Prediction of Functional Outcomes from Chronic Critical Illness

慢性危重疾病功能结果的预测

基本信息

批准号：
9158069
负责人：
Shannon S Carson
金额：
$ 66.07万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-26 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9158069
关键词：
Accounting Acute Address Biological Markers Caring Cessation of life Chronic Chronic Care Clinical Cognitive Cohort Studies Critical Care Critical Illness Data Decision Aid Decision Making Dependence Economic Burden Economic Factors Economics Emotional Enrollment Family Functional disorder Funding Future Goals Health Care Costs Health Status Healthcare Systems Hospitals Impaired cognition Injury Inpatients Intervention Interview Knowledge Life Measures Mechanical ventilation Medical Medical Records Medical center Medicine Methods Modeling Multicenter Studies Natural History Organ failure Outcome Patients Physical Function Physically Handicapped Population Psyche structure Research Research Infrastructure Resources Respiratory physiology Risk Factors Severities Survivors Syndrome Therapeutic Intervention United States National Institutes of Health Vital Status brain dysfunction clinical practice cognitive disability cognitive function cohort coping disability economic impact expectation experience frailty functional decline functional disability functional outcomes high risk improved indexing innovation meetings mortality neuromuscular outcome forecast outcome prediction predictive modeling prognostic prospective shared decision making social surrogate decision maker survival outcome survival prediction tool

项目摘要

ABSTRACT A substantial number of critically ill patients experience persistent organ failure leading to chronic critical illness (CCI). The majority of these patients die within a year, and many survivors must cope with long-term physical and cognitive limitations that are often severe. Survival with severe physical and cognitive dysfunction is a significant clinical, emotional, and economic burden in this population, but little is known about which patients are at highest risk for physical and cognitive dysfunction. Moreover, although long-term mortality in CCI can be reliably estimated with a validated mortality prediction model, there is currently no validated method to predict long-term functional disability for purposes of shared decision making and resource planning. In order to address these gaps in knowledge, we will conduct the first multicenter prospective cohort study that measures risk factors for long-term physical and cognitive dysfunction in CCI. Using these risk factors, we will construct a useful and innovative multi-outcome prognostic model to facilitate shared decision making and resource planning. Specific aims for the project are as follows: 1. Identify risk factors for long-term physical and cognitive dysfunction for patients with CCI. 2. Develop and validate an innovative multi-dimensional clinical prediction model to predict the combined outcome of long-term survival and physical and cognitive function in patients with CCI. We will accomplish these aims by prospectively enrolling 800 patients from 5 diverse medical centers who have required 7 days of mechanical ventilation after acute illness or injury, and we will follow them for up to 1 year. On day 7 of mechanical ventilation we will collect data on lung function, neuromuscular weakness, acute brain dysfunction, and other selected clinically available biomarkers. Premorbid functional decline including validated frailty indices, and social and environmental variables will be obtained from medical records and family interviews. For the first aim these variables will be evaluated as independent risk factors for severe physical and cognitive dysfunction at one-year, focusing first on clinical variables and then on social and economic factors. For the second aim we will construct and validate a single multi-outcome model using a single set of variables to predict survival with severe physical disability, survival with severe cognitive disability, survival with physical and cognitive disability, survival with normal function, and death. This project is important because it will directly provide new tools for patients and clinicians to understand CCI, informing bedside decision making and future medical and resource interventions for this extremely high-risk patient group.

抽象的大量重病患者经历了持续的器官衰竭，导致慢性疾病（CCI）。这些患者中的大多数在一年内死亡，许多幸存者必须应对长期的身体和经常严重的认知局限性。严重的身体和认知功能障碍的生存是该人群中的临床，情感和经济负担很大，但对哪些患者知之甚少身体和认知功能障碍的风险最高。而且，尽管CCI的长期死亡率可能是可靠地通过经过验证的死亡率预测模型估计，目前尚无验证的方法可以预测长期功能残疾，用于共享决策和资源计划的目的。为了解决这些知识的差距，我们将进行第一项测量的多中心前瞻性队列研究 CCI长期身体和认知功能障碍的危险因素。使用这些风险因素，我们将构建有用且创新的多结果预后模型，以促进共享决策和资源规划。该项目的具体目标如下： 1。确定CCI患者长期身体和认知功能障碍的危险因素。 2。开发和验证创新的多维临床预测模型，以预测合并的 CCI患者长期生存以及身体和认知功能的结果。我们将通过未来招募来自5个不同医疗中心的800名患者来实现这些目标急性疾病或受伤后需要7天的机械通气，我们将跟随它们最多1 年。在机械通风的第7天，我们将收集有关肺功能，神经肌肉无力，急性的数据脑功能障碍和其他选定的临床可用生物标志物。病前功能下降，包括经过验证的脆弱指数以及社会和环境变量将从医疗记录中获得家庭访谈。对于第一个目标，这些变量将被评估为严重的独立风险因素一年的身体和认知功能障碍，首先关注临床变量，然后关注社会和社交变量经济因素。对于第二个目标，我们将使用A构建和验证单个多结果模型单组变量，以预测严重身体残疾的生存，严重认知障碍的生存，具有身体和认知障碍的生存，正常功能和死亡的生存。这个项目很重要因为它将直接为患者和临床医生提供新的工具，以了解CCI，并告知床边这个极高风险的患者组的决策以及未来的医疗和资源干预措施。