardiovascular system; Caring; Case/Control Studies; Catheterization; Chronic; Clinical; Confusion; Cytology; Data; Data Sources; Databases; Development; Diagnosis; Diagnostic; Emergency department visit; Environment; Functional disorder; Goals; Guidelines; Health Care Costs; Healthcare; Heart Rate; Immunologics; Impairment; Infection; Inpatients; Laboratory Study; Leadership; Leukocytes; Measurement; Measures; Morbidity - disease rate; Multiple Abnormalities; National Institute of Child Health and Human Development; Neurogenic Bladder; Normal Range; Outcome; Participant; Patient advocacy; Patients; Performance; Peripheral; Persons; Physiological; Physiology; Population; Predictive Value; Provider; Public Health; Qualifying; Quality of Care; Quality of life; Research; Retrospective cohort study; Risk; Screening procedure; Severities; Signs and Symptoms; Societies; Spinal cord injury; Spinal cord injury patients; Symptoms; Temperature; United States National Institutes of Health; Urinary tract infection; Urine; Veterans Health Administration; Work; catheter associated UTI; classification algorithm; clinical diagnosis; cohort; cold temperature; comorbidity; cost; diagnostic accuracy; diagnostic criteria; disability; improved; instrumentation; mortality; multi-drug resistant pathogen; overtreatment; patient population; peripheral blood; prospective; support tools; tool

7. Project Summary/Abstract Urinary tract infection (UTI, including catheter-associated UTI), is consistently amongst the top three reasons for health care use for persons with spinal cord injury (SCI), with a yearly cost of over $2 billion, not to mention the significant impact of the condition on quality of life. While the importance of recognizing and treating true UTI is evident, distinguishing this condition from asymptomatic bacteriuria (ASB, a positive urine culture without clinical signs or symptoms of infection) is particularly challenging after SCI due to the impaired ability to sense the most common signs and symptoms used in UTI diagnosis. This often leads to subjective interpretations of UTI signs and symptoms by patients and SCI providers alike. Bladder instrumentation with either indwelling or intermittent catheterization is often necessary after SCI to safely eliminate urine and maintain continence, however leads to high rates of ASB that do not need to be treated. Inappropriate treatment of ASB with antibiotics leads to the development of multi-drug resistant organisms, which are higher in persons with SCI than their age and co-morbidity-matched cohorts, conveying high morbidity and mortality. A possible solution to this conundrum is a diagnostic support tool for UTI after SCI; previously successful tools measure the degree of abnormality of multiple physiologic variables to measure the severity of acute disease. To calculate the degree of abnormality, however, we must have a better sense of the normal values for vital sign measurements and common laboratory studies for the SCI patient population. Therefore, the aims of this study are to 1) Establish the association between chronic SCI and baseline vital sign and lab measurements through a case-control study utilizing national Veterans Health Administration (VHA) data sources; and 2) Determine the positive predictive value of a constellation of physiologic variables defined as a screening tool for severe UTI after SCI through a retrospective cohort study. The data obtained from this study will support a NIH R01 proposal aimed to externally validate and assess the performance of the severe UTI screening tool prospectively. The assembled study team and environment are uniquely suited to completing this work, and have the support of clinical, research, administrative and patient advocacy leadership locally and nationally. This project supports the NICHD/NCMRR priority of identifying and treating secondary conditions associated with disability.

7. 项目总结/摘要 尿路感染（UTI，包括导尿管相关性 UTI）始终位列前三大原因之一 用于脊髓损伤 (SCI) 患者的医疗保健，每年费用超过 20 亿美元，更不用说 病情对生活质量的重大影响。虽然认识和对待真实情况的重要性 尿路感染很明显，可将这种情况与无症状菌尿（ASB，尿培养阳性）区分开来 没有感染的临床体征或症状）在 SCI 后尤其具有挑战性，因为 感知尿路感染诊断中最常见的体征和症状。这往往会导致主观 患者和 SCI 提供者对 UTI 体征和症状的解释。膀胱器械 SCI 后通常需要留置或间歇性导尿，以安全地排出尿液和 保持节制，但是会导致不需要治疗的 ASB 发生率很高。不当 用抗生素治疗 ASB 会导致多重耐药微生物的发展，这种微生物的耐药性更高 SCI 患者的发病率和死亡率高于其年龄和合并症匹配的人群，从而导致高发病率和死亡率。 解决这个难题的一个可能的解决方案是 SCI 后 UTI 的诊断支持工具；以前成功的工具 测量多个生理变量的异常程度来衡量急性疾病的严重程度。 然而，为了计算异常程度，我们必须更好地了解生命值的正常值。 SCI 患者群体的体征测量和常见实验室研究。因此，本次活动的目的 研究目的是 1) 建立慢性 SCI 与基线生命体征和实验室测量之间的关联 通过利用国家退伍军人健康管理局 (VHA) 数据源的病例对照研究；和 2) 确定定义为筛查工具的一组生理变量的阳性预测值 通过一项回顾性队列研究来治疗 SCI 后的严重尿路感染。从这项研究中获得的数据将支持 NIH R01 提案旨在外部验证和评估严重尿路感染筛查工具的性能 前瞻性地。组建的研究团队和环境非常适合完成这项工作，并且 得到当地和全国临床、研究、行政和患者倡导领导的支持。 该项目支持 NICHD/NCMRR 识别和治疗相关继发性疾病的优先事项 患有残疾。