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  1. Article ; Online: Following the MAP for Improved Kidney Function in Hepatorenal Syndrome.

    Thau, Matthew R / Bhatraju, Pavan K

    Kidney360

    2023  Volume 4, Issue 4, Page(s) e427–e428

    MeSH term(s) Humans ; Hepatorenal Syndrome/therapy ; Kidney ; Liver Cirrhosis ; Urinary Tract Physiological Phenomena
    Language English
    Publishing date 2023-04-13
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0000000000000118
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Is There One Best Way to Define AKI?

    Zelnick, Leila R / Bhatraju, Pavan K

    Kidney360

    2022  Volume 3, Issue 7, Page(s) 1132–1133

    MeSH term(s) Acute Kidney Injury/diagnosis ; Humans ; Nephrology
    Language English
    Publishing date 2022-07-28
    Publishing country United States
    Document type Editorial ; Comment
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0002972022
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  3. Article ; Online: Sub-Phenotypes of Acute Kidney Injury: Do We Have Progress for Personalizing Care?

    Thau, Matthew R / Bhatraju, Pavan K

    Nephron

    2020  Volume 144, Issue 12, Page(s) 677–679

    Abstract: Acute kidney injury (AKI) is the most common form of organ dysfunction occurring in patients admitted to the intensive care unit and contributes significantly to poor long-term outcomes. Despite this public health impact, no effective pharmacotherapy ... ...

    Abstract Acute kidney injury (AKI) is the most common form of organ dysfunction occurring in patients admitted to the intensive care unit and contributes significantly to poor long-term outcomes. Despite this public health impact, no effective pharmacotherapy exists for AKI. One reason may be that heterogeneity is present within AKI as currently defined, thereby concealing unique pathophysiologic processes specific to certain AKI populations. Supporting this notion, we and others have shown that diversity within the AKI clinical syndrome exists, and the "one-size-fits-all" approach by current diagnostic guidelines may not be ideal. A "precision medicine" approach that exploits an individual's genetic, biologic, and clinical characteristics to identify AKI sub-phenotypes may overcome such limitations. Identification of AKI sub-phenotypes may address a critical unmet clinical need in AKI by (1) improving risk prognostication, (2) identifying novel pathophysiology, and (3) informing a patient's likelihood of responding to current therapeutics or establishing new therapeutic targets to prevent and treat AKI. This review discusses the current state of phenotyping AKI and future directions.
    MeSH term(s) Acute Kidney Injury/classification ; Acute Kidney Injury/physiopathology ; Acute Kidney Injury/therapy ; Biomarkers/blood ; Biomarkers/urine ; Humans ; Phenotype ; Precision Medicine
    Chemical Substances Biomarkers
    Language English
    Publishing date 2020-10-22
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 207121-6
    ISSN 2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
    ISSN (online) 2235-3186 ; 1423-0186
    ISSN 1660-8151 ; 0028-2766
    DOI 10.1159/000511321
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Kidney Outcomes and Trajectories of Tubular Injury and Function in Critically Ill Persons with and without Coronavirus-2019.

    Granda, Michael L / Tian, Frances / Zelnick, Leila R / Bhatraju, Pavan K / Wurfel, Mark M / Hoofnagle, Andrew / Morrell, Eric / Kestenbaum, Bryan

    Research square

    2024  

    Abstract: Background: Coronavirus disease-2019 (COVID-19) may injure the kidney tubules via activation of inflammatory host responses and/or direct viral infiltration. Most studies of kidney injury in COVID-19 lacked contemporaneous controls or measured kidney ... ...

    Abstract Background: Coronavirus disease-2019 (COVID-19) may injure the kidney tubules via activation of inflammatory host responses and/or direct viral infiltration. Most studies of kidney injury in COVID-19 lacked contemporaneous controls or measured kidney biomarkers at a single time point. To better understand mechanisms of AKI in COVID-19, we compared kidney outcomes and trajectories of tubular injury, viability, and function in prospectively enrolled critically ill adults with and without COVID-19.
    Methods: The COVID-19 Host Response and Outcomes (CHROME) study prospectively enrolled patients admitted to intensive care units in Washington state with symptoms of lower respiratory tract infection, determining COVID-19 status by nucleic acid amplification on arrival. We evaluated major adverse kidney events (MAKE) defined as a doubling of serum creatinine, kidney replacement therapy, or death, in 330 patients after inverse probability weighting. In the 181 patients with available biosamples, we determined trajectories of urine kidney injury molecule-1 (KIM-1) and epithelial growth factor (EGF), and urine:plasma ratios of endogenous markers of tubular secretory clearance.
    Results: At ICU admission, mean age was 55±16 years; 45% required mechanical ventilation; and mean serum creatinine concentration was 1.1 mg/dL. COVID-19 was associated with a 70% greater incidence of MAKE (95% CI 1.05, 2.74) and a 741% greater incidence of KRT (95% CI 1.69, 32.41). The biomarker cohort had a median of three follow-up measurements. Urine EGF, secretory clearance ratios, and eGFR increased over time in the COVID-19 negative group but remained unchanged in the COVID-19 positive group. In contrast, urine KIM-1 concentrations did not significantly change over the course of the study in either group.
    Conclusions: Among critically ill adults, COVID-19 is associated with a more protracted course of proximal tubular dysfunction.
    Language English
    Publishing date 2024-02-28
    Publishing country United States
    Document type Preprint
    DOI 10.21203/rs.3.rs-3974635/v1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Differential absolute plasma IL-6 concentrations between two immunoassay platforms in intensive care unit patients with COVID-19.

    Bhatraju, Pavan K / Morrell, Eric D / O'Connor, Nicholas G / Choi, Audrey / Fitzpatrick, Michael / Smith, Craig H / Wurfel, Mark M / Liles, Wayne Conrad

    Biomarkers in medicine

    2023  Volume 17, Issue 9, Page(s) 459–464

    Abstract: Objectives: ...

    Abstract Objectives:
    MeSH term(s) Humans ; Interleukin-6 ; COVID-19 ; Immunoassay ; Biological Assay ; Intensive Care Units
    Chemical Substances Interleukin-6
    Language English
    Publishing date 2023-08-31
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2481014-9
    ISSN 1752-0371 ; 1752-0363
    ISSN (online) 1752-0371
    ISSN 1752-0363
    DOI 10.2217/bmm-2023-0073
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  6. Article ; Online: Trajectory of Kidney Function: The Canary in Sepsis.

    Bhatraju, Pavan K / Wurfel, Mark M / Himmelfarb, Jonathan

    American journal of respiratory and critical care medicine

    2020  Volume 202, Issue 9, Page(s) 1211–1212

    MeSH term(s) Acute Kidney Injury ; Biomarkers ; Cell Cycle Checkpoints ; Humans ; Renal Dialysis ; Sepsis ; Shock, Septic ; Tissue Inhibitor of Metalloproteinase-2
    Chemical Substances Biomarkers ; Tissue Inhibitor of Metalloproteinase-2 (127497-59-0)
    Language English
    Publishing date 2020-07-20
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202007-2627ED
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  7. Article ; Online: Identifying ARDS using the Hierarchical Attention Network with Sentence Objectives Framework.

    Lybarger, Kevin / Mabrey, Linzee / Thau, Matthew / Bhatraju, Pavan K / Wurfel, Mark / Yetisgen, Meliha

    AMIA ... Annual Symposium proceedings. AMIA Symposium

    2022  Volume 2021, Page(s) 823–832

    Abstract: Acute respiratory distress syndrome (ARDS) is a life-threatening condition that is often undiagnosed or diagnosed late. ARDS is especially prominent in those infected with COVID-19. We explore the automatic identification of ARDS indicators and ... ...

    Abstract Acute respiratory distress syndrome (ARDS) is a life-threatening condition that is often undiagnosed or diagnosed late. ARDS is especially prominent in those infected with COVID-19. We explore the automatic identification of ARDS indicators and confounding factors in free-text chest radiograph reports. We present a new annotated corpus of chest radiograph reports and introduce the Hierarchical Attention Network with Sentence Objectives (HANSO) text classification framework. HANSO utilizes fine-grained annotations to improve document classification performance. HANSO can extract ARDS-related information with high performance by leveraging relation annotations, even if the annotated spans are noisy. Using annotated chest radiograph images as a gold standard, HANSO identifies bilateral infiltrates, an indicator of ARDS, in chest radiograph reports with performance (0.87 F1) comparable to human annotations (0.84 F1). This algorithm could facilitate more efficient and expeditious identification of ARDS by clinicians and researchers and contribute to the development of new therapies to improve patient care.
    MeSH term(s) Algorithms ; COVID-19 ; Humans ; Respiratory Distress Syndrome/diagnostic imaging
    Language English
    Publishing date 2022-02-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 1942-597X
    ISSN (online) 1942-597X
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  8. Article ; Online: Development and External Validation of Models to Predict Persistent Hypoxemic Respiratory Failure for Clinical Trial Enrichment.

    Sathe, Neha A / Zelnick, Leila R / Morrell, Eric D / Bhatraju, Pavan K / Kerchberger, V Eric / Hough, Catherine L / Ware, Lorraine B / Fohner, Alison E / Wurfel, Mark M

    Critical care medicine

    2024  Volume 52, Issue 5, Page(s) 764–774

    Abstract: Objectives: Improving the efficiency of clinical trials in acute hypoxemic respiratory failure (HRF) depends on enrichment strategies that minimize enrollment of patients who quickly resolve with existing care and focus on patients at high risk for ... ...

    Abstract Objectives: Improving the efficiency of clinical trials in acute hypoxemic respiratory failure (HRF) depends on enrichment strategies that minimize enrollment of patients who quickly resolve with existing care and focus on patients at high risk for persistent HRF. We aimed to develop parsimonious models predicting risk of persistent HRF using routine data from ICU admission and select research immune biomarkers.
    Design: Prospective cohorts for derivation ( n = 630) and external validation ( n = 511).
    Setting: Medical and surgical ICUs at two U.S. medical centers.
    Patients: Adults with acute HRF defined as new invasive mechanical ventilation (IMV) and hypoxemia on the first calendar day after ICU admission.
    Interventions: None.
    Measurements and main results: We evaluated discrimination, calibration, and practical utility of models predicting persistent HRF risk (defined as ongoing IMV and hypoxemia on the third calendar day after admission): 1) a clinical model with least absolute shrinkage and selection operator (LASSO) selecting Pa o2 /F io2 , vasopressors, mean arterial pressure, bicarbonate, and acute respiratory distress syndrome as predictors; 2) a model adding interleukin-6 (IL-6) to clinical predictors; and 3) a comparator model with Pa o2 /F io2 alone, representing an existing strategy for enrichment. Forty-nine percent and 69% of patients had persistent HRF in derivation and validation sets, respectively. In validation, both LASSO (area under the receiver operating characteristic curve, 0.68; 95% CI, 0.64-0.73) and LASSO + IL-6 (0.71; 95% CI, 0.66-0.76) models had better discrimination than Pa o2 /F io2 (0.64; 95% CI, 0.59-0.69). Both models underestimated risk in lower risk deciles, but exhibited better calibration at relevant risk thresholds. Evaluating practical utility, both LASSO and LASSO + IL-6 models exhibited greater net benefit in decision curve analysis, and greater sample size savings in enrichment analysis, compared with Pa o2 /F io2 . The added utility of LASSO + IL-6 model over LASSO was modest.
    Conclusions: Parsimonious, interpretable models that predict persistent HRF may improve enrichment of trials testing HRF-targeted therapies and warrant future validation.
    MeSH term(s) Adult ; Humans ; Interleukin-6 ; Prospective Studies ; Respiratory Insufficiency/therapy ; Hypoxia/therapy ; Intensive Care Units
    Chemical Substances Interleukin-6
    Language English
    Publishing date 2024-01-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000006181
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  9. Article ; Online: The Interaction of Acute Kidney Injury with Resuscitation Strategy in Sepsis: A Secondary Analysis of a Multicenter, Phase 3, Randomized Clinical Trial (CLOVERS).

    Khader, Ayesha / Zelnick, Leila R / Sathe, Neha A / Kestenbaum, Bryan R / Himmelfarb, Jonathan / Johnson, Nicholas J / Shapiro, Nathan I / Douglas, Ivor S / Hough, Catherine L / Bhatraju, Pavan K

    American journal of respiratory and critical care medicine

    2023  Volume 208, Issue 12, Page(s) 1335–1338

    MeSH term(s) Humans ; Acute Kidney Injury/therapy ; Acute Kidney Injury/complications ; Fluid Therapy ; Medicago ; Resuscitation ; Sepsis/complications ; Multicenter Studies as Topic ; Clinical Trials, Phase III as Topic ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2023-10-23
    Publishing country United States
    Document type Letter
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202308-1448LE
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  10. Article ; Online: Subphenotypes in acute kidney injury: a narrative review.

    Vaara, Suvi T / Bhatraju, Pavan K / Stanski, Natalja L / McMahon, Blaithin A / Liu, Kathleen / Joannidis, Michael / Bagshaw, Sean M

    Critical care (London, England)

    2022  Volume 26, Issue 1, Page(s) 251

    Abstract: Acute kidney injury (AKI) is a frequently encountered syndrome especially among the critically ill. Current diagnosis of AKI is based on acute deterioration of kidney function, indicated by an increase in creatinine and/or reduced urine output. However, ... ...

    Abstract Acute kidney injury (AKI) is a frequently encountered syndrome especially among the critically ill. Current diagnosis of AKI is based on acute deterioration of kidney function, indicated by an increase in creatinine and/or reduced urine output. However, this syndromic definition encompasses a wide variety of distinct clinical features, varying pathophysiology, etiology and risk factors, and finally very different short- and long-term outcomes. Lumping all AKI together may conceal unique pathophysiologic processes specific to certain AKI populations, and discovering these AKI subphenotypes might help to develop targeted therapies tackling unique pathophysiological processes. In this review, we discuss the concept of AKI subphenotypes, current knowledge regarding both clinical and biomarker-driven subphenotypes, interplay with AKI subphenotypes and other ICU syndromes, and potential future and clinical implications.
    MeSH term(s) Acute Kidney Injury/therapy ; Biomarkers ; Creatinine ; Critical Illness/therapy ; Humans ; Risk Factors
    Chemical Substances Biomarkers ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2022-08-19
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-022-04121-x
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