Christopher H Goss

Seattle Children’s Research Institute, Seattle, Washington, United States

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Publications (137)886.73 Total impact

  • Journal of Cystic Fibrosis 06/2015; 14. DOI:10.1016/S1569-1993(15)30039-4 · 3.48 Impact Factor
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    ABSTRACT: Systemic lupus erythematosus (SLE or lupus) is an autoimmune multisystem disease. While a complete understanding of lupus' origins, mechanisms, and progression is not yet available, a number of studies have demonstrated correlations between disease prevalence and severity, gender, and race. There have been few population based studies in the United States. To assess temporal changes in demographics and hospital mortality of patients with lupus in Washington State from 2003 to 2011. This study used data from the Healthcare Cost and Utilization Project (HCUP), a patient information database, and data from the Washington State census to study a group of patients in the state. Lupus hospitalizations were defined as any hospitalization with an ICD-9-CM diagnosis code for systemic lupus erythematosus. Regression analysis was used to assess the effect of calendar time on demographics and hospital outcomes. There were a total of 18,905 patients in this study with a diagnostic code for lupus. The mean age of the group was 51.5 years (95% CI: 50.6-52.3) in 2003 and 51.3 years (95% CI: 50.6-52.0) in 2011. The population was 88.6% female. Blacks were 2.8 times more likely to have a lupus hospitalization than whites when compared to the Washington population. While hospital mortality decreased during this eight year period (3.12% in 2003 to 1.28% in 2011, p=0.001) hospital length of stay remained statistically unchanged at an average of 4.9 days during that eight year period. We found a significant decrease in annual hospital mortality over the study period [odds ratio(OR): 0.92 per year, 95% CI 0.88-0.96, P<0.001]. Hospital mortality was higher in males (2.6% male death to 1.8% female death). In this large group of hospitalized lupus patients in Washington, hospital length of stay remained relatively stable over time but hospital mortality decreased by over 50% over the eight year study period.
    PLoS ONE 06/2015; 10(6):e0128920. DOI:10.1371/journal.pone.0128920 · 3.23 Impact Factor
  • Kathleen J. Ramos · Christopher H. Goss
    The Journal of Heart and Lung Transplantation 06/2015; DOI:10.1016/j.healun.2015.05.010 · 6.65 Impact Factor
  • Journal of Cystic Fibrosis 06/2015; 14. DOI:10.1016/S1569-1993(15)30007-2 · 3.48 Impact Factor
  • Journal of Cystic Fibrosis 06/2015; 14:S106. DOI:10.1016/S1569-1993(15)30365-9 · 3.48 Impact Factor
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    ABSTRACT: The rapidly growing non-tuberculous mycobacterial species, Mycobacterium abscessus (M. abscessus), has recently emerged as an important pathogen in patients with cystic fibrosis (CF). Treatment options are limited due to the organism's innate resistance to standard anti-tuberculous, as well as other currently available antibiotics. New antibiotic approaches to the treatment of M. abscessus are urgently needed. The goal of the present study was to assess the growth inhibitory activity of different Ga compounds against American Type Culture Collection (ATCC) and clinical isolates of M. abscessus obtained from CF and other patients. In our results, using Ga(NO3)3 and all of the other Ga compounds tested inhibited the growth of ATCC and clinical isolates of M. abscessus. Inhibition was mediated through disrupting iron-uptake, as the addition of exogenous iron (Fe) restored basal growth. There were modest differences in inhibition among the isolates for the same Ga chelates and for most Ga chelates there was only slight difference in potency relative to Ga(NO3)3. In contrast, Ga-protoporphyrin completely and significantly inhibited ATCC and clinical isolate strains of M. abscessus at much lower concentrations compared to Ga(NO3)3. In in vitro broth culture, Ga-protoporphyrin was more potent than Ga(NO3)3. When assessing M. abscessus growth inside the human macrophage THP-1 cell line, Ga-protoporphyrin was >20 times more active than Ga(NO3)3. The current work suggests that Ga exhibits potent growth inhibitory capacity for ATCC as well as antibiotic-resistant clinical isolates of M. abscessus, including a highly antibiotic resistant strain, MC2638. Ga-based therapy offers the potential for further development as a novel therapy against M. abscessus. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 06/2015; 59(8). DOI:10.1128/AAC.00331-15 · 4.48 Impact Factor
  • Journal of Cystic Fibrosis 06/2015; 14:S106. DOI:10.1016/S1569-1993(15)30366-0 · 3.48 Impact Factor
  • 05/2015; DOI:10.1038/nrdp.2015.10
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    ABSTRACT: Treatment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) varies widely with no consensus on management practices or best indicators of therapeutic success. To design trials evaluating PEx treatment factors, we characterise the heterogeneity of PEx care in adults and paediatrics, and correlate it with measures of clinical response including short-term and long-term lung function changes, change in symptom severity score and time to next intravenous antibiotic therapy. Data were used from a prospective observational study of patients with CF ≥10 years of age enrolled at six sites between 2007 and 2010. All were started on intravenous antibiotics for a clinically diagnosed PEx. Analysis of variance, logistic and Cox regression were used to examine the association of treatment factors with short-term and long-term clinical response. Of 123 patients with CF (60% women, aged 23.1±10.2 years), 33% experienced <10% relative improvement in FEV1 during treatment, which was associated with failing to recover baseline lung function 3 months after treatment (OR=7.8, 95% CI 1.9 to 31.6, p=0.004) and a longer time to next intravenous antibiotic (HR=0.48, 95% CI 0.27 to 0.85, p=0.011). Symptom improvement was observed but was not associated with subsequent lung function or time to next antibiotic therapy, which had a median recurrence time of 143 days. Immediate symptomatic or respiratory response to PEx treatment did not have a clear relationship with subsequent outcomes such as lung function or intravenous antibiotic-free interval. These results can inform future research of treatment regimens for PEx in terms of interventions and outcome measures. NCT00788359 ( Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Thorax 04/2015; DOI:10.1136/thoraxjnl-2014-206750 · 8.29 Impact Factor
  • Edward F McKone · Priscilla Velentgas · Anna J Swenson · Christopher H Goss
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    ABSTRACT: The extent to which sweat chloride concentration predicts survival and clinical phenotype independently of CFTR genotype in cystic fibrosis is not well understood. We analyzed the US Cystic Fibrosis Foundation Patient Registry data using Cox regression to examine the relationship between sweat chloride concentration (<60, 60-<80, ≥80mmol/L), CFTR genotype (high and lower risk for lung function decline), and survival and mixed linear regression to examine the relationship between sweat chloride, CFTR genotype, and measures of lung function and growth. When included in the same model, CFTR genotype, but not sweat chloride, was independently associated with survival and with lung function, height, and BMI. Among patients with unclassified CFTR genotype, sweat chloride was an independent predictor of survival (<60 HR 0.53 [0.37, 0.77], 60-<80 0.51 [0.42, 0.63]). Sweat chloride concentration may be a useful predictor of mortality and clinical phenotype when CFTR genotype functional class is unclassified. Copyright © 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
    Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society 02/2015; 14(5). DOI:10.1016/j.jcf.2015.01.005 · 3.48 Impact Factor
  • Bradley S Quon · Christopher H Goss
    American Journal of Respiratory and Critical Care Medicine 01/2015; 191(1):4-5. DOI:10.1164/rccm.201411-2089ED · 13.00 Impact Factor
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    ABSTRACT: Studies seeking to estimate the burden of influenza among hospitalized adults often use case definitions that require presence of pneumonia. The goal of this study was to assess the extent to which restricting influenza testing to adults hospitalized with pneumonia could underestimate the total burden of hospitalized influenza disease. We conducted a modelling study using the complete State Inpatient Databases from Arizona, California, and Washington and regional influenza surveillance data acquired from CDC from January 2003 through March 2009. The exposures of interest were positive laboratory tests for influenza A (H1N1), influenza A (H3N2), and influenza B from two contiguous US Federal Regions encompassing the study area. We identified the two outcomes of interest by ICD-9-CM code: respiratory and circulatory hospitalizations, as well as critical illness hospitalizations (acute respiratory failure, severe sepsis, and in-hospital death). We linked the hospitalization datasets with the virus surveillance datasets by geographic region and month of hospitalization. We used negative binomial regression models to estimate the number of influenza-associated events for the outcomes of interest. We sub-categorized these events to include all outcomes with or without pneumonia diagnosis codes. We estimated that there were 80,834 (95% CI 29,214-174,033) influenza-associated respiratory and circulatory hospitalizations and 26,760 (95% CI 14,541-47,464) influenza-associated critical illness hospitalizations. When a pneumonia diagnosis was excluded, the estimated number of influenza-associated respiratory and circulatory hospitalizations was 24,816 (95% CI 6,342-92,624). The estimated number of influenza-associated critical illness hospitalizations was 8,213 (95% CI 3,764-20,799). Around 30% of both influenza-associated respiratory and circulatory hospitalizations, as well as influenza-associated critical illness hospitalizations did not have pneumonia diagnosis codes. Surveillance studies which only consider hospitalizations that include a diagnosis of pneumonia may underestimate the total burden of influenza hospitalizations.
    PLoS ONE 11/2014; 9(11):e113903. DOI:10.1371/journal.pone.0113903 · 3.23 Impact Factor
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    ABSTRACT: Obese patients with Idiopathic Pulmonary Fibrosis (IPF) have a higher 90-day mortality after lung transplantation. We sought to investigate whether body mass index (BMI) differentially modified the effect of transplant procedure type on 90-day mortality in IPF patients. We analyzed data from the Organ Procurement and Transplantation Network (OPTN) for all patients with IPF who were transplanted between 2000-2010. Post-transplant survival was examined using Kaplan Meier estimates. Multivariable logistic regression modeling was used to determine the difference in 90-day survival. The primary variable of interest was the interaction term between BMI and transplant type. A total of 3,389 (58% single lung transplant [SLT]; 42% bilateral lung transplant) [BLT]) subjects were included. Multivariable logistic regression modeling demonstrated a statistically significant interaction between BMI and transplant type (p=0.047). Patients with a BMI>30 kg/m2 who received a BLT are 1.71 times (95% CI [1.03, 2.85], p=0.038) more likely to die within 90-days than BLT recipients with a BMI of 18.5-30 kg/m2. Our results suggest that obese patients who receive a BLT may be at higher risk of 90-day mortality compared to patients of normal weight. Future studies that evaluate more detailed information about co-morbidities and other risk factors for early death not included in the OPTN database are warranted.
    The Journal of Heart and Lung Transplantation 09/2014; 34(2). DOI:10.1016/j.healun.2014.09.031 · 6.65 Impact Factor
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    ABSTRACT: Background People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns. Objectives To compare cross-sectional demographics, practice patterns and clinical outcomes between US and UK CF patients. Methods This was a cross-sectional study using 2010 data from patients in the US Cystic Fibrosis Foundation and the UK Cystic Fibrosis patient registries. The a priori outcome measures of interest were lung function and nutritional status. Descriptive statistics and two sample comparisons were performed. Stratification and multivariable linear regression were used to adjust for confounding. Results The study cohort included 13 777 children and 11 058 adults from the USA and 3968 children and 3965 adults from the UK. In children, mean body mass index centiles were similar. Lung function (FEV1 and FVC% predicted) was significantly higher in US patients ages 6–25 years of age. In a regression model adjusted for only age, FEV1% predicted was on average 3.31% of predicted (95% CI 2.65 to 3.96) higher in the USA compared with the UK. When adjusted for age, age at diagnosis, gender, pancreatic insufficiency and genotype, FEV1% predicted was on average 3.03% of predicted (95% CI 2.37 to 3.69) higher in the USA compared with the UK These differences persisted despite adjustment for possible confounders. Hypertonic saline and dornase alfa were much more commonly prescribed in US children. Conclusions Children and young adults with CF have better lung function in the USA compared with the UK despite similar nutritional status.
    Thorax 09/2014; 70(3). DOI:10.1136/thoraxjnl-2014-205718 · 8.29 Impact Factor
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    ABSTRACT: Purpose To evaluate the effects of oral N-acetylcysteine (NAC), which replenishes systemic glutathione, on decreasing inflammation and improving lung function in CF airways. Methods A multicenter, randomized, double-blind proof of concept study in which 70 CF subjects received NAC or placebo orally thrice daily for 24 weeks. Endpoints: primary, change in sputum human neutrophil elastase (HNE) activity; secondary, FEV1 and other clinical lung function measures; and safety, the safety and tolerability of NAC and the potential of NAC to promote pulmonary hypertension in subjects with CF. Results Lung function (FEV1 and FEF25–75%) remained stable or increased slightly in the NAC group but decreased in the placebo group (p = 0.02 and 0.02). Log10 HNE activity remained equal between cohorts (difference 0.21, 95% CI − 0.07 to 0.48, p = 0.14). Conclusions NAC recipients maintained their lung function while placebo recipients declined (24 week FEV1 treatment effect = 150 mL, p < 0.02). However no effect on HNE activity and other selected biomarkers of neutrophilic inflammation were detected. Further studies on mechanism and clinical outcomes are warranted.
    Journal of Cystic Fibrosis 09/2014; 14(2). DOI:10.1016/j.jcf.2014.08.008 · 3.48 Impact Factor
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    ABSTRACT: Influenza is the most common vaccine-preventable disease in the United States; however, little is known about the burden of critical illness due to influenza virus infection. Our primary objective was to estimate the proportion of all critical illness hospitalizations that are attributable to seasonal influenza.
    Critical Care Medicine 08/2014; 42(11). DOI:10.1097/CCM.0000000000000545 · 6.31 Impact Factor
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    ABSTRACT: Background: Advances in treatments for cystic fibrosis (CF) continue to extend survival. An updated estimate of survival is needed for better prognostication and to anticipate evolving adult care needs. Objective: To characterize trends in CF survival between 2000 and 2010 and to project survival for children born and diagnosed with the disease in 2010. Design: Registry-based study. Setting: 110 Cystic Fibrosis Foundation-accredited care centers in the United States. Patients: All patients represented in the Cystic Fibrosis Foundation Patient Registry (CFFPR) between 2000 and 2010. Measurements: Survival was modeled with respect to age, age at diagnosis, gender, race or ethnicity, F508del mutation status, and symptoms at diagnosis. Results: Between 2000 and 2010, the number of patients in the CFFPR increased from 21 000 to 26 000, median age increased from 14.3 to 16.7 years, and adjusted mortality decreased by 1.8% per year (95% CI, 0.5% to 2.7%). Males had a 19% (CI, 13% to 24%) lower adjusted risk for death than females. Median survival of children born and diagnosed with CF in 2010 is projected to be 37 years (CI, 35 to 39 years) for females and 40 years (CI, 39 to 42 years) for males if mortality remains at 2010 levels and more than 50 years if mortality continues to decrease at the rate observed between 2000 and 2010. Limitations: The CFFPR does not include all patients with CF in the United States, and loss to follow-up and missing data were observed. Additional analyses to address these limitations suggest that the survival projections are conservative. Conclusion: Children born and diagnosed with CF in the United States in 2010 are expected to live longer than those born earlier. This has important implications for prognostic discussions and suggests that the health care system should anticipate greater numbers of adults with CF.
    Annals of internal medicine 08/2014; 161(4):233-241. DOI:10.7326/M13-0636 · 17.81 Impact Factor
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    ABSTRACT: BACKGROUND Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study. OBJECTIVE To use clinical trial performance metrics data analysis to select high-performing cystic fibrosis (CF) clinical research teams and then identify factors contributing to their success. DESIGN Mixed-methods research, including semi-structured qualitative interviews of high-performing research teams. PARTICIPANTS CF research teams at nine clinical centers from the CF Foundation Therapeutics Development Network. APPROACH Survey of site characteristics, direct observation of team meetings and facilities, and semi-structured interviews with clinical research team members and institutional program managers and leaders in clinical research. KEY RESULTS Critical success factors noted at all nine high-performing centers were: 1) strong leadership, 2) established and effective communication within the research team and with the clinical care team, and 3) adequate staff. Other frequent characteristics included a mature culture of research, customer service orientation in interactions with study participants, shared efficient processes, continuous process improvement activities, and a businesslike approach to clinical research. CONCLUSIONS Clinical research metrics allowed identification of high-performing clinical research teams. Site visits identified several critical factors leading to highly successful teams that may help other clinical research teams improve clinical trial performance.
    Journal of General Internal Medicine 07/2014; 29(3). DOI:10.1007/s11606-014-2896-8 · 3.45 Impact Factor
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    Journal of Cystic Fibrosis 06/2014; 13:S15. DOI:10.1016/S1569-1993(14)60048-5 · 3.48 Impact Factor
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    ABSTRACT: Objective To examine the prevalence of symptoms of depression and anxiety among patients with cystic fibrosis (CF) followed at the University of Washington Adult CF Clinic and to identify sociodemographic and clinical factors associated with symptoms. Methods 178 CF adults were asked to complete the Patient Health Questionnaire-9 (PHQ-9) for depression and General Anxiety Disorder-7 (GAD-7) for anxiety when clinically stable. Clinically significant symptoms of depression and anxiety were defined in two ways: 1) symptom definition: presence of moderate-to-severe symptoms based on the questionnaires; 2) composite definition: symptom definition or the use of psychiatric medications to manage symptoms. Associations between PHQ-9 and GAD-7 scores with sociodemographic (gender, age, age of CF diagnosis, vocation, spousal status) and clinical factors (forced expiratory volume in 1 second (FEV1), body mass index, CF-related diabetes on insulin) were examined. Results 153 of 178 (85%) patients completed the screening questionnaires. Based on the symptom definition, 7% of patients had symptoms of depression and 5% had symptoms of anxiety. Using the composite definition, 22% of patients had symptoms of depression and 10% had symptoms of anxiety. Based on the PHQ-9, 5% of patients reported suicidal thoughts. In multiple linear regression analysis, only FEV1% predicted was independently associated with PHQ-9 depression scores and no sociodemographic or clinical factors were associated with GAD-7 anxiety scores. Conclusions We conclude that all CF adults should be screened for symptoms of depression and anxiety given the difficulty in identifying strong clinical risk factors and the unexpected high rates of suicidal ideation.
    Psychosomatics 06/2014; 56(4). DOI:10.1016/j.psym.2014.05.017 · 1.86 Impact Factor

Publication Stats

3k Citations
886.73 Total Impact Points


  • 2015
    • Seattle Children’s Research Institute
      Seattle, Washington, United States
  • 2003–2015
    • University of Washington Seattle
      • • Department of Pediatrics
      • • Department of Medicine
      • • Division of Pulmonary and Critical Care Medicine
      Seattle, Washington, United States
  • 2012
    • Seattle Children's Hospital
      • Department of Pediatrics
      Seattle, Washington, United States
  • 2008
    • Virginia Mason Medical Center
      Seattle, Washington, United States