A5002239589- Sepsis Diagnosis and Treatment
- Hemodynamic Monitoring and Therapy
- Respiratory Support and Mechanisms
- Acute Kidney Injury Research
- Clinical Nutrition and Gastroenterology
- Immune Response and Inflammation
- Adrenal Hormones and Disorders
- Electrolyte and hormonal disorders
- Neonatal Respiratory Health Research
- Cardiac Arrest and Resuscitation
- S100 Proteins and Annexins
- Intensive Care Unit Cognitive Disorders
- Anesthesia and Sedative Agents
- Clusterin in disease pathology
- Child Nutrition and Feeding Issues
- Lipoproteins and Cardiovascular Health
- Traumatic Brain Injury and Neurovascular Disturbances
- Renal function and acid-base balance
- Thermal Regulation in Medicine
- Intracranial Aneurysms: Treatment and Complications
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Non-Invasive Vital Sign Monitoring
- Optical Imaging and Spectroscopy Techniques
- Moyamoya disease diagnosis and treatment
- Anesthesia and Neurotoxicity Research
University of Florida Health
2017-2024
University of Florida
2012-2024
University of Florida Health Science Center
2017-2024
Cincinnati Children's Hospital Medical Center
2024
UF Health Shands Hospital
2017-2023
Children's Mercy Hospital
2023
Florida College
2022
Abstract Background Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between markers among children without SA-AKI, test whether this association varied across inflammatory biomarker-based risk strata, develop prediction models identify those at highest Methods...
Prognostic biomarkers for pediatric septic shock are conserved in a murine model of sepsis and accelerate testing precision medicine strategies.
Rationale: Acute kidney injury (AKI), a common complication of sepsis, is associated with substantial morbidity and mortality lacks definitive disease-modifying therapy. Early, reliable identification at-risk patients important for targeted implementation renal protective measures. The updated Pediatric Sepsis Biomarker Risk Model (PERSEVERE-II) validated, multibiomarker prognostic enrichment strategy to estimate baseline risk in pediatric septic shock.Objectives: To assess the association...
OBJECTIVES: Identification of children with sepsis-associated multiple organ dysfunction syndrome (MODS) at risk for poor outcomes remains a challenge. We sought to the determine reproducibility data-driven “persistent hypoxemia, encephalopathy, and shock” (PHES) phenotype its association inflammatory endothelial biomarkers, as well biomarker-based pediatric strata. DESIGN: retrained validated random forest classifier using subscores in 2012–2018 electronic health record (EHR) dataset used...
Abstract Background Multiple organ dysfunction syndrome (MODS) is a critical driver of sepsis morbidity and mortality in children. Early identification those at risk death persistent dysfunctions necessary to enrich patients for future trials therapeutics. Here, we sought integrate endothelial PERSEVERE biomarkers estimate the composite or on day 7 septic shock. Methods We measured markers from 1 serum among with existing data. TreeNet® classification model was derived incorporating 22...
Multiple organ dysfunction syndrome (MODS) disproportionately drives morbidity and mortality among critically ill patients. However, we lack a comprehensive understanding of its pathobiology. Identification genes associated with persistent MODS trajectory may shed light on underlying biology allow for accurate prediction those at-risk.
We previously derived the updated Pediatric Sepsis Biomarker Risk for Acute Kidney Injury (PERSEVERE-II AKI) prediction model, which had robust diagnostic test characteristics severe AKI on day 3 (D3 of septic shock. now sought to validate this model in an independent cohort children one was developed.
Abstract Background Sepsis poses a grave threat, especially among children, but treatments are limited owing to heterogeneity patients. We sought test the clinical and biological relevance of pediatric septic shock subclasses identified using reproducible approaches. Methods performed latent profile analyses clinical, laboratory, biomarker data from prospective multi-center observational cohort derive phenotypes trained support vector machine model assign in an internal validation set....
Abstract Background Endothelial activation is a key driver of multiple organ dysfunction syndrome (MODS). Soluble endoglin (sENG) expressed by mature and progenitor endothelial cells thought to have angiogenic properties. We sought determine the association between sENG pediatric sepsis associated MODS. Methods Prospective observational study septic shock. Primary outcome interest was complicated course -a composite death (or) MODS on day 7 illness. Secondary outcomes included individual...
Abstract Background Acute kidney injury (AKI) occurs commonly in pediatric septic shock and increases morbidity mortality. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. We previously modified the renal angina index (RAI), a validated AKI prediction tool, specificity this population (sRAI). Here, we prospectively assess sRAI performance separate cohort. Methods A secondary analysis prospective, multicenter, observational study children...
Abstract Background Sepsis is associated with significant mortality. Yet, there are no efficacious therapies beyond antibiotics. PCSK9 loss-of-function (LOF) and inhibition, through enhanced low-density lipoprotein receptor (LDLR) mediated endotoxin clearance, holds promise as a potential therapeutic approach among adults. In contrast, we have previously demonstrated higher mortality in the juvenile host. Given pleiotropic effects of on endothelium, canonical serum lipoproteins, both which...
Cat-scratch disease (CSD) is caused by
Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based strata upon adjusting for illness severity, presence of severe acute kidney injury (acute injury), and use continuous renal replacement therapy (CRRT) in pediatric septic shock.
Aims & Objectives: Our recent Association of Enteral Nutrition and Dexmedetomidine Usage for Critically Ill Children Requiring Non-Invasive Ventilation (NIV Dex EN) study aimed to investigate the relationship between enteral nutrition (EN) sedation in critically ill children acutely supported with non-invasive ventilation (NIV). Here we aim describe current feeding practices on NIV United States a large sample. Methods: Retrospective patients at least 12 hours over one-year period fourteen...
Aims & Objectives: Dexmedetomidine is a popular agent for non-invasive ventilation (NIV) tolerance due to preferred side effect profile. Usage and safety have been explored in single center studies. From our multicenter study looking at the association with feeding dexmedetomidine requirement during NIV, we secondarily aimed describe current practices this sample. Methods: Retrospective of one-year sample 14 U.S. PICUs including patients supported NIV least 12 hours. data was collected...
Aims & Objectives: There is growing pediatric safety evidence for enteral nutrition (EN) during non-invasive ventilation (NIV) as well dexmedetomidine the primary sedative of choice to improve tolerance NIV. Research exploring impact two practices lacking. We aimed describe in a multicenter study potential association EN with requirements children supported NIV respiratory compromise, hypothesizing that those fed would require less sedation. Methods: Retrospective one-year sample 14 U.S....
Abstract Background Sepsis poses a grave threat, especially among children, but treatments are limited due to clinical and biological heterogeneity patients. Thus, there is an urgent need for precise subclassification of patients guide therapeutic interventions. Methods We used clinical, laboratory, biomarker data from prospective multi-center pediatric septic shock cohort derive phenotypes using latent profile analyses. Thereafter, we trained support vector machine model assign in hold-out...
1Shands Children’s Hospital University of Florida, Gainesville, FL, 2N/A, 3Shands Florida Health, FL
Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Abstract Background: Sepsis is associated with significant mortality, yet there are no efficacious therapies beyond antibiotics and supportive care. In adult sepsis studies, PCSK9 loss-of-function (LOF) inhibition has shown therapeutic promise, likely through enhanced low-density lipoprotein receptor (LDLR) mediated endotoxin clearance. contrast, we previously demonstrated higher mortality in septic juvenile hosts LOF. addition to direct influence on serum levels, exerts pleiotropic effects...
Abstract Background Sepsis Associated Acute Kidney Injury (SA-AKI) is associated with high morbidity, no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between markers among children without SA-AKI, test whether this association varied across inflammatory biomarker-based mortality risk strata develop prediction models identify those at highest Methods...
<title>Abstract</title> Background Multiple organ dysfunction syndrome (MODS) disproportionately contributes to pediatric sepsis morbidity. Humanin (HN) is a small peptide encoded by mitochondrial DNA and thought exert cytoprotective effects in endothelial cells platelets. We sought test the association between serum HN (sHN) concentrations MODS prospectively enrolled cohort of septic shock. Methods Human MT-RNR2 ELISA was used determine sHN on day 1 3. The primary outcome thrombocytopenia...
Abstract Introduction : Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based strata upon adjusting for illness severity, presence of severe acute kidney injury (AKI), and use renal replacement therapy (CRRT) in pediatric septic shock. Design Ongoing multi-center prospective observational cohort. Setting Thirteen ICUs the United States (2003–2023)....
Identification of children with sepsis-associated multiple organ dysfunction syndrome (MODS) at risk for poor outcomes remains a challenge. Data-driven phenotyping approaches that leverage electronic health record (EHR) data hold promise given the widespread availability EHRs. We sought to externally validate data-driven 'persistent hypoxemia, encephalopathy, and shock' (PHES) phenotype determine its association inflammatory endothelial biomarkers, as well biomarker-based pediatric risk-strata.