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866 results on '"Coca, Steven G."'

203. Augmented Intelligence with Natural Language Processing Applied to Electronic Health Records is Useful for Identifying Patients with Non-Alcoholic Fatty Liver Disease at Risk for Disease Progression

Author

Van Vleck, Tielman T., primary, Chan, Lili, additional, Coca, Steven G., additional, Craven, Catherine K., additional, Do, Ron, additional, Ellis, Stephen B., additional, Kannry, Joseph L., additional, Loos, Ruth J.F., additional, Bonis, Peter A., additional, Cho, Judy, additional, and Nadkarni, Girish N., additional

Published
2019
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209. Comparison of Urine and Plasma Biomarker Concentrations Measured by Aptamer-Based versus Immunoassay Methods in Cardiac Surgery Patients.

Author

Kukova, Lidiya Z., Mansour, Sherry G., Coca, Steven G., de Fontnouvelle, Christina A., Thiessen-Philbrook, Heather R., Shlipak, Michael G., El-Khoury, Joe M., and Parikh, Chirag R.

Subjects
BIOMARKERS, IMMUNOASSAY, APTAMERS, PROTEIN analysis, CARDIAC surgery patients, ACUTE kidney failure
Abstract

Background: Protein detection assays are invaluable tools in the field of biomarker discovery. However, only immunoassays are widely used and can measure 10-20 analytes per biosample. The novel SOMAmer-based assay uses nucleotide aptamer technology to measure over 1300 analytes per biosample. We compared the SOMAmer-based platform to traditional approaches to quantify analytes in a clinical setting with paired samples before and after cardiac surgery. Methods: In a substudy of the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury cohort, 54 individuals with acute kidney injury after cardiac surgery were identified. Preoperative and postoperative plasma and urine samples that had been previously evaluated for biomarker concentrations via immunoassays were analyzed via SOMAmerbased assay. Results: Spearman correlations were estimated when >50% of biomarker values were within detectable ranges by immunoassay (plasma biomarkers: preoperative, 26/33; postoperative, 31/33; urine biomarkers: preoperative, 13/16; postoperative, 16/16). Overall, 27% of reportable plasma preoperative biomarkers displayed correlations ≥0.75 between immunoassay and SOMAmer measurements; 23% displayed correlations of 0.50-0.75, and 50% displayed correlations <0.50. In urine these values were 15%, 39%, and 46%, respectively. Forty-two percent of reportable plasma postoperative biomarkers displayed correlations ≥0.75, 16% displayed correlations 0.50-0.75, and 42% displayed correlations <0.50. In urine, these values were 19%, 25%, and 56%, respectively. Conclusions: In cardiac surgery patients, the SOMAmer-based assay detects proteins with moderate to strong correlation to current immunoassay methods. The correlations in urine are weaker than those in plasma. SOMAmer-based assay technology should be further evaluated in multiple settings as a high-throughput screening tool for biomarker discovery. [ABSTRACT FROM AUTHOR]

Published
2019
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213. Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury

Author

Ahmad, Tariq, primary, Jackson, Keyanna, additional, Rao, Veena S., additional, Tang, W.H. Wilson, additional, Brisco-Bacik, Meredith A., additional, Chen, Horng H., additional, Felker, G. Michael, additional, Hernandez, Adrian F., additional, O’Connor, Christopher M., additional, Sabbisetti, Venkata S., additional, Bonventre, Joseph V., additional, Wilson, F. Perry, additional, Coca, Steven G., additional, and Testani, Jeffrey M., additional

Published
2018
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214. The Authors Reply

Author

Coca, Steven G., primary, Nadkarni, Girish N., additional, Chauhan, Kinsuk, additional, and Parikh, Chirag R., additional

Published
2018
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215. Analysis of OPTN/UNOS registry suggests the number of HLA matches and not mismatches is a stronger independent predictor of kidney transplant survival

Author

Yacoub, Rabi, primary, Nadkarni, Girish N., additional, Cravedi, Paolo, additional, He, John Cijiang, additional, Delaney, Veronica B., additional, Kent, Rebecca, additional, Chauhan, Kinsuk N., additional, Coca, Steven G., additional, Florman, Sander S., additional, Heeger, Peter S., additional, Murphy, Barbara, additional, and Menon, Madhav C., additional

Published
2018
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216. Development of biomarker combinations for postoperative acute kidney injury via Bayesian model selection in a multicenter cohort study

Author

Meisner, Allison, primary, Kerr, Kathleen F., additional, Thiessen-Philbrook, Heather, additional, Wilson, Francis Perry, additional, Garg, Amit X., additional, Shlipak, Michael G., additional, Kavsak, Peter, additional, Whitlock, Richard P., additional, Coca, Steven G., additional, and Parikh, Chirag R., additional

Published
2018
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219. Payer budget impact of an artificial intelligence in vitrodiagnostic to modify diabetic kidney disease progression

Author

Datar, Manasi, Burchenal, William, Donovan, Michael J., Coca, Steven G., Wang, Elaine, and Goss, Thomas F.

Abstract

AbstractAimTo evaluate the U.S. payer budget-impact of KidneyIntelX, an artificial intelligence-enabled in vitrodiagnostic to predict kidney function decline in Type 2 Diabetic Kidney Disease (T2DKD) patients, stages 1–3b.Materials and methodsWe developed an Excel-based model according to International Society of Pharmacoeconomics and Outcomes Research (ISPOR) good practices to assess U.S. payer budget impact associated with the use of the KidneyIntelX test to optimize therapy T2DKD patients compared to standard of care (SOC) (without KidneyIntelX). A hypothetical cohort of 100,000 stages 1–3b T2DKD patients was followed for 5 years. Peer-reviewed publications were used to identify model parameter estimates. KidneyIntelX costs incremental to SOC (without KidneyIntelX) included test cost, additional prescription medication use, specialist referrals and PCP office visits. Patients managed with KidneyIntelX experienced a 20% slowed progression rate compared to SOC (without KidneyIntelX) attributed to slowed DKD progression, delayed or prevented dialysis and transplants, and reduced dialysis crashes. Associated costs were compared to SOC (without KidneyIntelX). Sensitivity analyses were conducted by varying the definition of progression and the DKD progression rate associated with KidneyIntelX testing and related interventions.ResultsProjected undiscounted base case 5-year savings for 100,000 patients tested with KidneyIntelX were $1.052 billion, attributed mostly to slowed progression through DKD stages. The breakeven point for the health plan adopting KidneyIntelX is expected to occur prior to year 2 after adoption. Sensitivity analysis based on the assessment of the most conservative definition of progression and a 5% reduction in progression rate attributed to KidneyIntelX, resulted in a projected 5-year savings of $145 million associated with KidneyIntelX.Limitations and conclusionsLimitations included reliance on literature-based parameter estimates, including effect size of delayed progression supported by the literature. Incorporating KidneyIntelX in contemporary care of early-stage T2DKD patients is projected to result in substantial savings to payers.

Published
2021
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220. Association of Peak Changes in Plasma Cystatin C and Creatinine with Mortality post Cardiac Surgery

Author

Park, Meyeon, Shlipak, Michael G., Thiessen-Philbrook, Heather, Garg, Amit X., Koyner, Jay L., Coca, Steven G., and Parikh, Chirag R.

Subjects
Adult, Aged, 80 and over, Male, Time Factors, Acute Kidney Injury, Middle Aged, Article, Hospitalization, Creatinine, Humans, Female, Longitudinal Studies, Cardiac Surgical Procedures, Cystatin C, Biomarkers, Aged
Abstract

Acute kidney injury is a risk factor for death in cardiac surgical patients. Plasma cystatin C and creatinine have different temporal profiles in the postoperative setting, but the associations of simultaneous changes in both filtration markers compared with change in only one marker with prognosis after hospital discharge are not well described.This is a longitudinal study of 1,199 high-risk adult cardiac surgical patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization. We examined in-hospital peak changes of cystatin C and creatinine in the 3 days after cardiac operations. We evaluated associations of these filtration markers with death, adjusting for demographics, operative characteristics, medical comorbidities, preoperative estimated glomerular filtration rate, preoperative urinary albumin-to-creatinine ratio, and site.During the first 3 days of hospitalization, nearly twice as many patients had a 25% or higher rise in creatinine (30%) compared with a 25% or higher peak rise in cystatin C (15%). The risk of death was higher in those with elevations in cystatin C (adjusted hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.4 to 2.37) or creatinine (adjusted HR, 1.90; 95% CI, 1.32 to 2.72) compared with patients who experienced a postoperative decrease in either filtration marker. Patients who had simultaneous elevations of 25% or higher in cystatin C and creatinine were at similar adjusted risk for 3-year mortality (HR, 1.79; 95% CI, 1.03 to 3.1) as those with a 25% or higher increase in cystatin C alone (HR, 2.2; 95% CI, 1.09 to 4.47).Elevations in creatinine postoperatively are more common than elevations in cystatin C. However, elevations in cystatin C appeared to be associated with a higher risk of death after hospital discharge.

Published
2016

232. Substantial discrepancy between fluid and weight loss during acute decompensated heart failure treatment: Important lessons for research and clinical care

Author

Testani, Jeffrey M., Brisco, Meredith A., Kociol, Robb D., Jacoby, Daniel, Bellumkonda, Lavanya, Parikh, Chirag R., Coca, Steven G., and Wilson Tang, W. H.

Subjects
Male, Risk Assessment, Severity of Illness Index, Article, Drug Administration Schedule, Statistics, Nonparametric, Cohort Studies, Sex Factors, Double-Blind Method, Weight Loss, Humans, Diuretics, Infusions, Intravenous, Aged, Randomized Controlled Trials as Topic, Aged, 80 and over, Heart Failure, Dose-Response Relationship, Drug, Age Factors, Middle Aged, Body Fluids, Survival Rate, Treatment Outcome, Acute Disease, Female, Follow-Up Studies
Abstract

Net fluid and weight loss are used ubiquitously to monitor diuretic response in acute decompensated heart failure research and patient care. However, the performance of these metrics has never been evaluated critically. The weight and volume of aqueous fluids such as urine should be correlated nearly perfectly and with very good agreement. As a result, significant discrepancy between fluid and weight loss during the treatment of acute decompensated heart failure would indicate measurement error in 1 or both of the parameters.The correlation and agreement (Bland-Altman method) between diuretic-induced fluid and weight loss were examined in 3 acute decompensated heart failure trials and cohorts: (1) Diuretic Optimization Strategies Evaluation (DOSE) (n = 254); (2) Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) (n = 348); and (3) Penn (n = 486).The correlation between fluid and weight loss was modest (DOSE r = 0.55; ESCAPE r = 0.48; Penn r = 0.51; P.001 for all), and the 95% limits of agreement were wide (DOSE -7.9 to 6.4 kg-L; ESCAPE -11.6 to 7.5 kg-L; Penn -14.5 to 11.3 kg-L). The median relative disagreement ranged from ±47.0% to 63.5%. A bias toward greater fluid than weight loss was found across populations (-0.74 to -2.1 kg-L, P ≤ .002). A consistent pattern of baseline characteristics or in-hospital treatment parameters that could identify patients at risk of discordant fluid and weight loss was not found.Considerable discrepancy between fluid balance and weight loss is common in patients treated for acute decompensated heart failure. Awareness of the limitations inherent to these commonly used metrics and efforts to develop more reliable measures of diuresis are critical for both patient care and research in acute decompensated heart failure.

Published
2015

233. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure

Author

Griffin, Matthew, Soufer, Aaron, Goljo, Erden, Colna, Matthew, Rao, Veena S., Jeon, Sangchoon, Raghavendra, Parinita, D’Ambrosi, Julie, Riello, Ralph, Coca, Steven G., Mahoney, Devin, Jacoby, Daniel, Ahmad, Tariq, Chen, Michael, Tang, W.H. Wilson, Turner, Jeffrey, Mullens, Wilfried, Wilson, Francis P., and Testani, Jeffrey M.

Abstract

The purpose of this study was to investigate real world safety and efficacy of hypertonic saline therapy in cases of refractory acute decompensated heart failure (ADHF) at a large U.S. academic medical center.

Published
2020
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234. “I don’t get no respect”: the role of chloride in acute kidney injury.

Author

Rein, Joshua L. and Coca, Steven G.

Abstract

Acute kidney injury (AKI) is a major public health problem that complicates 10 – 40% of hospital admissions. Importantly, AKI is independently associated with increased risk of progression to chronic kidney disease, end-stage renal disease, cardio- vascular events, and increased risk of in-hospital and long-term mortality. The chloride content of intravenous fluid has garnered much attention over the last decade, as well as its association with excess use and adverse outcomes, including AKI. Numerous studies show that changes in serum chloride concentration, independent of serum sodium and bicarbonate, are associated with increased risk of AKI, morbidity, and mortality. This comprehensive review details the complex renal physiology regarding the role of chloride in regulating renal blood flow, glomerular filtration rate, tubuloglomerular feed- back, and tubular injury, as well as the findings of clinical research related to the chloride content of intravenous fluids, changes in serum chloride concentration, and AKI. Chloride is underappreciated in both physiology and pathophysiology. Although the exact mechanism is debated, avoidance of excessive chloride administration is a reason- able treatment option for all patients and especially in those at risk for AKI. Therefore, high-risk patients and those with “incipient” AKI should receive balanced solutions rather than normal saline to minimize the risk of AKI. [ABSTRACT FROM AUTHOR]

Published
2019
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238. Association of Post-Hospitalization Vascular Biomarker Clusters with Future Heart Failure

Author

Shi, Audrey, Andrawis, Anna Simone, Obeid, Wassim, Go, Alan S., Liu, Kathleen D., Wurfel, Mark M., Himmelfarb, Jonathan, Parikh, Chirag R., Bhatraju, Pavan K., Chinchilli, Vernon M., Kimmel, Paul L., Kaufman, James S., Coca, Steven G., Reeves, William B., Garg, Amit X., Siew, Edward D., Ikizler, Talat Alp, Philbrook, Heather Thiessen, Hsu, Chi-yuan, Prince, David K., Wilson, Francis P., and Mansour, Sherry

Published
2023
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240. Association of cardiac biomarkers with acute kidney injury after cardiac surgery: A multicenter cohort study

Author

Belley-Côté, Emilie P., primary, Parikh, Chirag R., additional, Shortt, Colleen R., additional, Coca, Steven G., additional, Garg, Amit X., additional, Eikelboom, John W., additional, Kavsak, Peter, additional, McArthur, Eric, additional, Thiessen-Philbrook, Heather, additional, Whitlock, Richard P., additional, Devarajan, Prasad, additional, Edelstein, Charles, additional, Passik, Cary, additional, Swaminathan, Madhav, additional, Patel, Uptal, additional, Zappitelli, Michael, additional, and Butrymowicz, Isabel, additional

Published
2016
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247. Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure

Author

Kula, Alexander J., primary, Hanberg, Jennifer S., additional, Wilson, F. Perry, additional, Brisco, Meredith A., additional, Bellumkonda, Lavanya, additional, Jacoby, Daniel, additional, Coca, Steven G., additional, Parikh, Chirag R., additional, Tang, W.H. Wilson, additional, and Testani, Jeffrey M., additional

Published
2016
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