2019
A simple real-time model for predicting acute kidney injury in hospitalized patients in the US: A descriptive modeling study
Simonov M, Ugwuowo U, Moreira E, Yamamoto Y, Biswas A, Martin M, Testani J, Wilson FP. A simple real-time model for predicting acute kidney injury in hospitalized patients in the US: A descriptive modeling study. PLOS Medicine 2019, 16: e1002861. PMID: 31306408, PMCID: PMC6629054, DOI: 10.1371/journal.pmed.1002861.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAgedAged, 80 and overConnecticutDecision Support TechniquesElectronic Health RecordsFemaleHospital MortalityHumansInpatientsMaleMiddle AgedPatient AdmissionPredictive Value of TestsPrognosisRenal DialysisRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexTime FactorsConceptsAcute kidney injuryImminent acute kidney injuryElectronic health recordsKidney injuryHospital 1Prediction of AKIRenal replacement therapyOptimal treatment strategyLaboratory dataReceiver operator characteristic curveInternal validation setAKI occurrenceAKI severityHospitalized adultsMedical comorbiditiesOverall cohortAdverse eventsHospitalized patientsSurgical wardsSignificant morbidityReplacement therapyExternal validation data setsHospital 2Hospital 3Study hospital
2018
Enhancing the prediction of acute kidney injury risk after percutaneous coronary intervention using machine learning techniques: A retrospective cohort study
Huang C, Murugiah K, Mahajan S, Li SX, Dhruva SS, Haimovich JS, Wang Y, Schulz WL, Testani JM, Wilson FP, Mena CI, Masoudi FA, Rumsfeld JS, Spertus JA, Mortazavi BJ, Krumholz HM. Enhancing the prediction of acute kidney injury risk after percutaneous coronary intervention using machine learning techniques: A retrospective cohort study. PLOS Medicine 2018, 15: e1002703. PMID: 30481186, PMCID: PMC6258473, DOI: 10.1371/journal.pmed.1002703.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAgedClinical Decision-MakingData MiningDecision Support TechniquesFemaleHumansMachine LearningMaleMiddle AgedPercutaneous Coronary InterventionProtective FactorsRegistriesReproducibility of ResultsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeConceptsPercutaneous coronary interventionNational Cardiovascular Data RegistryRisk prediction modelAKI eventsAKI riskCoronary interventionAKI modelMean ageCardiology-National Cardiovascular Data RegistryAcute kidney injury riskAKI risk predictionRetrospective cohort studyIdentification of patientsCandidate variablesAvailable candidate variablesCohort studyPCI proceduresPoint of careBrier scoreAmerican CollegeData registryPatientsCalibration slopeInjury riskSame cohortWorsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury
Ahmad T, Jackson K, Rao VS, Tang WHW, Brisco-Bacik MA, Chen HH, Felker GM, Hernandez AF, O'Connor CM, Sabbisetti VS, Bonventre JV, Wilson FP, Coca SG, Testani JM. Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury. Circulation 2018, 137: 2016-2028. PMID: 29352071, PMCID: PMC6066176, DOI: 10.1161/circulationaha.117.030112.Peer-Reviewed Original ResearchMeSH KeywordsAcetylglucosaminidaseAcute DiseaseAcute Kidney InjuryAgedAged, 80 and overBiomarkersCreatinineCystatin CDiuresisFemaleGlomerular Filtration RateHeart FailureHepatitis A Virus Cellular Receptor 1HumansKidneyLipocalin-2MaleMiddle AgedSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeUnited StatesConceptsKidney injury molecule-1Neutrophil gelatinase-associated lipocalinInjury molecule-1Acute heart failureGelatinase-associated lipocalinRenal tubular injuryTubular injury biomarkersAggressive diuresisROSE-AHF trialsTubular injuryInjury biomarkersRenal functionHeart failureMolecule-1D-glucosaminidaseHigh-dose loop diuretic therapyAcute heart failure treatmentKidney tubular injuryLoop diuretic therapyAcute kidney injuryGlomerular filtration rateHeart failure treatmentDiuretic therapyFurosemide equivalentsKidney injury
2017
Approaches to Predicting Outcomes in Patients with Acute Kidney Injury
Saly D, Yang A, Triebwasser C, Oh J, Sun Q, Testani J, Parikh CR, Bia J, Biswas A, Stetson C, Chaisanguanthum K, Wilson FP. Approaches to Predicting Outcomes in Patients with Acute Kidney Injury. PLOS ONE 2017, 12: e0169305. PMID: 28122032, PMCID: PMC5266278, DOI: 10.1371/journal.pone.0169305.Peer-Reviewed Original ResearchConceptsAcute kidney injuryLength of stayKidney injuryReceiver operator characteristic curveOutcomes of interestOperator characteristic curveValidation cohortClinical eventsAccurate prognosticationOutcome eventsPredicting OutcomePrognostic modelDeath predictionLab valuesCharacteristic curveGood discrimination abilityPatientsStayInjuryDialysisModel discriminationOutcomesDaysMedicationsMorbidity
2016
Hypochloremia and Diuretic Resistance in Heart Failure
Hanberg JS, Rao V, Maaten J, Laur O, Brisco MA, Wilson F, Grodin JL, Assefa M, Broughton J, Planavsky NJ, Ahmad T, Bellumkonda L, Tang WH, Parikh CR, Testani JM. Hypochloremia and Diuretic Resistance in Heart Failure. Circulation Heart Failure 2016, 9: e003180. PMID: 27507113, PMCID: PMC4988527, DOI: 10.1161/circheartfailure.116.003180.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersChloridesConnecticutCross-Sectional StudiesDown-RegulationDrug ResistanceFemaleFurosemideHeart FailureHumansKidneyMaleMiddle AgedOdds RatioPilot ProjectsProspective StudiesReninRisk FactorsSodiumSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeConceptsDiuretic resistanceHeart failureCare centerSerum chloridePro-B-type natriuretic peptideChloride supplementationRenal free water excretionB-type natriuretic peptidePoor diuretic responsePlasma renin activityPlasma renin concentrationHeart failure cohortFree water excretionRecent epidemiological studiesBasic science evidenceBlood urea nitrogenSerum chloride levelsFurosemide equivalentsNeurohormonal activationRenin activityRenin concentrationCreatinine ratioLoop diureticsDiuretic responseSerum sodiumHypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure
Ter Maaten JM, Damman K, Hanberg JS, Givertz MM, Metra M, O'Connor CM, Teerlink JR, Ponikowski P, Cotter G, Davison B, Cleland JG, Bloomfield DM, Hillege HL, van Veldhuisen DJ, Voors AA, Testani JM. Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure. Circulation Heart Failure 2016, 9: e003109. PMID: 27507112, DOI: 10.1161/circheartfailure.116.003109.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overBiomarkersChloridesDisease ProgressionDiureticsDown-RegulationDrug ResistanceFemaleHeart FailureHospitalizationHumansKaplan-Meier EstimateLinear ModelsMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRisk FactorsTime FactorsTreatment OutcomeXanthinesConceptsAcute heart failureMEq/L.Heart failureDay 14Serum chloridePoor diuretic responseHours of admissionLower serum chlorideBlood urea nitrogenSerum chloride levelsAHF therapiesDiuretic resistancePROTECT trialNeurohormonal activationMultivariable adjustmentRenal functionHospital admissionMultivariable analysisDiuretic responseDiuretic responsivenessDiuretic targetChloride levelsUrea nitrogenHypochloremiaChloride homeostasisImportance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure
Grodin JL, Verbrugge FH, Ellis SG, Mullens W, Testani JM, Tang WH. Importance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure. Circulation Heart Failure 2016, 9: e002453. PMID: 26721916, PMCID: PMC4702267, DOI: 10.1161/circheartfailure.115.002453.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersChloridesChronic DiseaseCoronary AngiographyDown-RegulationFemaleHeart FailureHumansKaplan-Meier EstimateMaleMiddle AgedMultivariate AnalysisPrognosisProportional Hazards ModelsProspective StudiesRisk AssessmentRisk FactorsTime FactorsWater-Electrolyte BalanceWater-Electrolyte ImbalanceConceptsChronic heart failureStable chronic heart failureHeart failureLower serum chlorideSerum chlorideMortality riskElective diagnostic coronary angiographyLow serum chloride levelLong-term prognostic valueAdjusted mortality riskDiagnostic coronary angiographySerum chloride levelsAdjusted riskCause mortalityElectrolyte abnormalitiesCoronary angiographyStable patientsPrognostic implicationsPrognostic valueMultivariable modelChloride levelsSodium levelsPatientsChloride homeostasisMortalityRapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure
Testani JM, Hanberg JS, Cheng S, Rao V, Onyebeke C, Laur O, Kula A, Chen M, Wilson FP, Darlington A, Bellumkonda L, Jacoby D, Tang WH, Parikh CR. Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure. Circulation Heart Failure 2016, 9: e002370. PMID: 26721915, PMCID: PMC4741370, DOI: 10.1161/circheartfailure.115.002370.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAdministration, IntravenousAgedBiomarkersBumetanideDrug MonitoringDrug ResistanceFemaleHeart FailureHumansMaleMiddle AgedModels, BiologicalNatriuresisPredictive Value of TestsProspective StudiesReproducibility of ResultsSodiumSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeUrinalysisConceptsAcute decompensated heart failureDecompensated heart failureNatriuretic responseSpot urine samplesSodium outputHeart failureDiuretic administrationAcute decompensated heart failure patientsDecompensated heart failure patientsLoop diuretic administrationPrimary therapeutic objectiveUrine samplesHeart failure patientsPositive sodium balanceNet fluid outputDiuretic dosingIntravenous bumetanideMedian doseFailure patientsDiuretic responseSodium balanceUrine collectionFluid balanceTherapeutic objectivesFluid output
2015
Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials
Coca SG, Zabetian A, Ferket BS, Zhou J, Testani JM, Garg AX, Parikh CR. Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials. Journal Of The American Society Of Nephrology 2015, 27: 2529-2542. PMID: 26712525, PMCID: PMC4978048, DOI: 10.1681/asn.2015060642.Peer-Reviewed Original ResearchConceptsSerum creatinine levelsCreatinine levelsClinical trialsEnd pointAcute elevationRandomized trialsAcute changesPlacebo-controlled randomized trialSafety end pointRandomized clinical trialsStrong risk factorMeaningful clinical outcomesMeaningful end pointsClinical outcomesKidney functionPoor outcomeAcute increaseRisk factorsThorough literature searchObservational studyTemporary elevationMortality rateShort-term effectsPlaceboCKDInfluence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure
Kula AJ, Hanberg JS, Wilson FP, Brisco MA, Bellumkonda L, Jacoby D, Coca SG, Parikh CR, Tang WHW, Testani JM. Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure. Circulation Heart Failure 2015, 9: e002333. PMID: 26699390, PMCID: PMC4741376, DOI: 10.1161/circheartfailure.115.002333.Peer-Reviewed Original ResearchConceptsBlood pressure reductionDecompensated heart failureNeurohormonal antagonistsRenal functionSBP reductionBlood pressureDiuretic efficiencyHeart failureAcute decompensated heart failure hospitalizationAcute decompensated heart failure treatmentAcute decompensated heart failurePressure reductionChronic oral medicationHeart failure admissionsHeart failure hospitalizationHeart failure treatmentSystolic blood pressureDiuretic doseImproved diuresisFailure hospitalizationOral medicationsFailure treatmentDiuresisFluid outputAdmission
2014
The Incidence, Risk, and Consequences of Atrial Arrhythmias in Patients with Continuous‐Flow Left Ventricular Assist Devices
Brisco MA, Sundareswaran KS, Milano CA, Feldman D, Testani JM, Ewald GA, Slaughter MS, Farrar DJ, Goldberg LR, Investigators F. The Incidence, Risk, and Consequences of Atrial Arrhythmias in Patients with Continuous‐Flow Left Ventricular Assist Devices. Journal Of Cardiac Surgery 2014, 29: 572-580. PMID: 24750460, DOI: 10.1111/jocs.12336.Peer-Reviewed Original ResearchConceptsLeft ventricular assist deviceLate atrial arrhythmiaAtrial arrhythmiasVentricular assist deviceFunctional statusRisk factorsAssist deviceHeartMate II Left Ventricular Assist DeviceIncidence of AASix-minute walk distanceDestination therapy trialsDays of supportStrong risk factorQuality of lifePreoperative creatinineLVAD patientsSerum creatinineWalk distanceEjection fractionHeart failureLVAD supportQOL improvementMultivariable modelSimilar survivalBlanking period
2013
Timing of Hemoconcentration During Treatment of Acute Decompensated Heart Failure and Subsequent Survival Importance of Sustained Decongestion
Testani JM, Brisco MA, Chen J, McCauley BD, Parikh CR, Tang WH. Timing of Hemoconcentration During Treatment of Acute Decompensated Heart Failure and Subsequent Survival Importance of Sustained Decongestion. Journal Of The American College Of Cardiology 2013, 62: 516-524. PMID: 23747773, PMCID: PMC3892152, DOI: 10.1016/j.jacc.2013.05.027.Peer-Reviewed Original ResearchConceptsDecompensated heart failureHeart failureEarly hemoconcentrationIntravascular volumeSurvival advantageAcute decompensated heart failureLoop diuretic dosesSignificant mortality benefitPrimary discharge diagnosisSimilar baseline characteristicsSignificant survival advantageGreater weight lossDiuretic dosesOral diureticsBaseline characteristicsMortality benefitRenal functionImproved survivalLoop diureticsSingle centerDischarge diagnosisHealthy patientsConsecutive admissionsDiuretic responsivenessRapid diuresisCardiac transplantation can be safely performed using selected diabetic donors
Taghavi S, Jayarajan SN, Wilson LM, Komaroff E, Testani JM, Mangi AA. Cardiac transplantation can be safely performed using selected diabetic donors. Journal Of Thoracic And Cardiovascular Surgery 2013, 146: 442-447. PMID: 23490247, PMCID: PMC4067258, DOI: 10.1016/j.jtcvs.2013.02.047.Peer-Reviewed Original ResearchMeSH KeywordsAdultChi-Square DistributionDiabetes MellitusDonor SelectionFemaleHeart TransplantationHumansHypoglycemic AgentsInsulinKaplan-Meier EstimateMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRegistriesRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTissue and Organ ProcurementTissue DonorsTreatment OutcomeUnited StatesConceptsExtracorporeal membrane oxygenationBody mass indexDiabetic donorsCardiac transplantationIschemic timeMultivariate analysisHuman leukocyte antigen mismatchesDonor body mass indexHigher body mass indexRecipient black raceDuration of diabetesOrgan Sharing databaseInsulin-dependent diabetesAntigen mismatchesCardiac donorsRecipient creatinineRecipient diabetesMedian survivalMembrane oxygenationSharing databaseMass indexMechanical ventilationUnited NetworkRace mismatchBlack raceBlood Urea Nitrogen/Creatinine Ratio Identifies a High-Risk but Potentially Reversible Form of Renal Dysfunction in Patients With Decompensated Heart Failure
Brisco MA, Coca SG, Chen J, Owens AT, McCauley BD, Kimmel SE, Testani JM. Blood Urea Nitrogen/Creatinine Ratio Identifies a High-Risk but Potentially Reversible Form of Renal Dysfunction in Patients With Decompensated Heart Failure. Circulation Heart Failure 2013, 6: 233-239. PMID: 23325460, PMCID: PMC4067251, DOI: 10.1161/circheartfailure.112.968230.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersBlood Urea NitrogenCardio-Renal SyndromeChi-Square DistributionCreatinineFemaleGlomerular Filtration RateHeart FailureHumansKaplan-Meier EstimateKidneyLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient AdmissionPrognosisProportional Hazards ModelsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsUp-RegulationConceptsReversible renal dysfunctionBUN/CrBlood urea nitrogen/creatinine ratioUrea nitrogen/creatinine ratioHeart failureRenal functionRenal dysfunctionCreatinine ratioElevated BUN/CrPatients meeting eligibility criteriaDecompensated heart failure patientsDecompensated heart failureHigh-risk patientsHeart failure patientsGlomerular filtration rateRisk of deathMeeting eligibility criteriaConsecutive hospitalizationsBaseline characteristicsFailure patientsDischarge diagnosisFiltration rateEligibility criteriaPatientsReversible form