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Article: Utilization of Medical Codes for Hypotension in Shock Patients: A Retrospective Analysis.

Hunley, Charles / Murphy, Shannon M E / Bershad, Michael / Yapici, Halit O

2021 Volume 14, Page(s) 861–867

Abstract: Purpose: To evaluate the utilization of hypotension diagnosis codes by shock type and year in known hypotensive patients.: Patients and methods: Retrospective analysis of the Medicare fee-for-service claims database. Patients with a shock diagnosis ... ...

Abstract	Purpose: To evaluate the utilization of hypotension diagnosis codes by shock type and year in known hypotensive patients. Patients and methods: Retrospective analysis of the Medicare fee-for-service claims database. Patients with a shock diagnosis code between 2011 and 2017 were identified using the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM). Based on specific ICD codes corresponding to each shock type, patients were classified into four mutually exclusive cohorts: cardiogenic shock, hypovolemic shock, septic shock, and other/unspecified shock. Annual proportion and counts of cases with at least one hypotension ICD code for each shock cohort were generated to produce 7-year medical code utilization trends. A Cochran-Armitage test for trend was performed to evaluate the statistical significance. Results: A total of 2,200,275 shock patients were analyzed, 13.3% (n=292,192) of which received a hypotension code. Hypovolemic shock cases were the most likely to receive a hypotension code (18.02%, n=46,544), while septic shock cases had the lowest rate (11.48%, n=158,348). The proportion of patients with hypotension codes for other cohorts were 18.0% (n=46,544) for hypovolemic shock and 16.9% (n=32,024) for other/unspecified shock. The presence of hypotension codes decreased by 0.9% between 2011 and 2014, but significantly increased from 10.6% in 2014 to 17.9% in 2017 (p <0.0001, Z=-105.05). Conclusion: Hypotension codes are remarkably underutilized in known hypotensive patients. Patients, providers, and researchers are likely to benefit from improved hypotension coding practices.
Language	English
Publishing date	2021-04-19
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2453343-9
ISSN	1178-2390
ISSN	1178-2390
DOI	10.2147/JMDH.S305985
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Article ; Online: Comparison of Lurasidone Versus Quetiapine for the Treatment of Delirium in Critically Ill Patients.

Fox, Marlena A / Elefritz, Jessica L / Huang, Brandon M / Hunley, Charles

Journal of intensive care medicine

2018 Volume 34, Issue 2, Page(s) 172

MeSH term(s)	Antipsychotic Agents ; Critical Illness ; Delirium ; Humans ; Lurasidone Hydrochloride ; Quetiapine Fumarate
Chemical Substances	Antipsychotic Agents ; Quetiapine Fumarate (2S3PL1B6UJ) ; Lurasidone Hydrochloride (O0P4I5851I)
Language	English
Publishing date	2018-07-16
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/0885066618788018
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Article ; Online: Comparison of Lurasidone Versus Quetiapine for the Treatment of Delirium in Critically Ill Patients.

Fox, Marlena A / Elefritz, Jessica L / Huang, Brandon M / Hunley, Charles

Journal of intensive care medicine

2018 Volume 35, Issue 4, Page(s) 394–399

Abstract: Objective: To evaluate the efficacy and safety of lurasidone compared with quetiapine for treatment of delirium in critically ill patients.: Design: Prospective, observational cohort study.: Setting: Single-center community teaching hospital.: ... ...

Abstract	Objective: To evaluate the efficacy and safety of lurasidone compared with quetiapine for treatment of delirium in critically ill patients. Design: Prospective, observational cohort study. Setting: Single-center community teaching hospital. Patients: Forty adult intensive care unit (ICU) patients with delirium (Confusion Assessment Method in the ICU positive), tolerating enteral nutrition, and without active alcohol withdrawal or prior use of atypical antipsychotics. Interventions: Patients were treated at the discretion of the prescriber with either lurasidone or quetiapine for delirium. Dose escalation and/or discontinuation were determined at the discretion of individual providers. Results: Baseline characteristics differed with a higher severity of illness in patients in the quetiapine group (n = 20) and a higher baseline QTc interval in the lurasidone group (n = 20). No significant difference was seen in the time to delirium resolution (3.2 vs 3.4 days), average daily haloperidol requirements (5.7 vs 6.9 mg), hospital length of stay (LOS; 23.6 vs 27.9 days), or ICU LOS (12.1 vs 14.2 days). Lurasidone was associated with fewer ventilator support days (4.0 [interquartile range, IQR: 2.3-6.8] days vs 7 [IQR: 4.0-9.8; Conclusions: Lurasidone for the treatment of delirium in critically ill patients did not differ in the time to delirium resolution when compared to quetiapine. Additionally, the incidence of QTc prolongation between agents does not appear to be different. Future randomized trials should evaluate dose escalation schemes and a larger proportion of patients to evaluate differences in mortality, efficacy, and life-threatening arrhythmias associated with atypical antipsychotic use.
MeSH term(s)	Aged ; Antipsychotic Agents/therapeutic use ; Critical Care Outcomes ; Critical Illness/psychology ; Delirium/drug therapy ; Delirium/etiology ; Female ; Humans ; Intensive Care Units ; Lurasidone Hydrochloride/therapeutic use ; Male ; Middle Aged ; Prospective Studies ; Quetiapine Fumarate/therapeutic use ; Severity of Illness Index ; Treatment Outcome
Chemical Substances	Antipsychotic Agents ; Quetiapine Fumarate (2S3PL1B6UJ) ; Lurasidone Hydrochloride (O0P4I5851I)
Language	English
Publishing date	2018-01-22
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/0885066617754187
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Article ; Online: Association between perioperative fluid management and patient outcomes: a multicentre retrospective study.

Miller, Timothy E / Mythen, Monty / Shaw, Andrew D / Hwang, Seungyoung / Shenoy, Apeksha V / Bershad, Michael / Hunley, Charles

British journal of anaesthesia

2020 Volume 126, Issue 3, Page(s) 720–729

Abstract: Background: Postoperative complications increase hospital length of stay and patient mortality. Optimal perioperative fluid management should decrease patient complications. This study examined associations between fluid volume and noncardiac surgery ... ...

Abstract	Background: Postoperative complications increase hospital length of stay and patient mortality. Optimal perioperative fluid management should decrease patient complications. This study examined associations between fluid volume and noncardiac surgery patient outcomes within a large multicentre US surgical cohort. Methods: Adults undergoing noncardiac procedures from January 1, 2012 to December 31, 2017, with a postoperative length of stay ≥24 h, were extracted from a large US electronic health record database. Patients were segmented into quintiles based on recorded perioperative fluid volumes with Quintile 3 (Q3) serving as the reference. The primary outcome was defined as a composite of any complications during the surgical admission and a postoperative length of stay ≥7 days. Secondary outcomes included in-hospital mortality, respiratory complications, and acute kidney injury. Results: A total of 35 736 patients met the study criteria. There was a U-shaped pattern with highest (Q5) and lowest (Q1) quintiles of fluid volumes having increased odds of complications and a postoperative length of stay ≥7 days (Q5: odds ratio [OR] 1.51 [95% confidence interval {CI}: 1.30-1.74], P<0.001; Q1: OR 1.20 [95% CI: 1.04-1.38], P=0.011) compared with Q3. Patients in Q5 had greater odds of more severe acute kidney injury compared with Q3 (OR 1.52 [95% CI: 1.22-1.90]; P<0.001) and respiratory complications (OR 1.44 [95% CI: 1.17-1.77]; P<0.001). Conclusions: Both very high and very low perioperative fluid volumes were associated with an increase in complications after noncardiac surgery.
MeSH term(s)	Cohort Studies ; Elective Surgical Procedures ; Electronic Health Records ; Female ; Fluid Therapy/adverse effects ; Hospital Mortality ; Humans ; Length of Stay ; Male ; Middle Aged ; Perioperative Care/methods ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Retrospective Studies
Language	English
Publishing date	2020-12-13
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2020.10.031
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Article ; Online: Abnormal shock index exposure and clinical outcomes among critically ill patients: A retrospective cohort analysis.

Maheshwari, Kamal / Nathanson, Brian H / Munson, Sibyl H / Hwang, Seungyoung / Yapici, Halit O / Stevens, Mitali / Ruiz, Carlos / Hunley, Charles F

Journal of critical care

2020 Volume 57, Page(s) 5–12

Abstract: Purpose: To assess the predictive value of a single abnormal shock index reading (SI ≥0.9; heart rate/systolic blood pressure [SBP]) for mortality, and association between cumulative abnormal SI exposure and mortality/morbidity.: Materials and methods! ...

Abstract	Purpose: To assess the predictive value of a single abnormal shock index reading (SI ≥0.9; heart rate/systolic blood pressure [SBP]) for mortality, and association between cumulative abnormal SI exposure and mortality/morbidity. Materials and methods: Cohort comprised of adult patients with an intensive care unit (ICU) stay ≥24-h (years 2010-2018). SI ≥0.9 exposure was evaluated via cumulative minutes or time-weighted average; SBP ≤100-mmHg was analyzed. Outcomes were in-hospital mortality, acute kidney injury (AKI), and myocardial injury. Results: 18,197 patients from 82 hospitals were analyzed. Any single SI ≥0.9 within the ICU predicted mortality with 90.8% sensitivity and 36.8% specificity. Every 0.1-unit increase in maximum-SI during the first 24-h increased the odds of mortality by 4.8% [95%CI; 2.6-7.0%; p < .001]. Every 4-h exposure to SI ≥0.9 increased the odds of death by 5.8% [95%CI; 4.6-7.0%; p < .001], AKI by 4.3% [95%CI; 3.7-4.9%; p < .001] and myocardial injury by 2.1% [95%CI; 1.2-3.1%; p < .001]. ≥2-h exposure to SBP ≤100-mmHg was significantly associated with mortality. Conclusions: A single SI reading ≥0.9 is a poor predictor of mortality; cumulative SI exposure is associated with greater risk of mortality/morbidity. The associations with in-hospital mortality were comparable for SI ≥0.9 or SBP ≤100-mmHg exposure. Dynamic interactions between hemodynamic variables need further evaluation among critically ill patients.
MeSH term(s)	Acute Kidney Injury/blood ; Acute Kidney Injury/complications ; Adult ; Aged ; Blood Pressure ; Cohort Studies ; Critical Care ; Critical Illness ; Female ; Heart Injuries/complications ; Heart Rate ; Hospital Mortality ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Morbidity ; Predictive Value of Tests ; Probability ; Retrospective Studies ; Risk ; Severity of Illness Index ; Shock/complications ; Shock/diagnosis ; Shock/mortality ; Treatment Outcome
Language	English
Publishing date	2020-01-21
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2020.01.024
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Article: Determinants of left ventricular ejection fraction and a novel method to improve its assessment of myocardial contractility.

Monge García, Manuel Ignacio / Jian, Zhongping / Settels, Jos J / Hunley, Charles / Cecconi, Maurizio / Hatib, Feras / Pinsky, Michael R

Annals of intensive care

2019 Volume 9, Issue 1, Page(s) 48

Abstract: Background: The aim of this study was to quantify the impact of different cardiovascular factors on left ventricular ejection fraction (LVEF) and test a novel LVEF calculation considering these factors.: Results: 10 pigs were studied. The ... ...

Abstract	Background: The aim of this study was to quantify the impact of different cardiovascular factors on left ventricular ejection fraction (LVEF) and test a novel LVEF calculation considering these factors. Results: 10 pigs were studied. The experimental protocol consisted of sequentially changing afterload, preload and contractility. LV pressure-volume (PV) loops and peripheral arterial pressure were obtained before and after each intervention. LVEF was calculated as stroke volume (SV)/end-diastolic volume (EDV). We studied global cardiac function variables: LV end-systolic elastance (Ees), effective arterial elastance (Ea), end-diastolic volume and heart rate. Diastolic function was evaluated by means of the ventricular relaxation time (τ) and ventricular stiffness constant (β) obtained from the end-diastolic PV relationship. Ventriculo-arterial coupling (VAC), an index of cardiovascular performance, was calculated as Ea/Ees. LV mechanical efficiency (LVeff) was calculated as the ratio of stroke work to LV pressure-volume area. A linear mixed model was used to determine the impact of cardiac factors (Ees, Ea, EDV and heart rate), VAC and LVeff on LVEF during all experimental conditions. LVEF was mainly related to Ees and Ea. There was a strong relationship between LVEF and both VAC and LVeff (r Conclusions: LVEF was mainly affected by contractility and afterload changes and was strongly related to VAC and LVeff. An adjustment to LVEF that considers the impact of afterload provided a better assessment of LV contractility.
Language	English
Publishing date	2019-04-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-019-0526-7
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Article ; Online: A 1-minute blood test detects decreased immune function and increased clinical risk in COVID-19 patients.

Deb, Chirajyoti / Salinas, Allan N / Zheng, Tianyu / Middleton, Aurea / Kern, Katelyn / Penoyer, Daleen / Borsadia, Rahul / Hunley, Charles / Abomoelak, Bassam / Mehta, Vijay / Irastorza, Laura / Mehta, Devendra I / Huo, Qun

Scientific reports

2021 Volume 11, Issue 1, Page(s) 23491

Abstract: Upon infection with SARS-CoV-2, the virus that causes COVID-19, most people will develop no or mild symptoms. However, a small percentage of the population will become severely ill, and some will succumb to death. The clinical severity of COVID-19 has a ... ...

Abstract	Upon infection with SARS-CoV-2, the virus that causes COVID-19, most people will develop no or mild symptoms. However, a small percentage of the population will become severely ill, and some will succumb to death. The clinical severity of COVID-19 has a close connection to the dysregulation of the patient's immune functions. We previously developed a simple, nanoparticle-enabled blood test that can determine the humoral immune status in animals. In this study, we applied this new test to analyze the immune function in relation to disease severity in COVID-19 patients. From the testing of 153 COVID-19 patient samples and 142 negative controls, we detected a drastic decrease of humoral immunity in COVID-19 patients who developed moderate to severe symptoms, but not in patients with no or mild symptoms. The new test may be potentially used to monitor the immunity change and predict the clinical risk of patients with COVID-19.
MeSH term(s)	COVID-19/immunology ; COVID-19/pathology ; COVID-19/virology ; Case-Control Studies ; Gold/chemistry ; Humans ; Immunity, Humoral ; Immunoassay/methods ; Immunoglobulin G ; Metal Nanoparticles/chemistry ; Risk Factors ; SARS-CoV-2/isolation & purification ; Severity of Illness Index
Chemical Substances	Immunoglobulin G ; Gold (7440-57-5)
Language	English
Publishing date	2021-12-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-02863-2
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Article ; Online: Author Correction: A 1-minute blood test detects decreased immune function and increased clinical risk in COVID-19 patients.

Scientific reports

2021 Volume 11, Issue 1, Page(s) 24461

Language	English
Publishing date	2021-12-21
Publishing country	England
Document type	Published Erratum
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-04067-0
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Article ; Online: Performance comparison of ventricular and arterial dP/dt

Monge Garcia, Manuel Ignacio / Jian, Zhongping / Settels, Jos J / Hunley, Charles / Cecconi, Maurizio / Hatib, Feras / Pinsky, Michael R

Critical care (London, England)

2018 Volume 22, Issue 1, Page(s) 325

Abstract: Background: Maximal left ventricular (LV) pressure rise (LV dP/dt: Methods: We measured LV pressure-volume data using a conductance catheter and femoral and radial arterial pressures using a fluid-filled catheter in 10 anesthetized pigs. Ees was ... ...

Abstract	Background: Maximal left ventricular (LV) pressure rise (LV dP/dt Methods: We measured LV pressure-volume data using a conductance catheter and femoral and radial arterial pressures using a fluid-filled catheter in 10 anesthetized pigs. Ees was calculated as the slope of the end-systolic pressure-volume relationship during a transient inferior vena cava occlusion. Afterload was assessed by the effective arterial elastance. The experimental protocol consisted of sequentially changing afterload (phenylephrine/nitroprusside), preload (bleeding/fluid bolus), and contractility (esmolol/dobutamine). A linear-mixed analysis was used to assess the contribution of cardiac (Ees, end-diastolic volume, effective arterial elastance, heart rate, preload-dependency) and arterial factors (total vascular resistance and arterial compliance) to LV and arterial dP/dt Results: Both LV and arterial dP/dt Conclusion: Although arterial dP/dt
MeSH term(s)	Adrenergic beta-1 Receptor Antagonists/therapeutic use ; Animals ; Cardiotonic Agents/therapeutic use ; Catheterization, Central Venous/methods ; Myocardial Contraction/physiology ; Nitroprusside/therapeutic use ; Phenylephrine/therapeutic use ; Propanolamines/therapeutic use ; Swine ; Vasodilator Agents/therapeutic use ; Ventricular Function, Left/physiology ; Weights and Measures/standards
Chemical Substances	Adrenergic beta-1 Receptor Antagonists ; Cardiotonic Agents ; Propanolamines ; Vasodilator Agents ; Nitroprusside (169D1260KM) ; Phenylephrine (1WS297W6MV) ; esmolol (MDY902UXSR)
Language	English
Publishing date	2018-11-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2051256-9
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-018-2260-1
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Article ; Online: A One-Minute Blood Test to Monitor Immune Responses in COVID-19 Patients and Predict Clinical Risks of Developing Moderate to Severe Symptoms

Deb, Chirajyoti / Salinas, Allan N / Middleton, Aurea / Kern, Katelyn / Penoyer, Daleen / Borsadia, Rahul / Hunley, Charles / Mehta, Vijay / Irastorza, Laura / Mehta, Devendra I / Zheng, Tianyu / HUO, QUN

medRxiv

Abstract: Coronavirus disease 2019 (COVID-19) has brought enormous loss and interruption to human life and the global economy since the first outbreak reported in China between late 2019 to early 2020, and will likely remain a public health threat in the months ... ...

Abstract	Coronavirus disease 2019 (COVID-19) has brought enormous loss and interruption to human life and the global economy since the first outbreak reported in China between late 2019 to early 2020, and will likely remain a public health threat in the months and years to come. Upon infection with SARS-CoV-2, the virus that causes COVID-19, most people will develop no or mild symptoms, however, a small percentage of the population will become severely ill, require hospitalization, intensive care, and some succumb to death. The current knowledge of COVID-19 disease progression with worsening symptom complex implicates the critical importance of identifying patients with high clinical risk compared to those who would be at lower risk for disease control and patient management with better therapeutic output. Currently no clinical test is available that can predict risk factors and immune status change at different severity scales. The immune system plays a critical role in the defense against infectious diseases. Extensive research has found that COVID-19 patients with poor clinical outcomes differ significantly in their immune responses to the virus from those who exhibit milder symptoms. We previously developed a nanoparticle-enabled blood test that can detect the humoral immune status change in animals. In this study, we applied this new test to analyze the immune response in relation to disease severity in COVID-19 patients. From the testing of 153 COVID-19 patient samples and 142 negative controls, we detected statistically significant differences between COVID-19 patients with no or mild symptoms from those who developed moderate to severe symptoms. Mechanistic study suggests that these differences are associated with type 1 versus type 2 immune responses. We conclude that this new rapid test could potentially become a valuable clinical tool for COVID-19 patient risk stratification and management.
Keywords	covid19
Language	English
Publishing date	2020-10-02
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.09.30.20203844
Database	COVID19

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