437 results on '"Girish N Nadkarni"'
Search Results
102. Artificial intelligence-enabled decision support in nephrology
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Tyler J. Loftus, Benjamin Shickel, Tezcan Ozrazgat-Baslanti, Yuanfang Ren, Benjamin S. Glicksberg, Jie Cao, Karandeep Singh, Lili Chan, Girish N. Nadkarni, and Azra Bihorac
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Artificial Intelligence ,Nephrology ,Humans ,Decision Support Systems, Clinical ,Algorithms ,Article - Abstract
Kidney pathophysiology is often complex, nonlinear and heterogeneous, which limits the utility of hypothetical-deductive reasoning and linear, statistical approaches to diagnosis and treatment. Emerging evidence suggests that artificial intelligence (AI)-enabled decision support systems - which use algorithms based on learned examples - may have an important role in nephrology. Contemporary AI applications can accurately predict the onset of acute kidney injury before notable biochemical changes occur; can identify modifiable risk factors for chronic kidney disease onset and progression; can match or exceed human accuracy in recognizing renal tumours on imaging studies; and may augment prognostication and decision-making following renal transplantation. Future AI applications have the potential to make real-time, continuous recommendations for discrete actions and yield the greatest probability of achieving optimal kidney health outcomes. Realizing the clinical integration of AI applications will require cooperative, multidisciplinary commitment to ensure algorithm fairness, overcome barriers to clinical implementation, and build an AI-competent workforce. AI-enabled decision support should preserve the pre-eminence of wisdom and augment rather than replace human decision-making. By anchoring intuition with objective predictions and classifications, this approach should favour clinician intuition when it is honed by experience.
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- 2022
103. Effects of Testing and Disclosing Ancestry-Specific Genetic Risk for Kidney Failure on Patients and Health Care Professionals: A Randomized Clinical Trial
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Girish N. Nadkarni, Kezhen Fei, Michelle A. Ramos, Diane Hauser, Emilia Bagiella, Stephen B. Ellis, Saskia Sanderson, Stuart A. Scott, Tatiana Sabin, Ebony Madden, Richard Cooper, Martin Pollak, Neil Calman, Erwin P. Bottinger, and Carol R. Horowitz
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Adult ,Male ,Health Personnel ,General Medicine ,Disclosure ,Middle Aged ,Apolipoprotein L1 ,Black or African American ,Hypertension ,Humans ,Female ,Genetic Predisposition to Disease ,Genetic Testing ,Renal Insufficiency, Chronic - Abstract
Risk variants in the apolipoprotein L1 (APOL1 [OMIM 603743]) gene on chromosome 22 are common in individuals of West African ancestry and confer increased risk of kidney failure for people with African ancestry and hypertension. Whether disclosing APOL1 genetic testing results to patients of African ancestry and their clinicians affects blood pressure, kidney disease screening, or patient behaviors is unknown.To determine the effects of testing and disclosing APOL1 genetic results to patients of African ancestry with hypertension and their clinicians.This pragmatic randomized clinical trial randomly assigned 2050 adults of African ancestry with hypertension and without existing chronic kidney disease in 2 US health care systems from November 1, 2014, through November 28, 2016; the final date of follow-up was January 16, 2018. Patients were randomly assigned to undergo immediate (intervention) or delayed (waiting list control group) APOL1 testing in a 7:1 ratio. Statistical analysis was performed from May 1, 2018, to July 31, 2020.Patients randomly assigned to the intervention group received APOL1 genetic testing results from trained staff; their clinicians received results through clinical decision support in electronic health records. Waiting list control patients received the results after their 12-month follow-up visit.Coprimary outcomes were the change in 3-month systolic blood pressure and 12-month urine kidney disease screening comparing intervention patients with high-risk APOL1 genotypes and those with low-risk APOL1 genotypes. Secondary outcomes compared these outcomes between intervention group patients with high-risk APOL1 genotypes and controls. Exploratory analyses included psychobehavioral factors.Among 2050 randomly assigned patients (1360 women [66%]; mean [SD] age, 53 [10] years), the baseline mean (SD) systolic blood pressure was significantly higher in patients with high-risk APOL1 genotypes vs those with low-risk APOL1 genotypes and controls (137 [21] vs 134 [19] vs 133 [19] mm Hg; P = .003 for high-risk vs low-risk APOL1 genotypes; P = .001 for high-risk APOL1 genotypes vs controls). At 3 months, the mean (SD) change in systolic blood pressure was significantly greater in patients with high-risk APOL1 genotypes vs those with low-risk APOL1 genotypes (6 [18] vs 3 [18] mm Hg; P = .004) and controls (6 [18] vs 3 [19] mm Hg; P = .01). At 12 months, there was a 12% increase in urine kidney disease testing among patients with high-risk APOL1 genotypes (from 39 of 234 [17%] to 68 of 234 [29%]) vs a 6% increase among those with low-risk APOL1 genotypes (from 278 of 1561 [18%] to 377 of 1561 [24%]; P = .10) and a 7% increase among controls (from 33 of 255 [13%] to 50 of 255 [20%]; P = .01). In response to testing, patients with high-risk APOL1 genotypes reported more changes in lifestyle (a subjective measure that included better dietary and exercise habits; 129 of 218 [59%] vs 547 of 1468 [37%]; P .001) and increased blood pressure medication use (21 of 218 [10%] vs 68 of 1468 [5%]; P = .005) vs those with low-risk APOL1 genotypes; 1631 of 1686 (97%) declared they would get tested again.In this randomized clinical trial, disclosing APOL1 genetic testing results to patients of African ancestry with hypertension and their clinicians was associated with a greater reduction in systolic blood pressure, increased kidney disease screening, and positive self-reported behavior changes in those with high-risk genotypes.ClinicalTrials.gov Identifier: NCT02234063.
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- 2022
104. Type 2 Diabetes Partitioned Polygenic Scores Associate With Disease Outcomes in 454,193 Individuals Across 13 Cohorts
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Daniel DiCorpo, Jessica LeClair, Joanne B. Cole, Chloé Sarnowski, Fariba Ahmadizar, Lawrence F. Bielak, Anneke Blokstra, Erwin P. Bottinger, Layal Chaker, Yii-Der I. Chen, Ye Chen, Paul S. de Vries, Tariq Faquih, Mohsen Ghanbari, Valborg Gudmundsdottir, Xiuqing Guo, Natalie R. Hasbani, Dorina Ibi, M. Arfan Ikram, Maryam Kavousi, Hampton L. Leonard, Aaron Leong, Josep M. Mercader, Alanna C. Morrison, Girish N. Nadkarni, Mike A. Nalls, Raymond Noordam, Michael Preuss, Jennifer A. Smith, Stella Trompet, Petra Vissink, Jie Yao, Wei Zhao, Eric Boerwinkle, Mark O. Goodarzi, Vilmundur Gudnason, J. Wouter Jukema, Sharon L.R. Kardia, Ruth J.F. Loos, Ching-Ti Liu, Alisa K. Manning, Dennis Mook-Kanamori, James S. Pankow, H. Susan J. Picavet, Naveed Sattar, Eleanor M. Simonsick, W.M. Monique Verschuren, Ko Willems van Dijk, Jose C. Florez, Jerome I. Rotter, James B. Meigs, Josée Dupuis, Miriam S. Udler, Epidemiology, and Internal Medicine
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Endocrinology, Diabetes and Metabolism ,Cardiovascular ,Medical and Health Sciences ,Endocrinology & Metabolism ,SDG 3 - Good Health and Well-being ,Internal Medicine ,Diabetes Mellitus ,Genetics ,Humans ,2.1 Biological and endogenous factors ,Obesity ,Aetiology ,Alleles ,Heart Disease - Coronary Heart Disease ,Metabolic and endocrine ,Nutrition ,Advanced and Specialized Nursing ,Liver Disease ,Prevention ,Diabetes ,Cross-Sectional Studies ,Heart Disease ,Good Health and Well Being ,Diabetes Mellitus, Type 2 ,Pharmaceutical Preparations ,Genetic Loci ,Digestive Diseases ,Type 2 - Abstract
OBJECTIVE Type 2 diabetes (T2D) has heterogeneous patient clinical characteristics and outcomes. In previous work, we investigated the genetic basis of this heterogeneity by clustering 94 T2D genetic loci using their associations with 47 diabetes-related traits and identified five clusters, termed β-cell, proinsulin, obesity, lipodystrophy, and liver/lipid. The relationship between these clusters and individual-level metabolic disease outcomes has not been assessed. RESEARCH DESIGN AND METHODS Here we constructed individual-level partitioned polygenic scores (pPS) for these five clusters in 12 studies from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and the UK Biobank (n = 454,193) and tested for cross-sectional association with T2D-related outcomes, including blood pressure, renal function, insulin use, age at T2D diagnosis, and coronary artery disease (CAD). RESULTS Despite all clusters containing T2D risk-increasing alleles, they had differential associations with metabolic outcomes. Increased obesity and lipodystrophy cluster pPS, which had opposite directions of association with measures of adiposity, were both significantly associated with increased blood pressure and hypertension. The lipodystrophy and liver/lipid cluster pPS were each associated with CAD, with increasing and decreasing effects, respectively. An increased liver/lipid cluster pPS was also significantly associated with reduced renal function. The liver/lipid cluster includes known loci linked to liver lipid metabolism (e.g., GCKR, PNPLA3, and TM6SF2), and these findings suggest that cardiovascular disease risk and renal function may be impacted by these loci through their shared disease pathway. CONCLUSIONS Our findings support that genetically driven pathways leading to T2D also predispose differentially to clinical outcomes.
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- 2022
105. Natural Language Processing to Identify Patients with Cognitive Impairment
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Khalil I Hussein, Lili Chan, Tielman Van Vleck, Kelly Beers, Monica R Mindt, Michael Wolf, Laura M. Curtis, Parul Agarwal, Juan Wisnivesky, Girish N. Nadkarni, and Alex Federman
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INTRODUCTIONEarly detection of patients with cognitive impairment may facilitate care for individuals in this population. Natural language processing (NLP) is a potential approach to identifying patients with cognitive impairment from electronic health records (EHR).METHODSWe used three machine learning algorithms (logistic regression, multilayer perceptron, and random forest) using clinical terms extracted by NLP to predict cognitive impairment in a cohort of 199 patients. Cognitive impairment was defined as a mini-mental status exams (MMSE) score RESULTSNLP identified 69 (35%) patients with cognitive impairment and ICD codes identified 44 (22%). Using MMSE as a reference standard, NLP sensitivity was 35%, specificity 66%, precision 41%, and NPV 61%. The random forest method had the best test parameters; sensitivity 95%, specificity 100%, precision 100%, and NPV 97%DISCUSSIONNLP can identify adults with cognitive impairment with moderate test performance that is enhanced with machine learning.
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- 2022
106. Population-Based Penetrance of Deleterious Clinical Variants
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Iain S. Forrest, Kumardeep Chaudhary, Ha My T. Vy, Ben O. Petrazzini, Shantanu Bafna, Daniel M. Jordan, Ghislain Rocheleau, Ruth J. F. Loos, Girish N. Nadkarni, Judy H. Cho, and Ron Do
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General Medicine ,Original Investigation - Abstract
IMPORTANCE: Population-based assessment of disease risk associated with gene variants informs clinical decisions and risk stratification approaches. OBJECTIVE: To evaluate the population-based disease risk of clinical variants in known disease predisposition genes. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 72 434 individuals with 37 780 clinical variants who were enrolled in the BioMe Biobank from 2007 onwards with follow-up until December 2020 and the UK Biobank from 2006 to 2010 with follow-up until June 2020. Participants had linked exome and electronic health record data, were older than 20 years, and were of diverse ancestral backgrounds. EXPOSURES: Variants previously reported as pathogenic or predicted to cause a loss of protein function by bioinformatic algorithms (pathogenic/loss-of-function variants). MAIN OUTCOMES AND MEASURES: The primary outcome was the disease risk associated with clinical variants. The risk difference (RD) between the prevalence of disease in individuals with a variant allele (penetrance) vs in individuals with a normal allele was measured. RESULTS: Among 72 434 study participants, 43 395 were from the UK Biobank (mean [SD] age, 57 [8.0] years; 24 065 [55%] women; 2948 [7%] non-European) and 29 039 were from the BioMe Biobank (mean [SD] age, 56 [16] years; 17 355 [60%] women; 19 663 [68%] non-European). Of 5360 pathogenic/loss-of-function variants, 4795 (89%) were associated with an RD less than or equal to 0.05. Mean penetrance was 6.9% (95% CI, 6.0%-7.8%) for pathogenic variants and 0.85% (95% CI, 0.76%-0.95%) for benign variants reported in ClinVar (difference, 6.0 [95% CI, 5.6-6.4] percentage points), with a median of 0% for both groups due to large numbers of nonpenetrant variants. Penetrance of pathogenic/loss-of-function variants for late-onset diseases was modified by age: mean penetrance was 10.3% (95% CI, 9.0%-11.6%) in individuals 70 years or older and 8.5% (95% CI, 7.9%-9.1%) in individuals 20 years or older (difference, 1.8 [95% CI, 0.40-3.3] percentage points). Penetrance of pathogenic/loss-of-function variants was heterogeneous even in known disease predisposition genes, including BRCA1 (mean [range], 38% [0%-100%]), BRCA2 (mean [range], 38% [0%-100%]), and PALB2 (mean [range], 26% [0%-100%]). CONCLUSIONS AND RELEVANCE: In 2 large biobank cohorts, the estimated penetrance of pathogenic/loss-of-function variants was variable but generally low. Further research of population-based penetrance is needed to refine variant interpretation and clinical evaluation of individuals with these variant alleles.
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- 2022
107. Neonatal outcomes during the COVID-19 pandemic in New York City
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Ethylin Wang Jabs, Girish N. Nadkarni, Katherine Guttmann, Mayte Suárez-Fariñas, Arielle S. Strasser, Felix Richter, Shan Zhao, and Benjamin S. Glicksberg
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Male ,2019-20 coronavirus outbreak ,Neonatal intensive care unit ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Time windows ,Intensive Care Units, Neonatal ,030225 pediatrics ,Pandemic ,Correspondence ,Humans ,Medicine ,Pandemics ,SARS-CoV-2 ,business.industry ,Infant, Newborn ,COVID-19 ,Hospitalization ,Neonatal outcomes ,Quarantine ,Pediatrics, Perinatology and Child Health ,Intensive Care, Neonatal ,Premature Birth ,Female ,New York City ,business ,030217 neurology & neurosurgery ,Demography - Abstract
We explored rates of premature births and neonatal intensive care unit (NICU) admissions at the Mount Sinai Hospital after the implementation of COVID-19 lockdown measures (March 16, 2020) and phase one reopening (June 8, 2020), comparing them to those of the same time periods from 2012-2019. Mount Sinai Hospital is in New York City (NYC), an early epicenter of COVID-19 in the United States, which was heavily impacted by the pandemic during the study period. Among 43,963 singleton births, we observed no difference in either outcome after the implementation of lockdown measures when compared to the same trends in prior years (p=0.09-0.35). Of interest, we observed a statistically significant decrease in premature births after NYC phase one reopening compared to those of the same time period in 2012-2019 across all time windows (p=0.0028-0.049), and a statistically significant decrease in NICU admissions over the largest time window (2.75 months) compared to prior years (p=0.0011).
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- 2021
108. AKI in Hospitalized Patients with COVID-19
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Riccardo Miotto, Benjamin S. Glicksberg, Lili Chan, Allan C. Just, Felix Richter, Anuradha Lala, Valentin Fuster, Girish N. Nadkarni, Arash Kia, Carlos Cordon-Cardo, Akhil Vaid, Alexander W. Charney, Aparna Saha, Robert Freeman, Sulaiman Somani, Prem Timsina, Eric E. Schadt, Barbara Murphy, John Cijiang He, Ishan Paranjpe, David Reich, Kumardeep Chaudhary, Matthew A. Levin, Shan Zhao, Jagat Narula, Steven G. Coca, Rong Chen, Erwin P. Bottinger, Li Li, Kinsuk Chauhan, Carol R. Horowitz, and Zahi A. Fayad
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medicine.medical_specialty ,Proteinuria ,urogenital system ,Hospitalized patients ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Renal function ,General Medicine ,Urine ,Odds ratio ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,female genital diseases and pregnancy complications ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Nephrology ,Internal medicine ,Intensive care ,medicine ,medicine.symptom ,business ,Dialysis - Abstract
Background Early reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described. Methods This retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality. Results Of 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up. Conclusions AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.
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- 2020
109. Electronic vs manual approaches to identify patients from the EHR for cancer clinical trials–what’s feasible
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Sylvia Lin, Helena L. Chang, Annetine C Gelijns, Girish N. Nadkarni, Hannah Jacobs El, Nina A. Bickell, Tielman Van Vleck, Michael Shafir, and Amy Tiersten
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medicine.medical_specialty ,business.industry ,Cancer clinical trial ,Medicine ,business ,Intensive care medicine - Published
- 2020
110. Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19
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Shan Zhao, Girish N. Nadkarni, Zahi A. Fayad, Sulaiman Somani, Matthew A. Levin, Erwin P. Bottinger, Jessica K De Freitas, Benjamin S. Glicksberg, Valentin Fuster, Anuradha Lala, Keith Sigel, Felix Richter, Allan C Just, Alexander W. Charney, and Nidhi Naik
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Male ,Comorbidity ,030204 cardiovascular system & hematology ,01 natural sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,030212 general & internal medicine ,Original Research ,Respiratory Distress Syndrome ,COPD ,Respiratory distress ,Middle Aged ,After discharge ,3. Good health ,Hypertension ,Female ,Coronavirus Infections ,Emergency Service, Hospital ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Patient Readmission ,Article ,Betacoronavirus ,03 medical and health sciences ,Internal medicine ,Intensive care ,Internal Medicine ,medicine ,Humans ,0101 mathematics ,Pandemics ,Aged ,Retrospective Studies ,SARS-CoV-2 ,business.industry ,010102 general mathematics ,Case-control study ,Anticoagulants ,COVID-19 ,Retrospective cohort study ,Emergency department ,Length of Stay ,medicine.disease ,Pneumonia ,Case-Control Studies ,Emergency medicine ,New York City ,Index hospitalization ,business - Abstract
Background Data on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care. Objective To describe clinical characteristics of patients with COVID-19 who returned to the emergency department (ED) or required readmission within 14 days of discharge. Design Retrospective cohort study of SARS-COV-2-positive patients with index hospitalization between February 27 and April 12, 2020, with ≥ 14-day follow-up. Significance was defined as P < 0.05 after multiplying P by 125 study-wide comparisons. Participants Hospitalized patients with confirmed SARS-CoV-2 discharged alive from five New York City hospitals. Main Measures Readmission or return to ED following discharge. Results Of 2864 discharged patients, 103 (3.6%) returned for emergency care after a median of 4.5 days, with 56 requiring inpatient readmission. The most common reason for return was respiratory distress (50%). Compared with patients who did not return, there were higher proportions of COPD (6.8% vs 2.9%) and hypertension (36% vs 22.1%) among those who returned. Patients who returned also had a shorter median length of stay (LOS) during index hospitalization (4.5 [2.9,9.1] vs 6.7 [3.5, 11.5] days; Padjusted = 0.006), and were less likely to have required intensive care on index hospitalization (5.8% vs 19%; Padjusted = 0.001). A trend towards association between absence of in-hospital treatment-dose anticoagulation on index admission and return to hospital was also observed (20.9% vs 30.9%, Padjusted = 0.06). On readmission, rates of intensive care and death were 5.8% and 3.6%, respectively. Conclusions Return to hospital after admission for COVID-19 was infrequent within 14 days of discharge. The most common cause for return was respiratory distress. Patients who returned more likely had COPD and hypertension, shorter LOS on index-hospitalization, and lower rates of in-hospital treatment-dose anticoagulation. Future studies should focus on whether these comorbid conditions, longer LOS, and anticoagulation are associated with reduced readmissions. Electronic supplementary material The online version of this article (10.1007/s11606-020-06120-6) contains supplementary material, which is available to authorized users.
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- 2020
111. The association of standard Kt/V and surface <scp>area‐normalized</scp> standard Kt/V with clinical outcomes in hemodialysis patients
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Jaime Uribarri, Shuchita Sharma, Lili Chan, Pattharawin Pattharanitima, Girish N. Nadkarni, Steven G. Coca, Kinsuk Chauhan, Kumardeep Chaudhary, and Osama El Shamy
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Male ,medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Logistic regression ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,Humans ,Urea ,Medicine ,Hypoalbuminemia ,Aged ,business.industry ,Hazard ratio ,Hematology ,Odds ratio ,Reference Standards ,medicine.disease ,Nephrology ,Kt/V ,Cohort ,Kidney Failure, Chronic ,population characteristics ,Female ,Hemodialysis ,business - Abstract
INTRODUCTION A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period. METHODS We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V
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- 2020
112. Machine Learning in Cardiology—Ensuring Clinical Impact Lives Up to the Hype
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Riccardo Miotto, Fayzan Chaudhry, Adam Russak, Shan Zhao, Benjamin S. Glicksberg, Tejeshwar Bawa, Kipp W. Johnson, Phillip D. Levy, Mohsin Ali, Jessica K De Freitas, Solomon Bienstock, Akhil Vaid, Felix Richter, Sulaiman Somani, Farhan Chaudhry, Garrett Baron, Girish N. Nadkarni, and Ishan Paranjpe
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medicine.medical_specialty ,Cardiology ,030204 cardiovascular system & hematology ,Machine learning ,computer.software_genre ,Machine Learning ,03 medical and health sciences ,Deep Learning ,0302 clinical medicine ,Internal medicine ,Mainstream medicine ,medicine ,Data Mining ,Humans ,Pharmacology (medical) ,Diagnosis, Computer-Assisted ,030212 general & internal medicine ,Pharmacology ,business.industry ,Deep learning ,Private sector ,Transformative learning ,Therapy, Computer-Assisted ,Artificial intelligence ,Diffusion of Innovation ,Cardiology and Cardiovascular Medicine ,business ,computer ,Forecasting - Abstract
Despite substantial advances in the study, treatment, and prevention of cardiovascular disease, numerous challenges relating to optimally screening, diagnosing, and managing patients remain. Simultaneous improvements in computing power, data storage, and data analytics have led to the development of new techniques to address these challenges. One powerful tool to this end is machine learning (ML), which aims to algorithmically identify and represent structure within data. Machine learning’s ability to efficiently analyze large and highly complex data sets make it a desirable investigative approach in modern biomedical research. Despite this potential and enormous public and private sector investment, few prospective studies have demonstrated improved clinical outcomes from this technology. This is particularly true in cardiology, despite its emphasis on objective, data-driven results. This threatens to stifle ML’s growth and use in mainstream medicine. We outline the current state of ML in cardiology and outline methods through which impactful and sustainable ML research can occur. Following these steps can ensure ML reaches its potential as a transformative technology in medicine.
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- 2020
113. Limitations of Contemporary Guidelines for Managing Patients at High Genetic Risk of Coronary Artery Disease
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George Hindy, Lu-Chen Weng, Patrick T. Ellinor, Kumardeep Chaudhary, Phoebe Finneran, Girish N. Nadkarni, Anthony A. Philippakis, Amanda Dobbyn, Ruth J. F. Loos, Andrew Cagan, Jeffrey S. Reid, Renae Judy, Rachel L. Kember, Jordan W. Smoller, Amit Khera, Sekar Kathiresan, Daniel J. Rader, Scott T. Weiss, Aris Baras, John D. Overton, Krishna G. Aragam, Ron Do, Steven A. Lubitz, Pradeep Natarajan, Scott M. Damrauer, Mark Chaffin, Elizabeth W. Karlson, and Judy H. Cho
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Adult ,Male ,Multifactorial Inheritance ,medicine.medical_specialty ,Statin ,Databases, Factual ,medicine.drug_class ,primary prevention ,CAD ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,genetic risk ,Article ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Primary prevention ,Health care ,medicine ,Electronic Health Records ,Humans ,Genetic Predisposition to Disease ,cardiovascular diseases ,030212 general & internal medicine ,Genetic risk ,Intensive care medicine ,Aged ,Aged, 80 and over ,business.industry ,statin ,Disease Management ,Guideline ,Odds ratio ,Middle Aged ,medicine.disease ,Practice Guidelines as Topic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care - Abstract
Polygenic risk scores (PRS) for coronary artery disease (CAD) identify high-risk individuals more likely to benefit from primary prevention statin therapy. Whether polygenic CAD risk is captured by conventional paradigms for assessing clinical cardiovascular risk remains unclear.This study sought to intersect polygenic risk with guideline-based recommendations and management patterns for CAD primary prevention.A genome-wide CAD PRS was applied to 47,108 individuals across 3 U.S. health care systems. The authors then assessed whether primary prevention patients at high polygenic risk might be distinguished on the basis of greater guideline-recommended statin eligibility and higher rates of statin therapy.Of 47,108 study participants, the mean age was 60 years, and 11,020 (23.4%) had CAD. The CAD PRS strongly associated with prevalent CAD (odds ratio: 1.4 per SD increase in PRS; p 0.0001). High polygenic risk (top 20% of PRS) conferred 1.9-fold odds of developing CAD (p 0.0001). However, among primary prevention patients (n = 33,251), high polygenic risk did not correspond with increased recommendations for statin therapy per the American College of Cardiology/American Heart Association (46.2% for those with high PRS vs. 46.8% for all others, p = 0.54) or U.S. Preventive Services Task Force (43.7% vs. 43.7%, p = 0.99) or higher rates of statin prescriptions (25.0% vs. 23.8%, p = 0.04). An additional 4.1% of primary prevention patients may be recommended for statin therapy if high CAD PRS were considered a guideline-based risk-enhancing factor.Current paradigms for primary cardiovascular prevention incompletely capture a polygenic susceptibility to CAD. An opportunity may exist to improve CAD prevention efforts by integrating both genetic and clinical risk.
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- 2020
114. Applications of machine learning methods in kidney disease
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Akhil Vaid, Lili Chan, and Girish N. Nadkarni
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Nephrology ,medicine.medical_specialty ,Computer science ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Health records ,Machine learning ,computer.software_genre ,Article ,Machine Learning ,Translational Research, Biomedical ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Healthcare data ,Natural Language Processing ,business.industry ,Unstructured data ,medicine.disease ,Harm ,Scale (social sciences) ,Kidney Diseases ,Artificial intelligence ,business ,computer ,Algorithms ,Kidney disease - Abstract
PURPOSE OF REVIEW: The universal adoption of electronic health records, improvement in technology, and the availability of continuous monitoring has generated large quantities of healthcare data. Machine learning is increasingly adopted by nephrology researchers to analyze this data in order to improve the care of their patients. RECENT FINDINGS: In this review, we provide a broad overview of the different types of machine learning algorithms currently available and how researchers have applied these methods in nephrology research. Current applications have included prediction of acute kidney disease and chronic kidney disease along with progression of kidney disease. Researchers have demonstrated the ability of machine learning to read kidney biopsy samples, identify patient outcomes from unstructured data, identify subtypes in complex diseases, and discuss the potential benefits on drug discovery. We end with a discussion on the ethics and potential pitfalls of machine learning. SUMMARY: Machine learning provides researchers with the ability to analyze data which was previously inaccessible. While still burgeoning several studies show promising results which will enable researchers to perform larger scale studies and clinicians the ability to provide more personalized care. However, we must ensure that implementation aids providers and does not lead to harm to patients.
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- 2020
115. Racial and Ethnic Disparities in Pregnancy-Related Acute Kidney Injury
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Kinsuk Chauhan, Mihir Dave, Huei Hsun Wen, Lili Chan, Aparna Saha, Steven G. Coca, Girish N. Nadkarni, and Kelly Beers
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medicine.medical_specialty ,Original Investigations ,urologic and male genital diseases ,Logistic regression ,White People ,Miscarriage ,Pregnancy ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Eclampsia ,business.industry ,Incidence (epidemiology) ,Infant, Newborn ,Retrospective cohort study ,Hispanic or Latino ,General Medicine ,Odds ratio ,Acute Kidney Injury ,medicine.disease ,United States ,female genital diseases and pregnancy complications ,Black or African American ,Female ,Diagnosis code ,business - Abstract
BACKGROUND: Pregnancy-related AKI (PR-AKI) is increasing in the United States. PR-AKI is associated with adverse maternal outcomes. Disparities in racial/ethnic differences in PR-AKI by race have not been studied. METHODS: This was a retrospective cohort study using the National Inpatient Sample (NIS) from 2005 to 2015. We identified patients who were admitted for a pregnancy-related diagnosis using the Neomat variable provided by the NIS database that indicates the presence of a maternal or neonatal diagnosis code or procedure code. PR-AKI was identified using ICD codes. Survey logistic regression was used for multivariable analysis adjusting for age, medical comorbidities, socioeconomic factors, and hospital/admission factors. RESULTS: From 48,316,430 maternal hospitalizations, 34,001 (0.07%) were complicated by PR-AKI. Hospitalizations for PR-AKI increased from 3.5/10,000 hospitalizations in 2005 to 11.8/10,000 hospitalizations in 2015 with the largest increase seen in patients aged ≥35 and black patients. PR-AKI was associated with higher odds of miscarriage (adjusted odds ratio [aOR], 1.64; 95% CI, 1.34 to 2.07) and mortality (aOR, 1.53; 95% CI, 1.25 to 1.88). After adjustment for age, medical comorbidities, and socioeconomic factors, blacks were more likely than whites to develop PR-AKI (aOR, 1.17; 95% CI, 1.04 to 1.33). On subgroup analyses in hospitalizations of patients with PR-AKI, blacks and Hispanics were more likely to have preeclampsia/eclampsia compared with whites (aOR, 1.29; 95% CI, 1.01 to 1.65; and aOR, 1.69; 95% CI, 1.23 to 2.31, respectively). Increased odds of mortality in PR-AKI compared with whites were only seen in black patients (aOR, 1.61; 95% CI, 1.02 to 2.55). CONCLUSIONS: The incidence of PR-AKI has increased and the largest increase was seen in older patients and black patients. PR-AKI is associated with miscarriages, adverse discharge from hospital, and mortality. Black and Hispanic patients with PR-AKI were more likely to have adverse outcomes than white patients. Further research is needed to identify factors contributing to these discrepancies.
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- 2020
116. Natural language processing of electronic health records is superior to billing codes to identify symptom burden in hemodialysis patients
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Kumardeep Chaudhary, Alex D. Federman, Lili Chan, Steven G. Coca, Kinsuk Chauhan, Girish N. Nadkarni, Neha Debnath, Kelly Beers, Pattharawin Pattharanitima, Aparna Saha, Amy A. Yau, Aine Duffy, Peter Kotanko, Judy H. Cho, and Tielman Van Vleck
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0301 basic medicine ,Databases, Factual ,Nausea ,030232 urology & nephrology ,computer.software_genre ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Electronic Health Records ,Humans ,Medicine ,Depression (differential diagnoses) ,Natural Language Processing ,business.industry ,Patient-centered outcomes ,Geriatric nephrology ,Biobank ,030104 developmental biology ,Nephrology ,Informatics ,Cohort ,Vomiting ,Artificial intelligence ,medicine.symptom ,business ,computer ,Algorithms ,Natural language processing - Abstract
Symptoms are common in patients on maintenance hemodialysis but identification is challenging. New informatics approaches including natural language processing (NLP) can be utilized to identify symptoms from narrative clinical documentation. Here we utilized NLP to identify seven patient symptoms from notes of maintenance hemodialysis patients of the BioMe Biobank and validated our findings using a separate cohort and the MIMIC-III database. NLP performance was compared for symptom detection with International Classification of Diseases (ICD)-9/10 codes and the performance of both methods were validated against manual chart review. From 1034 and 519 hemodialysis patients within BioMe and MIMIC-III databases, respectively, the most frequently identified symptoms by NLP were fatigue, pain, and nausea/vomiting. In BioMe, sensitivity for NLP (0.85 - 0.99) was higher than for ICD codes (0.09 - 0.59) for all symptoms with similar results in the BioMe validation cohort and MIMIC-III. ICD codes were significantly more specific for nausea/vomiting in BioMe and more specific for fatigue, depression, and pain in the MIMIC-III database. A majority of patients in both cohorts had four or more symptoms. Patients with more symptoms identified by NLP, ICD, and chart review had more clinical encounters. NLP had higher specificity in inpatient notes but higher sensitivity in outpatient notes and performed similarly across pain severity subgroups. Thus, NLP had higher sensitivity compared to ICD codes for identification of seven common hemodialysis-related symptoms, with comparable specificity between the two methods. Hence, NLP may be useful for the high-throughput identification of patient-centered outcomes when using electronic health records.
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- 2020
117. Trans-ethnic and Ancestry-Specific Blood-Cell Genetics in 746,667 Individuals from 5 Global Populations
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Andrew D Beswick, Tõnu Esko, Niki Dimou, Xue Zhong, Jette Bork-Jensen, Petra Schubert, Masato Akiyama, Girish N. Nadkarni, Ruth J. F. Loos, Huijun Qian, Michele K. Evans, Stephen S. Rich, Nicole Soranzo, Henry Völzke, Yongmei Liu, Nicholas A. Watkins, Markus M. Lerch, Richard C. Trembath, Adam S. Butterworth, Erwin P. Bottinger, Jennifer E. Huffman, Bruce M. Psaty, Jingzhong Ding, Michael Preuss, Yoav Ben-Shlomo, Bhavi Trivedi, Yoichiro Kamatani, David A. van Heel, Kjell Nikus, Torben Hansen, Adolfo Correa, Mohsen Ghanbari, Paul L. Auer, Véronique Laplante, Ken Sin Lo, Hua Tang, Peter W.F. Wilson, Paul Elliott, David J. Roberts, Hilary C. Martin, Jean-Claude Tardif, Praveen Surendran, Regina Manansala, Terho Lehtimäki, Emanuele Di Angelantonio, Fotis Koskeridis, Alexander P. Reiner, Mélissa Beaudoin, Vijay G. Sankaran, Benjamin Rodriguez, William J. Astle, Parsa Akbari, Frank J. A. van Rooij, Yun Li, Andreas Greinacher, Abdou Mousas, Andrew D. Johnson, Yukinori Okada, Michael H. Guo, Leo-Pekka Lyytikäinen, Traci M. Bartz, Minhui Chen, Alan B. Zonderman, Niels Grarup, Oluf Pedersen, Kumaraswamynaidu Chitrala, Jeffrey Haessler, Ming-Huei Chen, Cassandra N. Spracklen, Karen L. Mohlke, Guillaume Lettre, Erik L. Bao, Bingshan Li, James S. Floyd, Wei Huang, Ani Manichaikul, John Danesh, Uwe Völker, Allan Linneberg, Evangelos Evangelou, Joanna M. M. Howson, Olli T. Raitakari, Tim Kacprowski, Jean-François Gauchat, Hélène Choquet, Arden Moscati, Saori Sakaue, Mika Kähönen, Linda Broer, Caleb A. Lareau, Qin Qin Huang, Matthias Nauck, Yoshinori Murakami, Charleston W. K. Chiang, VA Million Veteran Program, Nina Mononen, Tao Jiang, Laura M. Raffield, Jerome I. Rotter, Leslie A. Lange, Jonathan D. Rosen, Eric Jorgenson, Savita Karthikeyan, Karen A. Hunt, Nathan Pankratz, Kelly Cho, Masahiro Kanai, Willem H. Ouwehand, Jennifer A. Brody, Koichi Matsuda, Dragana Vuckovic, Epidemiology, and Internal Medicine
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LOCI ,Mutation, Missense ,Ethnic group ,POLYGENIC RISK SCORES ,HUMAN HEMATOPOIESIS ,Biology ,BIOBANK ,phenome-wide association study ,Polymorphism, Single Nucleotide ,DISEASE ,White People ,General Biochemistry, Genetics and Molecular Biology ,Article ,Blood cell ,03 medical and health sciences ,SINGLE-CELL ,selective sweeps ,0302 clinical medicine ,Asian People ,parasitic diseases ,Genetics ,medicine ,Humans ,GENOME-WIDE ASSOCIATION ,030304 developmental biology ,AFRICAN-AMERICANS ,0303 health sciences ,interleukin-7 ,Interleukin-7 ,genetic architecture ,Genetic architecture ,TRAIT ,HEK293 Cells ,Phenotype ,medicine.anatomical_structure ,fine-mapping ,polygenic trait score ,lipids (amino acids, peptides, and proteins) ,FREQUENCY CODING VARIANTS ,030217 neurology & neurosurgery ,Genome-Wide Association Study - Abstract
Most loci identified by GWASs have been found in populations of European ancestry (EUR). In trans-ethnic meta-analyses for 15 hematological traits in 746,667 participants, including 184,535 non-EUR individuals, we identified 5,552 trait-variant associations at p < 5 × 10-9, including 71 novel associations not found in EUR populations. We also identified 28 additional novel variants in ancestry-specific, non-EUR meta-analyses, including an IL7 missense variant in South Asians associated with lymphocyte count in vivo and IL-7 secretion levels in vitro. Fine-mapping prioritized variants annotated as functional and generated 95% credible sets that were 30% smaller when using the trans-ethnic as opposed to the EUR-only results. We explored the clinical significance and predictive value of trans-ethnic variants in multiple populations and compared genetic architecture and the effect of natural selection on these blood phenotypes between populations. Altogether, our results for hematological traits highlight the value of a more global representation of populations in genetic studies.
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- 2020
118. Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19
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Adam B. Keene, Andrew J. Admon, Samantha K. Brenner, Shruti Gupta, Deepa Lazarous, David E. Leaf, Hayley B. Gershengorn, Carl P. Walther, Samaya J. Anumudu, Justin Arunthamakun, Kathleen F. Kopecky, Gregory P. Milligan, Peter A. McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Brian P. O’Gara, Megan L. Krajewski, Sean M. Baskin, Sidharth Shankar, Juan D. Valencia, Ameeka Pannu, Margaret M. Hayes, E. Wilson Grandin, Sushrut S. Waikar, Zoe A. Kibbelaar, Ambarish M. Athavale, Peter Hart, Shristi Upadhyay, Ishaan Vohra, Ajiboye Oyintayo, Adam Green, Jean-Sebastien Rachoin, Christa A. Schorr, Lisa Shea, Daniel L. Edmonston, Christopher L. Mosher, Alexandre M. Shehata, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor ul aain Bhatti, Bijal Mehta, Aquino Williams, Patricia Walters, Ronaldo C. Go, Keith M. Rose, Miguel A. Hernán, Rebecca Lisk, Lili Chan, Kusum S. Mathews, Steven G. Coca, Deena R. Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A. Leven, Jing G. Wang, Gohar Mosoyan, Girish N. Nadkarni, Pattharawin Pattharanitima, Emily J. Gallagher, Allon N. Friedman, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine J. Kelly, Chirag R. Parikh, Brian T. Garibaldi, Celia P. Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F. Malik, Carmen Elena Cervantes, Samir C. Gautam, Mary C. Mallappallil, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddhartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, Leon Boudourakis, H. Bryant Nguyen, Afshin Ahoubim, Leslie F. Thomas, Dheeraj Reddy Sirganagari, Pramod K. Guru, Kianoush Kashani, Shahrzad Tehranian, Yan Zhou, Paul A. Bergl, Jesus Rodriguez, Jatan A. Shah, Mrigank S. Gupta, Princy N. Kumar, Deepa G. Lazarous, Seble G. Kassaye, Michal L. Melamed, Tanya S. Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V. Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Neelja Kumar, Michael Chang, Jyotsana Thakkar, Ritesh Raichoudhury, Akshay Athreya, Mohamed Farag, Edward J. Schenck, Soo Jung Cho, Maria Plataki, Sergio L. Alvarez-Mulett, Luis G. Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, David Charytan, Ashley Macina, Sobaata Chaudhry, Benjamin Wu, Frank Modersitzki, Anand Srivastava, Alexander S. Leidner, Carlos Martinez, Jacqueline M. Kruser, Richard G. Wunderink, Alexander J. Hodakowski, Juan Carlos Q. Velez, Eboni G. Price-Haywood, Luis A. Matute-Trochez, Anna E. Hasty, Muner MB. Mohamed, Rupali S. Avasare, David Zonies, Meghan E. Sise, Erik T. Newman, Samah Abu Omar, Kapil K. Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Omer Kamal, Wei Wang, Heather Yang, Jeffery O. Boateng, Meghan Lee, Ian A. Strohbehn, Jiahua Li, Ariel L. Mueller, Roberta E. Redfern, Nicholas S. Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, Laura Bickley, Chris Rowan, Farah Madhani-Lovely, Vasil Peev, Jochen Reiser, John J. Byun, Andrew Vissing, Esha M. Kapania, Zoe Post, Nilam P. Patel, Joy-Marie Hermes, Anne K. Sutherland, Amee Patrawalla, Diana G. Finkel, Barbara A. Danek, Sowminya Arikapudi, Jeffrey M. Paer, Peter Cangialosi, Mark Liotta, Jared Radbel, Sonika Puri, Jag Sunderram, Matthew T. Scharf, Ayesha Ahmed, Ilya Berim, Jayanth S. Vatson, Shuchi Anand, Joseph E. Levitt, Pablo Garcia, Suzanne M. Boyle, Rui Song, Ali Arif, Jingjing Zhang, Sang Hoon Woo, Xiaoying Deng, Goni Katz-Greenberg, Katharine Senter, Moh’d A. Sharshir, Vadym V. Rusnak, Muhammad Imran Ali, Terri Peters, Kathy Hughes, Anip Bansal, Amber S. Podoll, Michel Chonchol, Sunita Sharma, Ellen L. Burnham, Arash Rashidi, Rana Hejal, Eric Judd, Laura Latta, Ashita Tolwani, Timothy E. Albertson, Jason Y. Adams, Steven Y. Chang, Rebecca M. Beutler, Carl E. Schulze, Etienne Macedo, Harin Rhee, Kathleen D. Liu, Vasantha K. Jotwani, Jay L. Koyner, Alissa Kunczt, Chintan V. Shah, Vishal Jaikaransingh, Stephanie M. Toth-Manikowski, Min J. Joo, James P. Lash, Javier A. Neyra, Nourhan Chaaban, Madona Elias, Yahya Ahmad, Rajany Dy, Alfredo Iardino, Elizabeth H. Au, Jill H. Sharma, Marie Anne Sosa, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Alessia Fornoni, Salim S. Hayek, Pennelope Blakely, Hanna Berlin, Tariq U. Azam, Husam Shadid, Michael Pan, Patrick O' Hayer, Chelsea Meloche, Rafey Feroze, Kishan J. Padalia, Abbas Bitar, Jeff Leya, John P. Donnelly, Jennifer E. Flythe, Matthew J. Tugman, Emily H. Chang, Brent R. Brown, Amanda K. Leonberg-Yoo, Ryan C. Spiardi, Todd A. Miano, Meaghan S. Roche, Charles R. Vasquez, Amar D. Bansal, Natalie C. Ernecoff, Sanjana Kapoor, Siddharth Verma, Huiwen Chen, Csaba P. Kovesdy, Miklos Z. Molnar, Ambreen Azhar, S. Susan Hedayati, Mridula V. Nadamuni, Shani Shastri, Duwayne L. Willett, Samuel A.P. Short, Amanda D. Renaghan, Kyle B. Enfield, Pavan K. Bhatraju, A. Bilal Malik, Matthew W. Semler, Anitha Vijayan, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F. Kao, Greg L. Schumaker, Nitender Goyal, Anthony J. Faugno, Caroline M. Hsu, Asma Tariq, Leah Meyer, Ravi K. Kshirsagar, Aju Jose, Daniel E. Weiner, Marta Christov, Savneek Chugh, Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, Perry Wilson, Tanima Arora, and Ugochukwu Ugwuowo
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Adult ,Cohort Studies ,Male ,Intensive Care Units ,SARS-CoV-2 ,Critical Illness ,COVID-19 ,Humans ,Female ,Hospital Mortality ,Middle Aged ,Critical Care and Intensive Care Medicine - Abstract
Objective To determine whether surge conditions were associated with increased mortality. Design Multicenter cohort study. Setting U.S. ICUs participating in STOP-COVID. Patients Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020. Interventions None Measurements and Main Results The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 – May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals). Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p Conclusions Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.
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- 2021
119. StudyU: A Platform for Designing and Conducting Innovative Digital N-of-1 Trials (Preprint)
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Stefan Konigorski, Sarah Wernicke, Tamara Slosarek, Alexander M Zenner, Nils Strelow, Darius F Ruether, Florian Henschel, Manisha Manaswini, Fabian Pottbäcker, Jonathan A Edelman, Babajide Owoyele, Matteo Danieletto, Eddye Golden, Micol Zweig, Girish N Nadkarni, and Erwin Böttinger
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UNSTRUCTURED N-of-1 trials are the gold standard study design to evaluate individual treatment effects and derive personalized treatment strategies. Digital tools have the potential to initiate a new era of N-of-1 trials in terms of scale and scope, but fully functional platforms are not yet available. Here, we present the open source StudyU platform, which includes the StudyU Designer and StudyU app. With the StudyU Designer, scientists are given a collaborative web application to digitally specify, publish, and conduct N-of-1 trials. The StudyU app is a smartphone app with innovative user-centric elements for participants to partake in trials published through the StudyU Designer to assess the effects of different interventions on their health. Thereby, the StudyU platform allows clinicians and researchers worldwide to easily design and conduct digital N-of-1 trials in a safe manner. We envision that StudyU can change the landscape of personalized treatments both for patients and healthy individuals, democratize and personalize evidence generation for self-optimization and medicine, and can be integrated in clinical practice.
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- 2021
120. StudyU: A Platform for Designing and Conducting Innovative Digital N-of-1 Trials
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Stefan Konigorski, Sarah Wernicke, Tamara Slosarek, Alexander M Zenner, Nils Strelow, Darius F Ruether, Florian Henschel, Manisha Manaswini, Fabian Pottbäcker, Jonathan A Edelman, Babajide Owoyele, Matteo Danieletto, Eddye Golden, Micol Zweig, Girish N Nadkarni, and Erwin Böttinger
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FOS: Computer and information sciences ,Research Design ,Digital Engineering Fakultät ,Computer Science - Human-Computer Interaction ,Humans ,Health Informatics ,ddc:004 ,Mobile Applications ,Human-Computer Interaction (cs.HC) - Abstract
N-of-1 trials are the gold standard study design to evaluate individual treatment effects and derive personalized treatment strategies. Digital tools have the potential to initiate a new era of N-of-1 trials in terms of scale and scope, but fully functional platforms are not yet available. Here, we present the open source StudyU platform, which includes the StudyU Designer and StudyU app. With the StudyU Designer, scientists are given a collaborative web application to digitally specify, publish, and conduct N-of-1 trials. The StudyU app is a smartphone app with innovative user-centric elements for participants to partake in trials published through the StudyU Designer to assess the effects of different interventions on their health. Thereby, the StudyU platform allows clinicians and researchers worldwide to easily design and conduct digital N-of-1 trials in a safe manner. We envision that StudyU can change the landscape of personalized treatments both for patients and healthy individuals, democratize and personalize evidence generation for self-optimization and medicine, and can be integrated in clinical practice., Zweitveröffentlichungen der Universität Potsdam : Reihe der Digital Engineering Fakultät; 12
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- 2021
121. Molecular and clinical signatures in Acute Kidney Injury define distinct subphenotypes that associate with death, kidney, and cardiovascular events
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George Vasquez-Rios, Wonsuk Oh, Samuel Lee, Pavan Bhatraju, Sherry G. Mansour, Dennis G. Moledina, Heather Thiessen-Philbrook, Eddie Siew, Amit X. Garg, Vernon M. Chinchilli, James S. Kaufman, Chi-yuan Hsu, Kathleen D. Liu, Paul L. Kimmel, Alan S. Go, Mark M. Wurfel, Jonathan Himmelfarb, Chirag R. Parikh, Steven G. Coca, and Girish N. Nadkarni
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IntroductionAKI is a heterogeneous syndrome defined via serum creatinine and urine output criteria. However, these markers are insufficient to capture the biological complexity of AKI and not necessarily inform on future risk of kidney and clinical events.MethodsData from ASSESS-AKI was obtained and analyzed to uncover different clinical and biological signatures within AKI. We utilized a set of unsupervised machine learning algorithms incorporating a comprehensive panel of systemic and organ-specific biomarkers of inflammation, injury, and repair/health integrated into electronic data. Furthermore, the association of these novel biomarker-enriched subphenotypes with kidney and cardiovascular events and death was determined. Clinical and biomarker concentration differences among subphenotypes were evaluated via classic statistics. Kaplan-Meier and cumulative incidence curves were obtained to evaluate longitudinal outcomes.ResultsAmong 1538 patients from ASSESS-AKI, we included 748 AKI patients in the analysis. The median follow-up time was 4.8 years. We discovered 4 subphenotypes via unsupervised learning. Patients with AKI subphenotype 1 (‘injury’ cluster) were older (mean age ± SD): 71.2 ± 9.4 (pConclusionWe discovered four clinically meaningful AKI subphenotypes with statistical differences in biomarker composites that associate with longitudinal risks of adverse clinical events. Our approach is a novel look at the potential mechanisms underlying AKI and the putative role of biomarkers investigation.
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- 2021
122. Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome
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Javier A. Neyra, Joshua Lambert, Victor Ortiz-Soriano, Daniel Cleland, Jon Colquitt, Paul Adams, Brittany D. Bissell, Lili Chan, Girish N. Nadkarni, Ashita Tolwani, and Stuart L. Goldstein
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Adult ,Male ,Multidisciplinary ,Continuous Renal Replacement Therapy ,Critical Illness ,Acute Kidney Injury ,Middle Aged ,Water-Electrolyte Balance ,Cohort Studies ,Death ,Renal Replacement Therapy ,Humans ,Female ,Retrospective Studies - Abstract
Background Fluid management during continuous renal replacement therapy (CRRT) requires accuracy in the prescription of desired patient fluid balance (FBGoal) and precision in the attainable patient fluid balance (FBAchieved). Herein, we examined the association of the gap between prescribed vs. achieved patient fluid balance during CRRT (%FBGap) with hospital mortality in critically ill patients. Methods Cohort study of critically ill adults with acute kidney injury (AKI) requiring CRRT and a prescription of negative fluid balance (mean patient fluid balance goal of negative ≥0.5 liters per day). Fluid management parameters included: 1) NUF (net ultrafiltration rate); 2) FBGoal; 3) FBAchieved; and 4) FBGap (% gap of fluid balance achieved vs. goal), all adjusted by patient’s weight (kg) and duration of CRRT (hours). Results Data from 653 patients (median of 102.2 patient-hours of CRRT) were analyzed. Mean (SD) age was 56.7 (14.6) years and 61.9% were male. Hospital mortality rate was 64%. Despite FBGoal was similar in patients who died vs. survived, survivors achieved greater negative fluid balance during CRRT than non-survivors: median FBAchieved -0.25 [-0.52 to -0.05] vs. 0.06 [-0.26 to 0.62] ml/kg/h, ppGap was higher in patients who died (112.8%, 61.5 to 165.7) vs. survived (64.2%, 30.5 to 91.8), pGap was independently associated with increased risk of hospital mortality: aOR (95% CI) 1.01 (1.01–1.02), pGap and other clinical parameters: aOR 0.96 (0.72–1.28), p = 0.771. Conclusions Higher %FBGap was independently associated with an increased risk of hospital mortality in critically ill adults with AKI on CRRT in whom clinicians prescribed negative fluid balance via CRRT. %FBGap represents a novel quality indicator of CRRT delivery that could assist with operationalizing fluid management interventions during CRRT.
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- 2021
123. Multi-ethnic polygenic risk modifies the association between APOL1 high risk genotypes and chronic kidney disease
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Richard S. Cooper, Judy H. Cho, Ha My T. Vy, Orlando M. Gutiérrez, Girish N. Nadkarni, Ron Do, Erwin P. Bottinger, Ruth J. F. Loos, Benjamin S. Glicksberg, Faris F. Gulamali, and Carol R. Horowitz
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business.industry ,Risk stratification ,Genotype ,medicine ,Ethnic group ,Polygenic risk score ,Population screening ,medicine.disease ,business ,Penetrance ,Kidney disease ,Demography - Abstract
The burden of advanced chronic kidney disease (CKD) falls disproportionately on minorities including African Americans (AAs) and Hispanic Americans (HAs) with admixed ancestry. Even though APOL1 high-risk genotypes increase risk of kidney disease, their penetrance is incomplete, indicating that the modification of APOL1 high risk may be polygenic. For this study, we used three multi-ethnic cohorts with APOL1 high risk genotypes and calculated a multi-ethnic PRS using publicly available summary statistics. We show that CKD risk is significantly modified by a multi-ethnic polygenic risk score. Standardizing population screening for CKD by including APOL1 high-risk genotypes and polygenic risk score may improve risk stratification and outcomes.
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- 2021
124. Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week
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Michael E, Farkouh, Gregg W, Stone, Anuradha, Lala, Emilia, Bagiella, Pedro R, Moreno, Girish N, Nadkarni, Ori, Ben-Yehuda, Juan F, Granada, Ovidiu, Dressler, Elizabeth O, Tinuoye, Carlos, Granada, Jessica, Bustamante, Carlos, Peyra, Lucas C, Godoy, Igor F, Palacios, and Valentin, Fuster
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Hospitalization ,Critical Care ,Pyridones ,Thromboembolism ,Anticoagulants ,COVID-19 ,Humans ,Pyrazoles ,Thrombosis ,Enoxaparin - Abstract
Clinical, laboratory, and autopsy findings support an association between coronavirus disease-2019 (COVID-19) and thromboembolic disease. Acute COVID-19 infection is characterized by mononuclear cell reactivity and pan-endothelialitis, contributing to a high incidence of thrombosis in large and small blood vessels, both arterial and venous. Observational studies and randomized trials have investigated whether full-dose anticoagulation may improve outcomes compared with prophylactic dose heparin. Although no benefit for therapeutic heparin has been found in patients who are critically ill hospitalized with COVID-19, some studies support a possible role for therapeutic anticoagulation in patients not yet requiring intensive care unit support. We summarize the pathology, rationale, and current evidence for use of anticoagulation in patients with COVID-19 and describe the main design elements of the ongoing FREEDOM COVID-19 Anticoagulation trial, in which 3,600 hospitalized patients with COVID-19 not requiring intensive care unit level of care are being randomized to prophylactic-dose enoxaparin vs therapeutic-dose enoxaparin vs therapeutic-dose apixaban. (FREEDOM COVID-19 Anticoagulation Strategy [FREEDOM COVID]; NCT04512079).
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- 2021
125. Evaluation of a Machine Learning Approach Utilizing Wearable Data for Prediction of SARS-CoV-2 Infection in Healthcare Workers
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Matteo Danieletto, Dennis S. Charney, Mayte Suárez-Fariñas, Lewis Tomalin, Eddye Golden, Renata Pyzik, Sparshdeep Kaur, Drew Helmus, Laurie Keefer, Micol Zweig, Zahi A. Fayad, Girish N. Nadkarni, Robert Hirten, Anthony Biello, and Erwin P. Bottinger
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Receiver operating characteristic ,business.industry ,Wearable computer ,Machine learning ,computer.software_genre ,Confidence interval ,Test (assessment) ,Health care ,Medicine ,Heart rate variability ,Observational study ,Artificial intelligence ,business ,computer ,Wearable technology - Abstract
ImportancePassive and non-invasive identification of SARS-CoV-2 infection remains a challenge. Widespread use of wearable devices represents an opportunity to leverage physiological metrics and fill this knowledge gap.ObjectiveTo determine whether a machine learning model can detect SARS-CoV-2 infection from physiological metrics collected from wearable devices.DesignA multicenter observational study enrolling health care workers with remote follow-up.SettingSeven hospitals from the Mount Sinai Health System in New York CityParticipantsEligibility criteria included health care workers who were ≥18 years, employees of one of the participating hospitals, with at least an iPhone series 6, and willing to wear an Apple Watch Series 4 or higher. We excluded participants with underlying autoimmune/inflammatory diseases, and medications known to interfere with autonomic function. We enrolled participants between April 29th, 2020, and March 2nd, 2021, and followed them for a median of 73 days (range, 3-253 days). Participants provided patient-reported outcome measures through a custom smartphone application and wore an Apple Watch, collecting heart rate variability and heart rate data, throughout the follow-up period.ExposureParticipants were exposed to SARS-CoV-2 infection over time due to ongoing community spread.Main Outcome and MeasureThe primary outcome was SARS-CoV-2 infection, defined as ±7 days from a self-reported positive SARS-CoV-2 nasal PCR test.ResultsWe enrolled 407 participants with 49 (12%) having a positive SARS-CoV-2 test during follow-up. We examined five machine-learning approaches and found that gradient-boosting machines (GBM) had the most favorable 10-CV performance. Across all testing sets, our GBM model predicted SARS-CoV-2 infection with an average area under the receiver operating characteristic (auROC)=85% (Confidence Interval 83-88%). The model was calibrated to improve sensitivity over specificity, achieving an average sensitivity of 76% (CI ±∼4%) and specificity of 84% (CI ±∼0.4%). The most important predictors included parameters describing the circadian HRV mean (MESOR) and peak-timing (acrophase), and age.Conclusions and RelevanceWe show that a tree-based ML algorithm applied to physiological metrics passively collected from a wearable device can identify and predict SARS-CoV2 infection. Utilizing physiological metrics from wearable devices may improve screening methods and infection tracking.
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- 2021
126. Derivation and Validation of Genome-Wide Polygenic Score for Ischemic Heart Failure
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Jessica K De Freitas, Ron Do, Kumardeep Chaudhary, Renae Judy, Benjamin S. Glicksberg, Ishan Paranjpe, Scott M. Damrauer, Manish Paranjpe, Noah L. Tsao, Girish N. Nadkarni, Suraj K. Jaladanki, Iain S. Forrest, Pranav Sharma, Jagat Narula, and Cbipm Genomics Team
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medicine.medical_specialty ,Multifactorial Inheritance ,Genomics ,Disease ,Coronary Artery Disease ,Genome ,Coronary artery disease ,Risk Factors ,Internal medicine ,medicine ,genomics ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Genetic Predisposition to Disease ,Derivation ,Prospective Studies ,Original Research ,Heart Failure ,business.industry ,personalized medicine ,medicine.disease ,RC666-701 ,Heart failure ,polygenic risk score ,Cardiology ,Personalized medicine ,Cardiology and Cardiovascular Medicine ,Ischemic heart ,business ,Genome-Wide Association Study - Abstract
Background Despite advances in cardiovascular disease and risk factor management, mortality from ischemic heart failure (HF) in patients with coronary artery disease (CAD) remains high. Given the partial role of genetics in HF and lack of reliable risk stratification tools, we developed and validated a polygenic risk score for HF in patients with CAD, which we term HF‐PRS. Methods and Results Using summary statistics from a recent genome‐wide association study for HF, we developed candidate PRSs in the Mount Sinai Bio Me CAD patient cohort (N=6274) by using the pruning and thresholding method and LDPred. We validated the best score in the Penn Medicine BioBank (N=7250) and performed a subgroup analysis in a high‐risk cohort who had undergone coronary catheterization. We observed a significant association between HF‐PRS score and ischemic HF even after adjusting for evidence of obstructive CAD in patients of European ancestry in both Bio Me (odds ratio [OR], 1.14 per SD; 95% CI, 1.05–1.24; P =0.003) and Penn Medicine BioBank (OR, 1.07 per SD; 95% CI, 1.01–1.13; P =0.016). In European patients with CAD in Penn Medicine BioBank who had undergone coronary catheterization, individuals in the top 10th percentile of PRS had a 2‐fold increased odds of ischemic HF (OR, 2.0; 95% CI, 1.1–3.7; P =0.02) compared with the bottom 10th percentile. Conclusions A PRS for HF enables risk stratification in patients with CAD. Future prospective studies aimed at demonstrating clinical utility are warranted for adoption in the patient setting.
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- 2021
127. Acute COVID-19 gene-expression profiles show multiple etiologies of long-term sequelae
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Laura M. Huckins, Jessica Le Berichel, Brian Fennessy, Edgar Gonzalez-Kozlova, Kai Nie, Seunghee Kim-Schulze, Kevin Tuballes, Lillian Wilkins, Konstantinos Mouskas, Esther Cheng, Aviva G. Beckmann, Mario A. Cedillo, Panagiotis Roussos, Lauren Lepow, Ryan Thompson, Eric E. Schadt, Nancy Francoeur, Nicole W. Simons, Gabriel E. Hoffman, Sacha Gnjatic, Miriam Merad, Noam D. Beckmann, Nicholas Zaki, Thomas U. Marron, Christie Chang, Alexander W. Charney, Vanessa Barcessat, Girish N. Nadkarni, Ying-Chih Wang, Jessica S. Johnson, Diane Marie Del-Valle, Benjamin S. Glicksberg, and Robert Sebra
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Immune system ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Concomitant ,Gene expression ,Immunology ,Etiology ,Medicine ,business ,Virus ,Article ,Whole blood - Abstract
Summary ParagraphTwo years into the SARS-CoV-2 pandemic, the post-acute sequelae of infection are compounding the global health crisis. Often debilitating, these sequelae are clinically heterogeneous and of unknown molecular etiology. Here, a transcriptome-wide investigation of this new condition was performed in a large cohort of acutely infected patients followed clinically into the post-acute period. Gene expression signatures of post-acute sequelae were already present in whole blood during the acute phase of infection, with both innate and adaptive immune cells involved. Plasma cells stood out as driving at least two distinct clusters of sequelae, one largely dependent on circulating antibodies against the SARS-CoV-2 spike protein and the other antibody-independent. Altogether, multiple etiologies of post-acute sequelae were found concomitant with SARS-CoV-2 infection, directly linking the emergence of these sequelae with the host response to the virus.
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- 2021
128. Association of Uremic Solutes With Cardiovascular Death in Diabetic Kidney Disease
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Hima Sapa, Orlando M. Gutiérrez, Michael G. Shlipak, Ronit Katz, Joachim H. Ix, Mark J. Sarnak, Mary Cushman, Eugene P. Rhee, Paul L. Kimmel, Ramachandran S. Vasan, Sarah J. Schrauben, Harold I. Feldman, Jesse C. Seegmiller, Henri Brunengraber, Thomas H. Hostetter, Jeffrey R. Schelling, Joseph Massaro, Clary Clish, Michelle Denburg, Susan Furth, Bradley Warady, Joseph Bonventre, Sushrut Waikar, Gearoid McMahon, Venkata Sabbisetti, Josef Coresh, Morgan Grams, Casey Rebholz, Alison Abraham, Adriene Tin, Chirag Parikh, Jon Klein, Steven Coca, Bart S. Ferket, Girish N. Nadkarni, Daniel Gossett, Brad Rovin, Andrew S. Levey, Lesley A. Inker, Meredith Foster, Ruth Dubin, Rajat Deo, Amanda Anderson, Theodore Mifflin, Dawei Xie, Haochang Shou, Shawn Ballard, Krista Whitehead, Heather Collins, Jason Greenberg, and Peter Ganz
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Methylamines ,Cardiovascular Diseases ,Nephrology ,Diabetes Mellitus ,Humans ,Diabetic Nephropathies ,Oxides ,Arginine ,Biomarkers - Abstract
Cardiovascular disease (CVD) is a major cause of mortality among people with diabetic kidney disease (DKD). The pathophysiology is inadequately explained by traditional CVD risk factors. The uremic solutes trimethylamine-N-oxide (TMAO) and asymmetric and symmetric dimethylarginine (ADMA, SDMA) have been linked to CVD in kidney failure with replacement therapy (KFRT), but data are limited in populations with diabetes and less severe kidney disease.Observational cohort.Random subcohort of 555 REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants with diabetes and estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 mADMA, SDMA, and TMAO assayed by liquid chromatography-mass spectrometry in plasma and urine.Cardiovascular mortality (primary outcome); all-cause mortality and incident KFRT (secondary outcomes).Plasma concentrations and ratios of urine to plasma concentrations of ADMA, SDMA, and TMAO were tested for association with outcomes. Adjusted Cox regression models were fitted and hazard ratios of outcomes calculated per standard deviation and per doubling, and as interquartile comparisons.The mean baseline eGFR was 44 mL/min/1.73 mSingle cohort, restricted to patients with diabetes and eGFR 60 mL/min/1.73 mHigher plasma concentrations and lower ratios of urine to plasma concentrations of uremic solutes were independently associated with cardiovascular and all-cause mortality in DKD. Associations of ratios of urine to plasma concentrations with mortality suggest a connection between renal uremic solute clearance and CVD pathogenesis.
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- 2022
129. Prediction of Incident Heart Failure in TTR Val122Ile Carriers One Year Ahead of Diagnosis in a Multiethnic Biobank
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Kumardeep Chaudhary, Girish N. Nadkarni, Jagat Narula, Ron Do, and Ben Omega Petrazzini
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medicine.medical_specialty ,Penetrance ,Machine Learning ,Clinical Decision Rules ,Internal medicine ,medicine ,Electronic Health Records ,Humans ,Prealbumin ,Biological Specimen Banks ,Heart Failure ,Amyloid Neuropathies, Familial ,biology ,business.industry ,Incidence ,Hispanic or Latino ,medicine.disease ,Biobank ,Black or African American ,Transthyretin ,ROC Curve ,Area Under Curve ,Case-Control Studies ,Heart failure ,Mutation ,Emergency medicine ,Cardiology ,biology.protein ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
130. COVID-19: The Kidneys Tell a Tale
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Judy Hindi, Lili Chan, and Girish N. Nadkarni
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Male ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,New York ,urologic and male genital diseases ,Kidney ,AKI-on-CKD ,Kidney Function Tests ,recovery ,renal recovery ,Renal Dialysis ,Risk Factors ,death ,Humans ,Medicine ,acute kidney injury (AKI) ,kidney replacement therapy (KRT) ,Hospital Mortality ,severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Original Investigation ,acute renal failure (ARF) ,Retrospective Studies ,urogenital system ,renal prognosis ,SARS-CoV-2 ,business.industry ,Incidence ,COVID-19 ,Acute Kidney Injury ,Middle Aged ,Survival Analysis ,Virology ,female genital diseases and pregnancy complications ,United States ,COVID-19 outcomes ,Hospitalization ,Intensive Care Units ,Editorial ,Outcome and Process Assessment, Health Care ,Nephrology ,dialysis ,Kidney Diseases ,Female ,business ,in-hospital mortality - Abstract
Rationale & Objective Outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) are not well understood. The goal of this study was to investigate the survival and kidney outcomes of these patients. Study Design Retrospective cohort study. Setting & Participants Patients (aged ≥18 years) hospitalized with COVID-19 at 13 hospitals in metropolitan New York between March 1, 2020, and April 27, 2020, followed up until hospital discharge. Exposure AKI. Outcomes Primary outcome: in-hospital death. Secondary outcomes: requiring dialysis at discharge, recovery of kidney function. Analytical Approach Univariable and multivariable time-to-event analysis and logistic regression. Results Among 9,657 patients admitted with COVID-19, the AKI incidence rate was 38.4/1,000 patient-days. Incidence rates of in-hospital death among patients without AKI, with AKI not requiring dialysis (AKI stages 1-3), and with AKI receiving dialysis (AKI 3D) were 10.8, 31.1, and 37.5/1,000 patient-days, respectively. Taking those without AKI as the reference group, we observed greater risks for in-hospital death for patients with AKI 1-3 and AKI 3D (HRs of 5.6 [95% CI, 5.0-6.3] and 11.3 [95% CI, 9.6-13.1], respectively). After adjusting for demographics, comorbid conditions, and illness severity, the risk for death remained higher among those with AKI 1-3 (adjusted HR, 3.4 [95% CI, 3.0-3.9]) and AKI 3D (adjusted HR, 6.4 [95% CI, 5.5-7.6]) compared with those without AKI. Among patients with AKI 1-3 who survived, 74.1% achieved kidney recovery by the time of discharge. Among those with AKI 3D who survived, 30.6% remained on dialysis at discharge, and prehospitalization chronic kidney disease was the only independent risk factor associated with needing dialysis at discharge (adjusted OR, 9.3 [95% CI, 2.3-37.8]). Limitations Observational retrospective study, limited to the NY metropolitan area during the peak of the COVID-19 pandemic. Conclusions AKI in hospitalized patients with COVID-19 was associated with significant risk for death., Graphical abstract
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- 2021
131. Clinical utility of kidneyintelx in early stages of diabetic kidney disease the CANVAS trial
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David Lam, Girish N. Nadkarni, Gohar Mosoyan, Bruce Neal, Kenneth W. Mahaffey, Norman Rosenthal, Michael K. Hansen, Hiddo J.L. Heerspink, Fergus Fleming, Steven G. Coca, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), and Groningen Kidney Center (GKC)
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Male ,1103 Clinical Sciences ,Diabetic nephropathy ,Urology & Nephrology ,Prognosis ,Diabetes Mellitus, Type 2 ,Nephrology ,Humans ,Diabetic Nephropathies ,Female ,Canagliflozin ,Response to therapy ,Sodium-Glucose Transporter 2 Inhibitors ,Biomarkers ,Glomerular Filtration Rate - Abstract
Introduction: KidneyIntelX is a composite risk score, incorporating biomarkers and clinical variables for predicting progression of diabetic kidney disease (DKD). The utility of this score in the context of sodium glucose co-transporter 2 inhibitors and how changes in the risk score associate with future kidney outcomes are unknown. Methods: We measured soluble tumor necrosis factor receptor (TNFR)-1, soluble TNFR-2, and kidney injury molecule 1 on banked samples from CANagliflozin cardioVascular Assessment Study (CANVAS) trial participants with baseline DKD (estimated glomerular filtration rate [eGFR] 30–59 mL/min/1.73 m2 or urine albumin-to-creatinine ratio [UACR] ≥30 mg/g) and generated KidneyIntelX risk scores at baseline and years 1, 3, and 6. We assessed the association of baseline and changes in KidneyIntelX with subsequent DKD progression (composite outcome of an eGFR decline of ≥5 mL/min/year [using the 6-week eGFR as the baseline in the canagliflozin group], ≥40% sustained decline in the eGFR, or kidney failure). Results: We included 1,325 CANVAS participants with concurrent DKD and available baseline plasma samples (mean eGFR 65 mL/min/1.73 m2 and median UACR 56 mg/g). During a mean follow-up of 5.6 years, 131 participants (9.9%) experienced the composite kidney outcome. Using risk cutoffs from prior validation studies, KidneyIntelX stratified patients to low- (42%), intermediate- (44%), and high-risk (15%) strata with cumulative incidence for the outcome of 3%, 11%, and 26% (risk ratio 8.4; 95% confidence interval [CI]: 5.0, 14.2) for the high-risk versus low-risk groups. The differences in eGFR slopes for canagliflozin versus placebo were 0.66, 1.52, and 2.16 mL/min/1.73 m2 in low, intermediate, and high KidneyIntelX risk strata, respectively. KidneyIntelX risk scores declined by 5.4% (95% CI: −6.9, −3.9) in the canagliflozin arm at year 1 versus an increase of 6.3% (95% CI: 3.8, 8.7) in the placebo arm (p < 0.001). Changes in the KidneyIntelX score at year 1 were associated with future risk of the composite outcome (odds ratio per 10 unit decrease 0.80; 95% CI: 0.77, 0.83; p < 0.001) after accounting for the treatment arm, without evidence of effect modification by the baseline KidneyIntelX risk stratum or by the treatment arm. Conclusions: KidneyIntelX successfully risk-stratified a large multinational external cohort for progression of DKD, and greater numerical differences in the eGFR slope for canagliflozin versus placebo were observed in those with higher baseline KidneyIntelX scores. Canagliflozin treatment reduced KidneyIntelX risk scores over time and changes in the KidneyIntelX score from baseline to 1 year associated with future risk of DKD progression, independent of the baseline risk score and treatment arm.
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- 2021
132. Prognostic value of polygenic risk scores for adults with psychosis
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Paul F. O'Reilly, Steven A. McCarroll, Mark Hyman Rapaport, Noam D. Beckmann, Eric D. Achtyes, Dolores Malaspina, Ruth J. F. Loos, Michele T. Pato, Gillian M. Belbin, Liam Cotter, Alexander W. Charney, Michael Preuss, Carlos N. Pato, Benjamin S. Glicksberg, Ayman H. Fanous, Deepak Kaji, Eimear E. Kenny, Peter F. Buckley, Douglas S. Lehrer, Tim B. Bigdeli, Tielman Van Vleck, Isotta Landi, Girish N. Nadkarni, and Eric E. Schadt
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Adult ,Male ,medicine.medical_specialty ,Psychosis ,Multifactorial Inheritance ,MEDLINE ,Disease ,General Biochemistry, Genetics and Molecular Biology ,Article ,Risk Factors ,Medicine ,Humans ,Genetic Predisposition to Disease ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Psychotic Disorders ,Schizophrenia ,Predictive power ,Medical genetics ,Polygenic risk score ,Female ,Psychiatric interview ,business ,Clinical psychology ,Genome-Wide Association Study - Abstract
Polygenic risk scores (PRS) summarize genetic liability to a disease at the individual level, and the aim is to use them as biomarkers of disease and poor outcomes in real-world clinical practice. To date, few studies have assessed the prognostic value of PRS relative to standards of care. Schizophrenia (SCZ), the archetypal psychotic illness, is an ideal test case for this because the predictive power of the SCZ PRS exceeds that of most other common diseases. Here, we analyzed clinical and genetic data from two multi-ethnic cohorts totaling 8,541 adults with SCZ and related psychotic disorders, to assess whether the SCZ PRS improves the prediction of poor outcomes relative to clinical features captured in a standard psychiatric interview. For all outcomes investigated, the SCZ PRS did not improve the performance of predictive models, an observation that was generally robust to divergent case ascertainment strategies and the ancestral background of the study participants. The inclusion of polygenic risk scores does not improve the performance of standard-of-care predictive models of disease outcomes in patients with psychosis.
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- 2021
133. Electroencephalography at the height of a pandemic: EEG findings in patients with COVID-19
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Gabriela B. Tantillo, Nathalie Jetté, Kapil Gururangan, Parul Agarwal, Lara Marcuse, Anuradha Singh, Jonathan Goldstein, Churl-Su Kwon, Mandip S. Dhamoon, Allison Navis, Girish N. Nadkarni, Alexander W. Charney, James J. Young, Leah J. Blank, Madeline Fields, and Ji Yeoun Yoo
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Neurology ,Seizures ,Physiology (medical) ,COVID-19 ,Humans ,Electroencephalography ,Neurology (clinical) ,Pandemics ,Sensory Systems ,Retrospective Studies - Abstract
To characterize continuous video electroencephalogram (VEEG) findings of hospitalized COVID-19 patients.We performed a retrospective chart review of patients admitted at three New York City hospitals who underwent VEEG at the peak of the COVID-19 pandemic. Demographics, comorbidities, neuroimaging, VEEG indications and findings, treatment, and outcomes were collected.Of 93 patients monitored, 77% had severe COVID-19 and 40% died. Acute ischemic or hemorrhagic stroke was present in 26% and 15%, respectively. Most common VEEG indications were encephalopathy/coma (60%) and seizure-like movements (38%). Most common VEEG findings were generalized slowing (97%), generalized attenuation (31%), generalized periodic discharges (17%) and generalized sharp waves (15%). Epileptiform abnormalities were present in 43% and seizures in 8% of patients, all of whom had seizure risk factors. Factors associated with an epileptiform VEEG included increasing age (OR 1.07, p = 0.001) and hepatic/renal failure (OR 2.99, p = 0.03).Most COVID-19 patients who underwent VEEG monitoring had severe COVID-19 and over one-third had acute cerebral injury (e.g., stroke, anoxia). Seizures were uncommon. VEEG findings were nonspecific.VEEG findings in this cohort of hospitalized COVID-19 patients were those often seen in critical illness. Seizures were uncommon and occurred in the setting of common seizure risk factors.
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- 2021
134. Machine Learning Prediction of Death in Critically Ill Patients With Coronavirus Disease 2019
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Matthew M. Churpek, MD, MPH, PhD, Shruti Gupta, MD, MPH, Alexandra B. Spicer, MS, Salim S. Hayek, MD, Anand Srivastava, MD, MPH, Lili Chan, MD, MSCR, Michal L. Melamed, MD, MHS, Samantha K. Brenner, MD, MPH, Jared Radbel, MD, Farah Madhani-Lovely, MD, Pavan K. Bhatraju, MD, MSc, Anip Bansal, MD, Adam Green, MD, MBA, Nitender Goyal, MD, Shahzad Shaefi, MD, MPH, Chirag R. Parikh, MD, PhD, Matthew W. Semler, MD, David E. Leaf, MD, MMSc, Carol P. Walther, Samaya J. Anumudu, Justin Arunthamakun, Kathleen F. Kopecky, Gregory P. Milligan, Peter A. McCullough, ThuyDuyen Nguyen, Shahzad Shaefi, Megan L. Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D. Valencia, Sushrut S. Waikar, Zoe A. Kibbelaar, Ambarish M. Athavale, Peter Hart, Oyintayo Ajiboye, Matthew Itteera, Adam Green, Jean-Sebastien Rachoin, Christa A. Schorr, Lisa Shea, Daniel L. Edmonston, Christopher L. Mosher, Alexandre M. Shehata, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor ul aain Bhatti, Bijal Metha, Aquino Williams, Samantha K. Brenner, Patricia Walters, Ronaldo C. Go, Keith M. Rose, Miguel A. Hernán, Amy M. Zhou, Ethan C. Kim, Rebecca Lisk, Lili Chan, Kusum S. Mathews, Steven G. Coca, Deena R. Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily Leven, Jing G. Wang, Gohar Mosoyan, Girish N. Nadkarni, Allon N. Friedman, John Guirguis, Rajat Kapoor, Christopher Meshberger, Chirag R. Parikh, Brian T. Garibaldi, Celia P. Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F. Malik, Carmen Elena Cervantes, Samir C. Gautam, Crystal Chang, H. Bryant Nguyen, Afshin Ahoubim, Leslie F. Thomas, Pramod K. Guru, Paul A. Bergl, Yan Zhou, Jesus Rodriguez, Jatan A. Shah, Mrigank S. Gupta, Princy N. Kumar, Deepa G. Lazarous, Seble G. Kassaye, Michal L. Melamed, Tanya S. Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V. Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Jyotsana Thakkar, Neelja Kumar, Michael J. Ross, Michael Chang, Ritesh Raichoudhury, Edward J. Schenck, Soo Jung Cho, Maria Plataki, Sergio L. Alvarez-Mulett, Luis G. Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, David Charytan, Ashley Macina, Daniel W. Ross, Anand Srivastava, Alexander S. Leidner, Carlos Martinez, Jacqueline M. Kruser, Richard G. Wunderink, Alexander J. Hodakowski, Juan Carlos Q. Velez, Eboni G. Price-Haywood, Luis A. Matute-Trochez, Anna E. Hasty, Muner MB. Mohamed, Rupali S. Avasare, David Zonies, David E. Leaf, Shruti Gupta, Rebecca M. Baron, Meghan E. Sise, Erik T. Newman, Samah Abu Omar, Kapil K. Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa Gaviria, Tanveer Shaukat, Omer Kamal, Wei Wang, Heather Yang, Jeffery O. Boateng, Meghan Lee, Ian A. Strohbehn, Jiahua Li, Saif A. Muhsin, Ernest I. Mandel, Ariel L. Mueller, Nicholas S. Cairl, Farah Madhani-Lovely, Chris Rowan, Farah Madhai-Lovely, Vasil Peev, Jochen Reiser, John J. Byun, Andrew Vissing, Esha M. Kapania, Zoe Post, Nilam P. Patel, Joy-Marie Hermes, Anne K. Sutherland, Amee Patrawalla, Diana G. Finkel, Barbara A. Danek, Sowminya Arikapudi, Jeffrey M. Paer, Jared Radbel, Sonika Puri, Jag Sunderram, Matthew T. Scharf, Ayesha Ahmed, Ilya Berim, Jayanth Vatson, Shuchi Anand, Joseph E. Levitt, Pablo Garcia, Suzanne M. Boyle, Rui Song, Jingjing Zhang, Moh’d A. Sharshir, Vadym V. Rusnak, Anip Bansal, Amber S. Podoll, Michel Chonchol, Sunita Sharma, Ellen L. Burnham, Arash Rashidi, Rana Hejal, Eric Judd, Laura Latta, Ashita Tolwani, Timothy E. Albertson, Jason Y. Adams, Steven Y. Chang, Rebecca M. Beutler, Carl E. Schulze, Etienne Macedo, Harin Rhee, Kathleen D. Liu, Vasantha K. Jotwani, Jay L. Koyner, Chintan V. Shah, Vishal Jaikaransingh, Stephanie M. Toth-Manikowski, Min J. Joo, James P. Lash, Javier A. Neyra, Nourhan Chaaban, Alfredo Iardino, Elizabeth H. Au, Jill H. Sharma, Marie Anne Sosa, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Hayley B. Gershengorn, Salim S. Hayek, Pennelope Blakely, Hanna Berlin, Tariq U. Azam, Husam Shadid, Michael Pan, Patrick O’ Hayer, Chelsea Meloche, Rafey Feroze, Kishan J. Padalia, Jeff Leya, John P. Donnelly, Andrew J. Admon, Jennifer E. Flythe, Matthew J. Tugman, Brent R. Brown, Amanda K. Leonberg-Yoo, Ryan C. Spiardi, Todd A. Miano, Meaghan S. Roche, Charles R. Vasquez, Amar D. Bansal, Natalie C. Ernecoff, Csaba P. Kovesdy, Miklos Z. Molnar, S. Susan Hedayati, Mridula V. Nadamuni, Sadaf S. Khan, Duwayne L. Willett, Samuel A.P. Short, Amanda D. Renaghan, Pavan Bhatraju, A. Bilal Malik, Matthew W. Semler, Anitha Vijayan, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F. Kao, Greg L. Schumaker, Nitender Goyal, Anthony J. Faugno, Caroline M. Hsu, Asma Tariq, Leah Meyer, Marta Christov, Francis P. Wilson, Tanima Arora, and Ugochukwu Ugwuowo
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Coronavirus disease 2019 (COVID-19) ,Machine learning ,computer.software_genre ,intensive care unit ,law.invention ,coronavirus disease 2019 ,law ,Medicine ,Original Clinical Report ,Receiver operating characteristic ,business.industry ,Critically ill ,RC86-88.9 ,Medical emergencies. Critical care. Intensive care. First aid ,General Medicine ,artificial intelligence ,Early warning score ,Intensive care unit ,Triage ,Clinical trial ,machine learning ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Observational study ,Artificial intelligence ,business ,computer - Abstract
Supplemental Digital Content is available in the text., OBJECTIVES: Critically ill patients with coronavirus disease 2019 have variable mortality. Risk scores could improve care and be used for prognostic enrichment in trials. We aimed to compare machine learning algorithms and develop a simple tool for predicting 28-day mortality in ICU patients with coronavirus disease 2019. DESIGN: This was an observational study of adult patients with coronavirus disease 2019. The primary outcome was 28-day inhospital mortality. Machine learning models and a simple tool were derived using variables from the first 48 hours of ICU admission and validated externally in independent sites and temporally with more recent admissions. Models were compared with a modified Sequential Organ Failure Assessment score, National Early Warning Score, and CURB-65 using the area under the receiver operating characteristic curve and calibration. SETTING: Sixty-eight U.S. ICUs. PATIENTS: Adults with coronavirus disease 2019 admitted to 68 ICUs in the United States between March 4, 2020, and June 29, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study included 5,075 patients, 1,846 (36.4%) of whom died by day 28. eXtreme Gradient Boosting had the highest area under the receiver operating characteristic curve in external validation (0.81) and was well-calibrated, while k-nearest neighbors were the lowest performing machine learning algorithm (area under the receiver operating characteristic curve 0.69). Findings were similar with temporal validation. The simple tool, which was created using the most important features from the eXtreme Gradient Boosting model, had a significantly higher area under the receiver operating characteristic curve in external validation (0.78) than the Sequential Organ Failure Assessment score (0.69), National Early Warning Score (0.60), and CURB-65 (0.65; p < 0.05 for all comparisons). Age, number of ICU beds, creatinine, lactate, arterial pH, and Pao2/Fio2 ratio were the most important predictors in the eXtreme Gradient Boosting model. CONCLUSIONS: eXtreme Gradient Boosting had the highest discrimination overall, and our simple tool had higher discrimination than a modified Sequential Organ Failure Assessment score, National Early Warning Score, and CURB-65 on external validation. These models could be used to improve triage decisions and clinical trial enrichment.
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- 2021
135. Development of a machine learning model using electrocardiogram signals to improve acute pulmonary embolism screening
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Hossein Honarvar, Adam Russak, Jessica K De Freitas, Robert Freeman, Edgar Argulian, Isotta Landi, Suraj K. Jaladanki, Shelly Teng, Arvind Kumar, Yeraz Khachatoorian, Sukrit Narula, Shan P Zhao, Arsalan Rehmani, Shawn Lee, Sulaiman S Somani, Alexander C Kagen, Benjamin S. Glicksberg, Andrew Kim, Matthew A. Levin, and Girish N. Nadkarni
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medicine.medical_specialty ,business.industry ,medicine ,Intensive care medicine ,medicine.disease ,business ,Pulmonary embolism - Abstract
Aims Clinical scoring systems for pulmonary embolism (PE) screening have low specificity and contribute to computed tomography pulmonary angiogram (CTPA) overuse. We assessed whether deep learning models using an existing and routinely collected data modality, electrocardiogram (ECG) waveforms, can increase specificity for PE detection. Methods and results We create a retrospective cohort of 21 183 patients at moderate- to high suspicion of PE and associate 23 793 CTPAs (10.0% PE-positive) with 320 746 ECGs and encounter-level clinical data (demographics, comorbidities, vital signs, and labs). We develop three machine learning models to predict PE likelihood: an ECG model using only ECG waveform data, an EHR model using tabular clinical data, and a Fusion model integrating clinical data and an embedded representation of the ECG waveform. We find that a Fusion model [area under the receiver-operating characteristic curve (AUROC) 0.81 ± 0.01] outperforms both the ECG model (AUROC 0.59 ± 0.01) and EHR model (AUROC 0.65 ± 0.01). On a sample of 100 patients from the test set, the Fusion model also achieves greater specificity (0.18) and performance (AUROC 0.84 ± 0.01) than four commonly evaluated clinical scores: Wells’ Criteria, Revised Geneva Score, Pulmonary Embolism Rule-Out Criteria, and 4-Level Pulmonary Embolism Clinical Probability Score (AUROC 0.50–0.58, specificity 0.00–0.05). The model is superior to these scores on feature sensitivity analyses (AUROC 0.66–0.84) and achieves comparable performance across sex (AUROC 0.81) and racial/ethnic (AUROC 0.77–0.84) subgroups. Conclusion Synergistic deep learning of ECG waveforms with traditional clinical variables can increase the specificity of PE detection in patients at least at moderate suspicion for PE.
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- 2021
136. Genome-wide polygenic risk score method for diabetic kidney disease in patients with type 2 diabetes
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Ha My T. Vy, Sergio Dellepiane, Girish N. Nadkarni, Lili S Chan, John Cijiang He, Alexander Blair, Benjamin S. Glicksberg, Steven G. Coca, Ron Do, and Kumardeep Chaudhary
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Oncology ,medicine.medical_specialty ,business.industry ,Renal function ,Genome-wide association study ,Type 2 diabetes ,Disease ,medicine.disease ,Genome ,Biobank ,Internal medicine ,medicine ,Etiology ,business ,Genetic association - Abstract
Diabetic kidney disease (DKD) is considered partially hereditary, but the genetic factors underlying disease remain largely unknown. A key barrier to our understanding stems from its heterogeneity, and likely polygenic etiology. Proteinuric and non-proteinuric DKD are two sub-classes of DKD, defined by high urinary albumin-to-creatinine ratio (UACR) and low creatinine estimated glomerular filtration rate (eGFR). Prior genome-wide association studies (GWAS) have identified multiple loci associated with eGFR and UACR. We aimed to combine summary statistics from previous GWAS’ for eGFR and UACR in one prediction model and associate it with DKD prevalence. We then tested this using genetic data from 18,841 individuals diagnosed with type 2 diabetes in UK Biobank. We computed two genome-wide polygenic risk scores (GPS) aggregating effects of common variants associated with the two measurements, eGFR and UACR. We show that including both GPS’ in a single model confers significant improvement in comparison with the single GPS model generated from GWAS summary statistics for DKD. We also find in replication analysis in 5,389 individuals in the multi-ethnic BioMe Biobank, that although the combined model had consistent direction of association, the lowest performance was in individuals with recent African ancestry. In summary, we show that joint modeling of polygenic associations of eGFR and UACR is more significantly associated with DKD than individual modeling as well as a GPS comprised of only DKD summary statistics and may be used to gain insights into biology and progression. However, efforts should be made to develop and validate polygenic approaches in diverse populations.
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- 2021
137. Acute Kidney Injury in Patients Hospitalized With COVID-19 in New York City: Temporal Trends From March 2020 to April 2021
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Zahi A. Fayad, Akhil Vaid, Suraj K. Jaladanki, Benjamin S. Glicksberg, Alexander W. Charney, Erwin P. Bottinger, Steven G. Coca, Lili Chan, John Cijiang He, Sergio Dellepiane, and Girish N. Nadkarni
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Kidney Replacement Therapy ,Acute kidney injury ,COVID-19 ,Acute Kidney Injury ,medicine.disease ,Diseases of the genitourinary system. Urology ,Nephrology ,Internal medicine ,Hemodialysis ,Internal Medicine ,medicine ,Research Letter ,In patient ,RC870-923 ,business - Published
- 2021
138. Development and validation of techniques for phenotyping ST-elevation myocardial infarction encounters from electronic health records
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Shan Zhao, Shelly Teng, Sulaiman Somani, Stephen Yoffie, Shreyas Havaldar, Girish N. Nadkarni, and Benjamin S. Glicksberg
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medicine.medical_specialty ,phenotyping ,AcademicSubjects/SCI01060 ,medicine.medical_treatment ,Health Informatics ,Disease ,Health records ,Research and Applications ,big data ,St elevation myocardial infarction ,medicine ,cardiovascular diseases ,Myocardial infarction ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,Predictive value ,electronic health records ,myocardial infarction ,cardiology ,Emergency medicine ,Diagnosis code ,AcademicSubjects/SCI01530 ,AcademicSubjects/MED00010 ,business ,Electrocardiography - Abstract
Objectives Classifying hospital admissions into various acute myocardial infarction phenotypes in electronic health records (EHRs) is a challenging task with strong research implications that remains unsolved. To our knowledge, this study is the first study to design and validate phenotyping algorithms using cardiac catheterizations to identify not only patients with a ST-elevation myocardial infarction (STEMI), but the specific encounter when it occurred. Materials and Methods We design and validate multi-modal algorithms to phenotype STEMI on a multicenter EHR containing 5.1 million patients and 115 million patient encounters by using discharge summaries, diagnosis codes, electrocardiography readings, and the presence of cardiac catheterizations on the encounter. Results We demonstrate that robustly phenotyping STEMIs by selecting discharge summaries containing “STEM” has the potential to capture the most number of STEMIs (positive predictive value [PPV] = 0.36, N = 2110), but that addition of a STEMI-related International Classification of Disease (ICD) code and cardiac catheterizations to these summaries yields the highest precision (PPV = 0.94, N = 952). Discussion and Conclusion In this study, we demonstrate that the incorporation of percutaneous coronary intervention increases the PPV for detecting STEMI-related patient encounters from the EHR.
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- 2021
139. Development of a federated learning approach to predict acute kidney injury in adult hospitalized patients with COVID-19 in New York City
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Ashwin Sawant, Sergio Dellepiane, Jie Xu, Benjamin S. Glicksberg, Kush Shah, Akhil Vaid, Lili Chan, Suraj K. Jaladanki, Alexander W. Charney, Girish N. Nadkarni, Patricia Kovatch, Ishan Paranjpe, Fei Wang, and Karandeep Singh
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Information privacy ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Hospitalized patients ,privacy protection ,Acute kidney injury ,Vital signs ,Federated learning ,Data security ,COVID-19 ,Acute Kidney Injury ,medicine.disease ,Article ,machine learning ,electronic health records ,medicine ,Medical emergency ,business ,Kidney disease - Abstract
Federated learning is a technique for training predictive models without sharing patient-level data, thus maintaining data security while allowing inter-institutional collaboration. We used federated learning to predict acute kidney injury within three and seven days of admission, using demographics, comorbidities, vital signs, and laboratory values, in 4029 adults hospitalized with COVID-19 at five sociodemographically diverse New York City hospitals, between March-October 2020. Prediction performance of federated models was generally higher than single-hospital models and was comparable to pooled-data models. In the first use-case in kidney disease, federated learning improved prediction of a common complication of COVID-19, while preserving data privacy.
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- 2021
140. Design and rationale of GUARDD-US: A pragmatic, randomized trial of genetic testing for APOL1 and pharmacogenomic predictors of antihypertensive efficacy in patients with hypertension
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Michael T, Eadon, Kerri L, Cavanaugh, Lori A, Orlando, David, Christian, Hrishikesh, Chakraborty, Kady-Ann, Steen-Burrell, Peter, Merrill, Janet, Seo, Diane, Hauser, Rajbir, Singh, Cherry Maynor, Beasley, Jyotsna, Fuloria, Heather, Kitzman, Alexander S, Parker, Michelle, Ramos, Henry H, Ong, Erica N, Elwood, Sheryl E, Lynch, Sabrina, Clermont, Emily J, Cicali, Petr, Starostik, Victoria M, Pratt, Khoa A, Nguyen, Marc B, Rosenman, Neil S, Calman, Mimsie, Robinson, Girish N, Nadkarni, Ebony B, Madden, Natalie, Kucher, Simona, Volpi, Paul R, Dexter, Todd C, Skaar, Julie A, Johnson, Rhonda M, Cooper-DeHoff, and Carol R, Horowitz
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Black or African American ,Pharmacogenetics ,Hypertension ,Humans ,Blood Pressure ,Pharmacology (medical) ,Genetic Testing ,General Medicine ,Renal Insufficiency, Chronic ,Apolipoprotein L1 ,Antihypertensive Agents - Abstract
APOL1 risk alleles are associated with increased cardiovascular and chronic kidney disease (CKD) risk. It is unknown whether knowledge of APOL1 risk status motivates patients and providers to attain recommended blood pressure (BP) targets to reduce cardiovascular disease.Multicenter, pragmatic, randomized controlled clinical trial.6650 individuals with African ancestry and hypertension from 13 health systems.APOL1 genotyping with clinical decision support (CDS) results are returned to participants and providers immediately (intervention) or at 6 months (control). A subset of participants are re-randomized to pharmacogenomic testing for relevant antihypertensive medications (pharmacogenomic sub-study). CDS alerts encourage appropriate CKD screening and antihypertensive agent use.Blood pressure and surveys are assessed at baseline, 3 and 6 months. The primary outcome is change in systolic BP from enrollment to 3 months in individuals with two APOL1 risk alleles. Secondary outcomes include new diagnoses of CKD, systolic blood pressure at 6 months, diastolic BP, and survey results. The pharmacogenomic sub-study will evaluate the relationship of pharmacogenomic genotype and change in systolic BP between baseline and 3 months.To date, the trial has enrolled 3423 participants.The effect of patient and provider knowledge of APOL1 genotype on systolic blood pressure has not been well-studied. GUARDD-US addresses whether blood pressure improves when patients and providers have this information. GUARDD-US provides a CDS framework for primary care and specialty clinics to incorporate APOL1 genetic risk and pharmacogenomic prescribing in the electronic health record.ClinicalTrials.govNCT04191824.
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- 2022
141. Introduction to Artificial Intelligence and Machine Learning in Nephrology
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Girish N. Nadkarni
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Transplantation ,Nephrology ,Epidemiology ,Critical Care and Intensive Care Medicine - Published
- 2022
142. Artificial Intelligence for AKI!Now: Let's Not Await Plato's Utopian Republic
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Azra Bihorac, Jorge Cerdá, Danielle E. Soranno, Jay L. Koyner, Javier A. Neyra, Girish N. Nadkarni, Kianoush Kashani, Shina Menon, Neesh Pannu, Stuart L. Goldstein, and Karandeep Singh
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Literature ,Special Article ,business.industry ,Artificial Intelligence ,Nephrology ,Medicine ,Humans ,General Medicine ,Acute Kidney Injury ,business - Published
- 2021
143. Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data (Preprint)
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Robert P Hirten, Matteo Danieletto, Lewis Tomalin, Katie Hyewon Choi, Micol Zweig, Eddye Golden, Sparshdeep Kaur, Drew Helmus, Anthony Biello, Renata Pyzik, Claudia Calcagno, Robert Freeman, Bruce E Sands, Dennis Charney, Erwin P Bottinger, James W Murrough, Laurie Keefer, Mayte Suarez-Farinas, Girish N Nadkarni, and Zahi A Fayad
- Abstract
BACKGROUND The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. OBJECTIVE This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. METHODS HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. RESULTS A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. CONCLUSIONS High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic.
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- 2021
144. 185-OR: Longitudinal Changes in KidneyIntelX and Association with Progressive Decline in Kidney Function in the CANVAS Trial
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Michael K. Hansen, Steven G. Coca, Hiddo L. Heerspink, Kenneth W. Mahaffey, David Lam, Bruce Neal, Norm Rosenthal, and Girish N. Nadkarni
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medicine.medical_specialty ,Diabetic kidney ,business.industry ,Endocrinology, Diabetes and Metabolism ,Future risk ,Disease progression ,Schering-Plough ,Soluble Tumor Necrosis Factor Receptor ,Medical care ,Kidney injury molecule ,Family medicine ,Afferent ,Internal Medicine ,Medicine ,business - Abstract
KidneyIntelX is a composite risk score incorporating biomarkers and clinical variables for predicting progression of prevalent diabetic kidney disease (DKD). The change of this score over time in response to SGLT2 inhibitors and how these changes associate with future kidney outcomes is unknown. We measured soluble Tumor Necrosis Factor Receptor 1 (sTNFR-1), soluble Tumor Necrosis Factor Receptor 2 (sTNFR-2), and Kidney Injury Molecule (KIM-1) on banked samples from CANVAS trial participants with baseline DKD (eGFR In conclusion, CANA treatment reduced KidneyIntelX risk scores. Changes in the KidneyIntelX score from baseline to 1 year predict future risk of DKD progression whether they resulted from kidney protection afforded by SGLT2i therapy, or decline in kidney function caused by disease progression. Disclosure D. W. Lam: None. G. N. Nadkarni: Advisory Panel; Self; Renalytix AI plc., Consultant; Self; AstraZeneca, Renalytix AI plc., Variant Bio, Research Support; Self; Renalytix AI plc., Stock/Shareholder; Self; Renalytix AI plc. B. Neal: Advisory Panel; Self; Abbott, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Roche Pharma, Servier Laboratories, Research Support; Self; Janssen Pharmaceuticals, Inc., Merck Schering Plough, Roche Pharma, Servier Laboratories. K. W. Mahaffey: Consultant; Self; Abbott, Amgen Inc., Anthos, AstraZeneca, Baim Institute for Clinical Research, Bayer Healthcare Pharmaceuticals Inc., Boehringer Ingelheim Pharmaceuticals, Inc., CSL Behring, Elsevier, Inova, Intermountain Health, Johnson & Johnson, Medscape, Mount Sinai, Mundipharma International, MyoKardia, National Institutes of Health, Novartis Pharmaceuticals Corporation, Novo Nordisk, Otsuka America Pharmaceutical, Inc., Portola Pharmaceuticals, Inc., Regeneron Pharmaceuticals Inc., SmartMedics, Theravance Biopharma, Research Support; Self; Afferent, AHA, Amgen Inc., Apple, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Cardiva Medical, Inc, Eidos, Ferring Pharmaceuticals Inc., Gilead Sciences, Inc., Google, Johnson & Johnson, Luitpold Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., National Institutes of Health, Novartis Pharmaceuticals Corporation, Sanifit, Sanofi, St. Jude Medical. N. Rosenthal: Employee; Self; Janssen Research & Development, LLC. M. K. Hansen: Employee; Self; Janssen Pharmaceuticals, Inc. H. L. Heerspink: Consultant; Self; AbbVie Inc., Astellas Pharma Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Chinook, CSL Behring, Fresenius Medical Care, Gilead Sciences, Inc., Janssen Research & Development, LLC, Merck & Co., Inc., Mitsubishi Corporation Life Sciences Limited, Mundipharma International, Novo Nordisk, Retrophin, Inc., Research Support; Self; AbbVie Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Research & Development, LLC. S. Coca: Advisory Panel; Self; Akebia Therapeutics, Inc., Bayer AG, Boehringer Ingelheim International GmbH, Consultant; Self; CHF Solutions, Relypsa Inc., Renalytix AI plc., Takeda Pharmaceutical Co., Research Support; Self; inRegen, XORTX Therapeutics Inc., Stock/Shareholder; Self; Renalytix AI plc.
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- 2021
145. Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management
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Joseph L. Kannry, Victoria M. Pratt, Rhonda M. Cooper-DeHoff, Girish N. Nadkarni, Emma M. Tillman, Allison B. McCoy, Michael T. Eadon, Paul R. Dexter, Khoa A. Nguyen, Lori A. Orlando, Stuart A. Scott, Kerri L. Cavanaugh, Meghan J. Arwood, Carol R. Horowitz, and Thomas M. Schneider
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0301 basic medicine ,clinical decision support ,Process management ,Guiding Principles ,Computer science ,NAT2 ,030232 urology & nephrology ,Medicine (miscellaneous) ,Clinical decision support system ,Article ,APOL1 ,03 medical and health sciences ,Software portability ,0302 clinical medicine ,Interpretability ,pharmacogenetics ,Medical algorithm ,YEATS4 ,Laboratory results ,Clinical trial ,030104 developmental biology ,Workflow ,Medicine - Abstract
(1) Background: Clinical decision support (CDS) is a vitally important adjunct to the implementation of pharmacogenomic-guided prescribing in clinical practice. A novel CDS was sought for the APOL1, NAT2, and YEATS4 genes to guide optimal selection of antihypertensive medications among the African American population cared for at multiple participating institutions in a clinical trial. (2) Methods: The CDS committee, made up of clinical content and CDS experts, developed a framework and contributed to the creation of the CDS using the following guiding principles: 1. medical algorithm consensus, 2. actionability, 3. context-sensitive triggers, 4. workflow integration, 5. feasibility, 6. interpretability, 7. portability, and 8. discrete reporting of lab results. (3) Results: Utilizing the principle of discrete patient laboratory and vital information, a novel CDS for APOL1, NAT2, and YEATS4 was created for use in a multi-institutional trial based on a medical algorithm consensus. The alerts are actionable and easily interpretable, clearly displaying the purpose and recommendations with pertinent laboratory results, vitals and links to ordersets with suggested antihypertensive dosages. Alerts were either triggered immediately once a provider starts to order relevant antihypertensive agents or strategically placed in workflow-appropriate general CDS sections in the electronic health record (EHR). Detailed implementation instructions were shared across institutions to achieve maximum portability. (4) Conclusions: Using sound principles, the created genetic algorithms were applied across multiple institutions. The framework outlined in this study should apply to other disease-gene and pharmacogenomic projects employing CDS.
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- 2021
146. Heterogeneous Effects of Continuous Positive Airway Pressure (CPAP) Treatment on Cardiovascular Outcomes in Obstructive Sleep Apnea (OSA): Application of Machine Learning in the ISAACC Trial
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S. Grinek, S. Khan, Ferran Barbé, M. Suarez-Farinas, Girish N. Nadkarni, and M. Sanchez De La Torre
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Obstructive sleep apnea ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,medicine ,Cardiology ,Cpap treatment ,Continuous positive airway pressure ,medicine.disease ,business ,Cardiovascular outcomes - Published
- 2021
147. Hospital-Level Variation in Death for Critically Ill Patients with COVID-19
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Matthew M. Churpek, Shruti Gupta, Alexandra B. Spicer, William F. Parker, John Fahrenbach, Samantha K. Brenner, David E. Leaf, Carl P. Walther, Samaya J. Anumudu, Justin Arunthamakun, Kathleen F. Kopecky, Gregory P. Milligan, Peter A. McCullough, Thuy-Duyen Nguyen, Shahzad Shaefi, Megan L. Krajewski, Sidharth Shankar, Ameeka Pannu, Juan D. Valencia, Sushrut S. Waikar, Zoe A. Kibbelaar, Ambarish M. Athavale, Peter Hart, Shristi Upadhyay, Ishaan Vohra, Adam Green, Jean-Sebastien Rachoin, Christa A. Schorr, Lisa Shea, Daniel L. Edmonston, Christopher L. Mosher, Alexandre M. Shehata, Zaza Cohen, Valerie Allusson, Gabriela Bambrick-Santoyo, Noor ul aain Bhatti, Bijal Mehta, Aquino Williams, Patricia Walters, Ronaldo C. Go, Keith M. Rose, Miguel A. Hernán, Lili Chan, Kusum S. Mathews, Steven G. Coca, Deena R. Altman, Aparna Saha, Howard Soh, Huei Hsun Wen, Sonali Bose, Emily A. Leven, Jing G. Wang, Gohar Mosoyan, Girish N. Nadkarni, Pattharawin Pattharanitima, Emily J. Gallagher, Allon N. Friedman, John Guirguis, Rajat Kapoor, Christopher Meshberger, Katherine J. Kelly, Chirag R. Parikh, Brian T. Garibaldi, Celia P. Corona-Villalobos, Yumeng Wen, Steven Menez, Rubab F. Malik, Elena Cervantes, Samir Gautam, Mary C. Mallappallil, Jie Ouyang, Sabu John, Ernie Yap, Yohannes Melaku, Ibrahim Mohamed, Siddartha Bajracharya, Isha Puri, Mariah Thaxton, Jyotsna Bhattacharya, John Wagner, Leon Boudourakis, H. Bryant Nguyen, Afshin Ahoubim, Leslie F. Thomas, Dheeraj Reddy Sirganagari, Pramod K. Guru, Kianoush Kashani, Shahrzad Tehranian, Yan Zhou, Paul A. Bergl, Jesus Rodriguez, Jatan A. Shah, Mrigank S. Gupta, Princy N. Kumar, Deepa G. Lazarous, Seble G. Kassaye, Michal L. Melamed, Tanya S. Johns, Ryan Mocerino, Kalyan Prudhvi, Denzel Zhu, Rebecca V. Levy, Yorg Azzi, Molly Fisher, Milagros Yunes, Kaltrina Sedaliu, Ladan Golestaneh, Maureen Brogan, Neelja Kumar, Michael Chang, Jyotsana Thakkar, Ritesh Raichoudhury, Akshay Athreya, Mohamed Farag, Edward J. Schenck, Soo Jung Cho, Maria Plataki, Sergio L. Alvarez-Mulett, Luis G. Gomez-Escobar, Di Pan, Stefi Lee, Jamuna Krishnan, William Whalen, David Charytan, Ashley Macina, Sobaata Chaudhry, Benjamin Wu, Frank Modersitzki, Anand Srivastava, Alexander S. Leidner, Carlos Martinez, Jacqueline M. Kruser, Richard G. Wunderink, Alexander J. Hodakowski, Juan Carlos Q. Velez, Eboni G. Price-Haywood, Luis A. Matute-Trochez, Anna E. Hasty, Muner M. B. Mohamed, Rupali S. Avasare, David Zonies, Meghan E. Sise, Erik T. Newman, Samah Abu Omar, Kapil K. Pokharel, Shreyak Sharma, Harkarandeep Singh, Simon Correa, Tanveer Shaukat, Omer Kamal, Wei Wang, Heather Yang, Jeffery O. Boateng, Meghan Lee, Ian A. Strohbehn, Jiahua Li, Ariel L. Mueller, Roberta Redfern, Nicholas S. Cairl, Gabriel Naimy, Abeer Abu-Saif, Danyell Hall, Laura Bickley, Chris Rowan, Farah Madhai-Lovely, Vasil Peev, Jochen Reiser, John J. Byun, Andrew Vissing, Esha M. Kapania, Zoe Post, Nilam P. Patel, Joy-Marie Hermes, Anne K. Sutherland, Amee Patrawalla, Diana G. Finkel, Barbara A. Danek, Sowminya Arikapudi, Jeffrey M. Paer, Peter Cangialosi, Mark Liotta, Jared Radbel, Jag Sunderram, Sonika Puri, Jayanth S. Vatson, Matthew T. Scharf, Ayesha Ahmed, Ilya Berim, Shuchi Anand, Joseph E. Levitt, Pablo Garcia, Suzanne M. Boyle, Rui Song, Ali Arif, Jingjing Zhang, Sang Hoon Woo, Xiaoying Deng, Goni Katz-Greenberg, Katharine Senter, Moh’d A. Sharshir, Vadym V. Rusnak, Muhammad Imran Ali, Terri Peters, Kathy Hughes, Anip Bansal, Amber S. Podoll, Michel Chonchol, Sunita Sharma, Ellen L. Burnham, Arash Rashidi, Rana Hejal, Eric Judd, Laura Latta, Ashita Tolwani, Timothy E. Albertson, Jason Y. Adams, Steven Y. Chang, Rebecca M. Beutler, Santa Monica, Carl E. Schulze, Etienne Macedo, Harin Rhee, Kathleen D. Liu, Vasantha K. Jotwani, Jay L. Koyner, Chintan V. Shah, Vishal Jaikaransingh, Stephanie M. Toth-Manikowski, Min J. Joo, James P. Lash, Javier A. Neyra, Nourhan Chaaban, Alfredo Iardino, Elizabeth H. Au, Jill H. Sharma, Marie Anne Sosa, Sabrina Taldone, Gabriel Contreras, David De La Zerda, Alessia Fornoni, Hayley B. Gershengorn, Salim S. Hayek, Pennelope Blakely, Hanna Berlin, Tariq U. Azam, Husam Shadid, Michael Pan, Patrick O’Hayer, Chelsea Meloche, Rafey Feroze, Rayan Kaakati, Danny Perry, Abbas Bitar, Elizabeth Anderson, Kishan J. Padalia, Christopher Launius, John P. Donnelly, Andrew J. Admon, Jennifer E. Flythe, Matthew J. Tugman, Emily H. Chang, Brent R. Brown, Amanda K. Leonberg-Yoo, Ryan C. Spiardi, Todd A. Miano, Meaghan S. Roche, Charles R. Vasquez, Amar D. Bansal, Natalie C. Ernecoff, Sanjana Kapoor, Siddharth Verma, Huiwen Chen, Csaba P. Kovesdy, Miklos Z. Molnar, Ambreen Azhar, S. Susan Hedayati, Mridula V. Nadamuni, Shani Shastri, Duwayne L. Willett, Samuel A. P. Short, Amanda D. Renaghan, Kyle B. Enfield, Pavan K. Bhatraju, A. Bilal Malik, Matthew W. Semler, Anitha Vijayan, Christina Mariyam Joy, Tingting Li, Seth Goldberg, Patricia F. Kao, Greg L. Schumaker, Nitender Goyal, Anthony J. Faugno, Caroline M. Hsu, Asma Tariq, Leah Meyer, Ravi K. Kshirsagar, Daniel E. Weiner, Marta Christov, Jennifer Griffiths, Sanjeev Gupta, Aromma Kapoor, Perry Wilson, Tanima Arora, and Ugochukwu Ugwuowo
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,genetic structures ,Coronavirus disease 2019 (COVID-19) ,Critical Illness ,Disease ,Comorbidity ,Critical Care and Intensive Care Medicine ,medicine.disease_cause ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Coronavirus ,Aged ,Retrospective Studies ,Critically ill ,business.industry ,SARS-CoV-2 ,Incidence ,Editorials ,COVID-19 ,Hospital level ,Middle Aged ,Prognosis ,Intensive care unit ,Health equity ,United States ,Survival Rate ,Intensive Care Units ,Variation (linguistics) ,030228 respiratory system ,Emergency medicine ,Female ,business ,Algorithms ,Follow-Up Studies - Abstract
Variation in hospital mortality has been described for coronavirus disease 2019 (COVID-19), but the factors that explain these differences remain unclear.Our objective was to utilize a large, nationally representative dataset of critically ill adults with COVID-19 to determine which factors explain mortality variability.In this multicenter cohort study, we examined adults hospitalized in intensive care units with COVID-19 at 70 United States hospitals between March and June 2020. The primary outcome was 28-day mortality. We examined patient-level and hospital-level variables. Mixed-effects logistic regression was used to identify factors associated with interhospital variation. The median odds ratio (OR) was calculated to compare outcomes in higher- vs. lower-mortality hospitals. A gradient boosted machine algorithm was developed for individual-level mortality models.A total of 4,019 patients were included, 1537 (38%) of whom died by 28 days. Mortality varied considerably across hospitals (0-82%). After adjustment for patient- and hospital-level domains, interhospital variation was attenuated (OR decline from 2.06 [95% CI, 1.73-2.37] to 1.22 [95% CI, 1.00-1.38]), with the greatest changes occurring with adjustment for acute physiology, socioeconomic status, and strain. For individual patients, the relative contribution of each domain to mortality risk was: acute physiology (49%), demographics and comorbidities (20%), socioeconomic status (12%), strain (9%), hospital quality (8%), and treatments (3%).There is considerable interhospital variation in mortality for critically ill patients with COVID-19, which is mostly explained by hospital-level socioeconomic status, strain, and acute physiologic differences. Individual mortality is driven mostly by patient-level factors. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 2021
148. Using deep learning algorithms to simultaneously identify right and left ventricular dysfunction from the electrocardiogram
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Bette Kim, Kipp W. Johnson, Alexander W. Charney, Atul Kukar, Tatyana Danilov, Sulaiman Somani, Adam Russak, Isotta Landi, Robert S. Freeman, Akhil Vaid, Mesude Bicak, Stamatios Lerakis, Girish N. Nadkarni, Edgar Argulian, Jagat Narula, Benjamin S. Glicksberg, Matthew A. Levin, Shan Zhao, and Marcus A. Badgeley
- Subjects
Lv function ,medicine.medical_specialty ,Ejection fraction ,Ventricular function ,business.industry ,Deep learning ,Composite outcomes ,External validation ,medicine.disease ,Internal medicine ,Heart failure ,Area under curve ,medicine ,Cardiology ,cardiovascular diseases ,Artificial intelligence ,business - Abstract
BackgroundRapid evaluation of left and right ventricular function using deep learning (DL) on electrocardiograms (ECG) can assist diagnostic workflow. However, DL tools to estimate right ventricular (RV) function do not exist, while ones to estimate left ventricular (LV) function are restricted to quantification of very low LV function only.ObjectivesThis study sought to develop deep learning models capable of comprehensively quantifying left and right ventricular dysfunction from ECG data in a large, diverse population.MethodsA multi-center study was conducted with data from five New York City hospitals; four for internal testing and one serving as external validation. We created novel DL models to classify Left Ventricular Ejection Fraction (LVEF) into categories derived from the latest universal definition of heart failure, estimate LVEF through regression, and predict a composite outcome of either RV systolic dysfunction or RV dilation.ResultsWe obtained echocardiogram LVEF estimates for 147,636 patients paired to 715,890 ECGs. We used Natural Language Processing (NLP) to extract RV size and systolic function information from 404,502 echocardiogram reports paired to 761,510 ECGs for 148,227 patients.For LVEF classification in internal testing, Area Under Curve (AUC) at detection of LVEF50% was 0.94 (95% CI:0.94-0.94), 0.82 (0.81-0.83), and 0.89 (0.89-0.89) respectively. For external validation, these results were 0.94 (0.94-0.95), 0.73 (0.72-0.74) and 0.87 (0.87-0.88). For regression, the mean absolute error was 5.84% (5.82-5.85) for internal testing, and 6.14% (6.13-6.16) in external validation. For prediction of the composite RV outcome, AUC was 0.84 (0.84-0.84) in both internal testing and external validation.ConclusionsDL on ECG data can be utilized to create inexpensive screening, diagnostic, and predictive tools for both LV/RV dysfunction. Such tools may bridge the applicability of ECGs and echocardiography, and enable prioritization of patients for further interventions for either sided failure progressing to biventricular disease.
- Published
- 2021
149. Using Deep-Learning Algorithms to Simultaneously Identify Right and Left Ventricular Dysfunction From the Electrocardiogram
- Author
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Benjamin S. Glicksberg, Marcus A. Badgeley, Tatyana Danilov, Robert S. Freeman, Adam Russak, Alexander W. Charney, Stamatios Lerakis, Matthew A. Levin, Kipp W. Johnson, Edgar Argulian, Akhil Vaid, Shan Zhao, Sulaiman Somani, Girish N. Nadkarni, Mesude Bicak, Jagat Narula, Atul Kukar, Isotta Landi, and Bette Kim
- Subjects
Left and right ,medicine.medical_specialty ,Ventricular Dysfunction, Right ,Ventricular Function, Left ,Electrocardiography ,Ventricular Dysfunction, Left ,Text mining ,Right heart failure ,Deep Learning ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Ejection fraction ,business.industry ,Deep learning ,Left heart failure ,Stroke Volume ,Diverse population ,Cardiology ,Ventricular Function, Right ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
This study sought to develop DL models capable of comprehensively quantifying left and right ventricular dysfunction from ECG data in a large, diverse population.Rapid evaluation of left and right ventricular function using deep learning (DL) on electrocardiograms (ECGs) can assist diagnostic workflow. However, DL tools to estimate right ventricular (RV) function do not exist, whereas those to estimate left ventricular (LV) function are restricted to quantification of very low LV function only.A multicenter study was conducted with data from 5 New York City hospitals: 4 for internal testing and 1 serving as external validation. We created novel DL models to classify left ventricular ejection fraction (LVEF) into categories derived from the latest universal definition of heart failure, estimate LVEF through regression, and predict a composite outcome of either RV systolic dysfunction or RV dilation.We obtained echocardiogram LVEF estimates for 147,636 patients paired to 715,890 ECGs. We used natural language processing (NLP) to extract RV size and systolic function information from 404,502 echocardiogram reports paired to 761,510 ECGs for 148,227 patients. For LVEF classification in internal testing, area under curve (AUC) at detection of LVEF ≤40%, 40% LVEF ≤50%, and LVEF50% was 0.94 (95% CI: 0.94-0.94), 0.82 (95% CI: 0.81-0.83), and 0.89 (95% CI: 0.89-0.89), respectively. For external validation, these results were 0.94 (95% CI: 0.94-0.95), 0.73 (95% CI: 0.72-0.74), and 0.87 (95% CI: 0.87-0.88). For regression, the mean absolute error was 5.84% (95% CI: 5.82%-5.85%) for internal testing and 6.14% (95% CI: 6.13%-6.16%) in external validation. For prediction of the composite RV outcome, AUC was 0.84 (95% CI: 0.84-0.84) in both internal testing and external validation.DL on ECG data can be used to create inexpensive screening, diagnostic, and predictive tools for both LV and RV dysfunction. Such tools may bridge the applicability of ECGs and echocardiography and enable prioritization of patients for further interventions for either sided failure progressing to biventricular disease.
- Published
- 2021
150. Activation of cytotoxic T cell population and inversion of CD4:CD8 ratio as manifestations of cellular immune response in SARS-COV-2 infection
- Author
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Shafinaz Hussein, Benjamin S. Glicksberg, Girish N. Nadkarni, Siraj M. El Jamal, Pallavi Khattar, Tayler van den Akker, Fahad Khan, Bridget K. Marcellino, and Adolfo Firpo-Betancourt
- Subjects
medicine.medical_specialty ,education.field_of_study ,2019-20 coronavirus outbreak ,Histology ,Hematology ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Population ,CD4-CD8 Ratio ,Pathology and Forensic Medicine ,Immune system ,Internal medicine ,Immunology ,medicine ,Cytotoxic T cell ,education ,business ,Letter to the Editor - Published
- 2020
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