scholarly journals Identifying organ dysfunction trajectory-based subphenotypes in critically ill patients with COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chang Su ◽  
Zhenxing Xu ◽  
Katherine Hoffman ◽  
Parag Goyal ◽  
Monika M. Safford ◽  
...  
Keyword(s):  
New York ◽  
Respiratory Failure ◽  
Sofa Score ◽  
Severity Of Illness ◽  
Agglomerative Clustering ◽  
Baseline Severity ◽  
Organ Systems ◽  
Hierarchical Agglomerative Clustering ◽  
Dynamic Time ◽  
Post Intubation

AbstractCOVID-19-associated respiratory failure offers the unprecedented opportunity to evaluate the differential host response to a uniform pathogenic insult. Understanding whether there are distinct subphenotypes of severe COVID-19 may offer insight into its pathophysiology. Sequential Organ Failure Assessment (SOFA) score is an objective and comprehensive measurement that measures dysfunction severity of six organ systems, i.e., cardiovascular, central nervous system, coagulation, liver, renal, and respiration. Our aim was to identify and characterize distinct subphenotypes of COVID-19 critical illness defined by the post-intubation trajectory of SOFA score. Intubated COVID-19 patients at two hospitals in New York city were leveraged as development and validation cohorts. Patients were grouped into mild, intermediate, and severe strata by their baseline post-intubation SOFA. Hierarchical agglomerative clustering was performed within each stratum to detect subphenotypes based on similarities amongst SOFA score trajectories evaluated by Dynamic Time Warping. Distinct worsening and recovering subphenotypes were identified within each stratum, which had distinct 7-day post-intubation SOFA progression trends. Patients in the worsening suphenotypes had a higher mortality than those in the recovering subphenotypes within each stratum (mild stratum, 29.7% vs. 10.3%, p = 0.033; intermediate stratum, 29.3% vs. 8.0%, p = 0.002; severe stratum, 53.7% vs. 22.2%, p < 0.001). Pathophysiologic biomarkers associated with progression were distinct at each stratum, including findings suggestive of inflammation in low baseline severity of illness versus hemophagocytic lymphohistiocytosis in higher baseline severity of illness. The findings suggest that there are clear worsening and recovering subphenotypes of COVID-19 respiratory failure after intubation, which are more predictive of outcomes than baseline severity of illness. Distinct progression biomarkers at differential baseline severity of illness suggests a heterogeneous pathobiology in the progression of COVID-19 respiratory failure.

scholarly journals Identifying organ dysfunction trajectory-based subphenotypes in critically ill patients with COVID-19

2020 ◽  
Author(s):  
Chang Su ◽  
Zhenxing Xu ◽  
Katherine Hoffman ◽  
Parag Goyal ◽  
Monika M Safford ◽  
...  
Keyword(s):  
New York ◽  
Respiratory Failure ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Statistical Tests ◽  
Vital Signs ◽  
Severity Of Illness ◽  
Agglomerative Clustering ◽  
Differential Outcomes ◽  
Post Intubation

Rationale. COVID-19-associated respiratory failure offers the unprecedented opportunity to evaluate the differential host response to a uniform pathogenic insult. Prior studies of Acute Respiratory Distress Syndrome (ARDS) have identified subphenotypes with differential outcomes. Understanding whether there are distinct subphenotypes of severe COVID-19 may offer insight into its pathophysiology. Objectives. To identify and characterize distinct subphenotypes of COVID-19 critical illness defined by the post-intubation trajectory of Sequential Organ Failure Assessment (SOFA) score. Methods. Intubated COVID-19 patients at two hospitals in New York city were leveraged as development and validation cohorts. Patients were grouped into mild, intermediate, and severe strata by their baseline post-intubation SOFA. Hierarchical agglomerative clustering was performed within each stratum to detect subphenotypes based on similarities amongst SOFA score trajectories evaluated by Dynamic Time Warping. Statistical tests defined trajectory subphenotype predictive markers. Measurements and Main Results. Distinct worsening and recovering subphenotypes were identified within each stratum, which had distinct 7-day post-intubation SOFA progression trends. Patients in the worsening suphenotypes had a higher mortality than those in the recovering subphenotypes within each stratum (mild stratum, 29.7% vs. 10.3%, p=0.033; intermediate stratum, 29.3% vs. 8.0%, p=0.002; severe stratum, 53.7% vs. 22.2%, p<0.001). Worsening and recovering subphenotypes were replicated in the validation cohort. Routine laboratory tests, vital signs, and respiratory variables rather than demographics and comorbidities were predictive of the worsening and recovering subphenotypes. Conclusions. There are clear worsening and recovering subphenotypes of COVID-19 respiratory failure after intubation, which are more predictive of outcomes than baseline severity of illness. Organ dysfunction trajectory may be well suited as a surrogate for research in COVID-19 respiratory failure.

scholarly journals Sepsis Subphenotyping Based on Organ Dysfunction Trajectory

2021 ◽  
Author(s):  
Zhenxing Xu ◽  
Chengsheng Mao ◽  
Chang Su ◽  
Ilias Siempos ◽  
Lisa K Torres ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Sofa Score ◽  
Validation Cohort ◽  
Patient Characteristics ◽  
Agglomerative Clustering ◽  
Time Warping ◽  
Hierarchical Agglomerative Clustering ◽  
History Of ◽  
Dynamic Time ◽  
Development And Validation

Abstract (250 words) Purpose: Although organ dysfunction is a defining element of sepsis, its trajectory is not well studied. We sought to identify whether there are distinct Sequential Organ Failure Assessment (SOFA) score trajectory-based subphenotypes in sepsis. Methods: We created 72-hour SOFA score trajectories in patients with sepsis from two diverse intensive care unit (ICU) cohorts. We then used Dynamic Time Warping (DTW) to compute patient similarities to capture evolving heterogeneous sequences and establish similarities between groups with distinct trajectories. Hierarchical agglomerative clustering (HAC) was utilized to identify subphenotypes based on SOFA trajectory similarities. Patient characteristics were compared between subphenotypes and a random forest model was developed to predict subphenotype membership, within 6 hours of ICU arrival. The model was then tested on the validation cohort. Results: A total of 4,678 and 3,665 unique sepsis patients were included in development and validation cohorts. In the development cohort, four subphenotypes of organ dysfunction were identified: Rapidly Worsening (n=612, 13.08%), Delayed Worsening (n=960, 20.52%), Rapidly Improving (n=1,932, 41.3%) and Delayed Improving (n=1174, 25.1%). In-hospital mortality for patients within different subphenotypes demonstrated distinct patterns over time. Similar subphenotypes and their associated outcome patterns were replicated in the multicenter validation cohort. Conclusion: Four novel, clinically-defined, trajectory-based sepsis subphenotypes were identified and validated. Trajectory based subphenotyping is useful for describing the natural history of sepsis in the ICU. Understanding the pathophysiology of these differential trajectories may reveal unanticipated therapeutic targets for patients with sepsis and identify more precise populations and endpoints for the predictive enrichment of clinical trials.

The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State

2021 ◽  
pp. 153857442199331
Author(s):  
Nicole Ilonzo ◽  
Cody Goldberger ◽  
Songhon Hwang ◽  
Ajit Rao ◽  
Peter Faries ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Bypass Surgery ◽  
New York State ◽  
Severity Of Illness ◽  
Factors Associated ◽  
Peripheral Bypass ◽  
Extreme Risk ◽  
Risk Of Mortality ◽  
Fourth Quartile

Introduction: With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. Methods: Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. Results: 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). Conclusion: The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.

scholarly journals Clustering Techniques for Secondary Substations Siting

Energies ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 1028
Author(s):  
Silvia Corigliano ◽  
Federico Rosato ◽  
Carla Ortiz Dominguez ◽  
Marco Merlo
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Universal Access ◽  
Distribution Networks ◽  
Industrialized Countries ◽  
Agglomerative Clustering ◽  
Clustering Techniques ◽  
Hierarchical Agglomerative Clustering ◽  
Efficient Planning ◽  
Target Set

The scientific community is active in developing new models and methods to help reach the ambitious target set by UN SDGs7: universal access to electricity by 2030. Efficient planning of distribution networks is a complex and multivariate task, which is usually split into multiple subproblems to reduce the number of variables. The present work addresses the problem of optimal secondary substation siting, by means of different clustering techniques. In contrast with the majority of approaches found in the literature, which are devoted to the planning of MV grids in already electrified urban areas, this work focuses on greenfield planning in rural areas. K-means algorithm, hierarchical agglomerative clustering, and a method based on optimal weighted tree partitioning are adapted to the problem and run on two real case studies, with different population densities. The algorithms are compared in terms of different indicators useful to assess the feasibility of the solutions found. The algorithms have proven to be effective in addressing some of the crucial aspects of substations siting and to constitute relevant improvements to the classic K-means approach found in the literature. However, it is found that it is very challenging to conjugate an acceptable geographical span of the area served by a single substation with a substation power high enough to justify the installation when the load density is very low. In other words, well known standards adopted in industrialized countries do not fit with developing countries’ requirements.

scholarly journals 414. Association of SARS-CoV-2 Genomic Load Trends with Clinical Status in COVID-19:A Retrospective Analysis from an Academic Hospital Center in New York City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S275-S275
Author(s):  
Ioannis Zacharioudakis ◽  
Fainareti Zervou ◽  
Prithiv Prasad ◽  
Yongzhao Shao ◽  
Atreyee Basu ◽  
...  
Keyword(s):  
New York ◽  
Sofa Score ◽  
Research Question ◽  
Clinical Status ◽  
Inverse Correlation ◽  
Duration Of Symptoms ◽  
Cycle Threshold ◽  
Ct Value ◽  
Failure Assessment ◽  
Polymerase Chain

Abstract Background The Infectious Diseases Society of America has identified the potential use of SARS-CoV-2 genomic load for prognostication purposes as a key research question. Methods We designed a retrospective cohort study that included adult patients with COVID-19 pneumonia who had at least 2 positive nasopharyngeal tests at least 24 hours apart to study the correlation between the change in the genomic load of SARS-CoV-2 in nasopharyngeal samples, as reflected by the Cycle threshold (Ct) value of the real-time Polymerase Chain Reaction (PCR) assay, with change in clinical status. The Sequential Organ Failure Assessment (SOFA) score was used as a surrogate for patients’ clinical status. A linear mixed-effects regression analysis was performed. Results Among 457 patients who presented to the emergency department between 3/31/2020- 4/10/2020, we identified 42 patients who met the inclusion criteria. The median initial SOFA score was 2 (IQR 2–3). 20 out of 42 patients had a lower SOFA score on their subsequent tests. We identified a statistically significant inverse correlation between the change in SOFA score and change in the Ct value with a decrease in SOFA score by 0.05 (SE 0.02; p &lt; 0.05) for an increase in Ct values by 1. This correlation was independent of the duration of symptoms. Flow chart A graph of the Cycle Threshold (Ct) values of the of Cepheid Xpert® Xpress SARS-CoV-2 assay measured on repeat screening of the 42 included patients. Graph of the fitted SOFA scores based on the Cycle Threshold values per patient. Conclusion Our findings suggest that an increasing Ct value in sequential tests may be of prognostic value for patients diagnosed with COVID-19 pneumonia. Before repeat testing can be recommended routinely in clinical practice as a predictor of disease outcomes, prospective studies with a standardized interval between repeat tests should confirm our findings. Disclosures All Authors: No reported disclosures

Concepts of Disease: A Textbook of Human Pathology, edited by Joel C. Brunson, M.D. and Edward A. Gall, M.D. New York/London/Toronto: The Macmillan Company, 1971, 1134 pp., $23.95

PEDIATRICS ◽  
1972 ◽  
Vol 49 (3) ◽  
pp. 484-484
Author(s):  
Gordon W. Vawter
Keyword(s):  
New York ◽  
Cell Biology ◽  
Organ Systems ◽  
Human Pathology ◽  
Recent Developments ◽  
Concepts Of Disease ◽  
Novel Design

This is a lusty 7½ pound newborn book with most organ systems more than adequately mature to assure a long and fruitful life. The two senior obstetricians enlisted the aid and advice of 36 other especially knowledgeable specialists to assure successful delivery. Concepts of Disease is a textbook of pathology with a novel design, emphasizing pathology as process, and incorporates much of the newer information derived from cell biology, and from the recent developments in ultrastructural and immunofluorescent techniques.

scholarly journals New York Transplant Teams Versus COVID-19

2020 ◽  
Vol 30 (3) ◽  
pp. 194-198 ◽  
Author(s):  
Daryle Blackstock ◽  
Laura Butler ◽  
Samantha Delair ◽  
Katherine Dokus ◽  
Farrington Eileen ◽  
...  
Keyword(s):  
New York ◽  
Organ Procurement ◽  
Clinical Care ◽  
New York State ◽  
Severity Of Illness ◽  
Surgical Patient ◽  
Work Processes ◽  
Hospital Units ◽  
Lifetime Experience ◽  
Organ Procurement Organizations

New York State, and especially New York City, were hit hard by the coronavirus disease 2019 (COVID-19) virus. While we followed its course in other parts of the world, and began preparations, there was no way we could have been prepared for the volume and severity of illness that began to overflow in our emergency departments and hospital units. We expanded intensive care units into our medical surgical units while turning conference rooms into medical surgical patient care areas. Clinicians at the bedside described war-like situations with numerous patients arresting and requiring ventilator support. Our New York consortia and organ procurement organizations met online 3 times a week and shared creative strategies to address clinical care and work processes. We would like to share strategies from what we hope was a once in a lifetime experience.

scholarly journals Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakub Smiechowicz ◽  
Barbara Barteczko-Grajek ◽  
Barbara Adamik ◽  
Jozef Bojko ◽  
Waldemar Gozdzik ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Organ Failure ◽  
Intensive Care Units ◽  
Sofa Score ◽  
Influenza Infection ◽  
Winter Season ◽  
Respiratory Support ◽  
Costly Treatment ◽  
High Degree

Abstract Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure.

Hierarchical Agglomerative Clustering

2013 ◽  
pp. 886-887 ◽  
Author(s):  
Marie Lisandra Zepeda-Mendoza ◽  
Osbaldo Resendis-Antonio
Keyword(s):  
Agglomerative Clustering ◽  
Hierarchical Agglomerative Clustering
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