SARI-PREP Research Collaborative Aims To Revolutionize the Future

SARI-PREP is a prospective multicenter observational study that assesses patients hospitalized with SARI, whether due to COVID-19, influenza A or B, or other viral infections. The multicenter study is funded by the CDC Foundation and coordinated by Discovery. It encompasses 15 hospital sites throughout the United States, which have enrolled more than 700 patients since March 10, 2020, most of whom have COVID-19.
 
The study looks at severe respiratory illness broadly, building an infrastructure that lays the groundwork for improving clinical care through a better understanding of emerging and seasonal respiratory diseases and their treatments. Researchers collect detailed information about patients hospitalized for SARI, including biologic samples such as blood, sputum, nasal swabs, and urine during multiple time points in their hospital stays, as well as data on levels of hospital system stress.
 
The study aims to:

• Identify the clinical characteristics and treatments associated with risk for severity of the disease and important clinical outcomes
• Identify clinical characteristics and treatments differentiating patients with SARI due to specific respiratory viruses
• Identify the molecular markers of risk for poor in-hospital and post-discharge outcomes
• Evaluate which patient characteristics and treatments are associated with organ failure-free days and reduced risk of other poor health outcomes including the risk of death
• Examine the association between levels of hospital stress and patient outcomes

Collaborative research is vital to making these advancements happen, but such collaboration in the United States has been challenging because of episodic funding and siloed, disconnected health systems. SARI-PREP marks the first time a platform has been built in the United States to encourage and sustain a collaborative research model.
 
If a platform such as SARI-PREP had existed before the pandemic, the response might have looked vastly different. Patients could have been enrolled earlier in clinical studies to understand the impacts of COVID-19 and knowledge would have developed more quickly, which would have led to better patient outcomes. This connected platform better positions the critical care community to address future outbreaks, laying the groundwork to more quickly identify new viruses and address outbreaks to prevent future pandemics.
 
“SARI-PREP ensures we have an infrastructure in place so that we can respond quickly to the next emergency by learning and rapidly adapting to new events,” said Laura E. Evans, MD, MSc, FCCM, principal investigator of SARI-PREP and director of critical care/associate medical director of the University of Washington Medical Center Seattle. “SARI-PREP is allowing us to build this infrastructure on a platform of patients and collect quite a bit of broad-ranging data about them. We can build on this infrastructure to foster collaborative relationships and conduct other research.”
 
The platform plans to include 1,000 patients by its conclusion. While the SARI-PREP project is promising, there is a need to enroll more patients and follow them longer to advance the effort to inform treatment and care. This is why investigators are seeking funding sources to continue this vital research. SARI-PREP illustrates the power of a multiprofessional organization to bring a variety of clinicians and organizations to the table to engage in inclusive research.
 
These articles have been published about the SARI-PREP study:

• Anesi GL, Sevransky JE, Cobb JP, Evans LE. Hospital stress, adaptation, and resiliency during respiratory viral acute surge events. Crit Connections. 2021 spring;20(2):22-23.
• Bhatraju PK, Morrell ED, Zelnick L, et al. Comparison of host endothelial, epithelial and inflammatory response in ICU patients with and without COVID-19: a prospective observational cohort study. Crit Care. 2021 Apr 19;25(1):148.
• Sulaiman I, Chung M, Angel L, et al. Microbial signatures in the lower airways of mechanically ventilated COVID19 patients associated with poor clinical outcome. Nat Microbiol. 2021 Oct;6(10):1245-1258.

Launched five years ago, Discovery fosters collaborative research to improve outcomes for critically ill and injured patients and seeks to incorporate findings into practice using SCCM’s broad base of programs. Discovery supports a variety of programs and research, from emergency preparedness and prevention of organ failure to ICU delirium.
 
SARI-PREP is the latest example of Discovery’s value during the pandemic. Last year, Discovery launched the Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry, which tracks intensive care unit and hospital care patterns among adult and pediatric COVID-19 patients who are admitted to the hospital in real time. Subsequently, Discovery initiated Structured Team-Based Optimal Patient-Centered Care for Virus COVID-19 (STOP-VIRUS), a six-month learning collaborative that fosters a multisite learning system of U.S. hospitals currently participating in the VIRUS registry. These initiatives transform research into action by informing clinical practice and setting the stage for future efforts.
 
“Historically, there has been a siloed approach to understanding the causes of critical illness and the best treatment strategies in the ICU and looking at only a single hospital in a single city significantly hampers our ability to make advances that are needed to treat the patients across the world,” said Craig M. Coopersmith, MD, FACS, MCCM, chair of the Discovery Steering Committee and director of the Emory Critical Care Center and professor of surgery at Emory University School of Medicine Atlanta. “The Discovery network brings together investigators from geographically diverse regions with distinct healthcare delivery models, allowing generalizable insights that can only come from broad-based team efforts. Due to its unique ability to fund and support critically important research projects like SARI-PREP, the Discovery network plays a key role in accelerating our understanding of critical illness and should lead to improvements in the care of our sickest patients in a way that would otherwise not be possible.”
 

Hospital Stress and SARI-PREP

George L. Anesi, MD, MSCE, MBE, discusses how SARI-PREP is gathering qualitative data from study sites to answer questions on how hospital strain has influenced usual operations and staffing.
 

SARI-PREP and Microbes in COVID-19

Leopoldo Segal, MD, shares how his research lab developed novel ways to investigate what COVID-19 does in the body, especially the lungs.