Christopher H Goss

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

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Publications (142)900.33 Total impact

  • Siddhartha G. Kapnadak · Christopher H. Goss · Moira L. Aitken ·

    Chest 11/2015; 148(5):e156. DOI:10.1378/chest.15-1124 · 7.48 Impact Factor
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    N Am CF Conf, Phoeniz AZ; 10/2015
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    North American Cystic Fibrosis Conference, Phoenix AZ; 10/2015
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    ABSTRACT: Objective: Our objective was to quantify the effect of different statistical techniques, inclusion/exclusion criteria and missing data on the predicted median survival age. Study design and setting: Using the Canadian CF registry (CCFR), the median age of survival was calculated using both the Cox Proportional Hazards (PH) and the life-table methods. Through simulations, we examined how the median age of survival would change when: 1) patients were excluded, 2) death dates were inaccurate, 3) patients were lost to follow-up, 4) entire years with no clinic visits were excluded even if the patient had a visit in subsequent years, and 5) censoring patients at their date of transplant. Simulations were run assuming 5% to 35% of data were affected by each scenario. Results: Over the period 2009 to 2013, there were 4,666 individuals in the CCFR with 240 deaths. The observed median age of survival calculated by the Cox PH method was 50.9 (95% CI: 47.4-54.3) and 50.5 from the life-table method (95% CI: 47.5-53.5). Censoring patients at their transplant date overestimated the median age of survival by 7.2 years (58.1, 95% CI: 53.3-64.7). Simulations determined that by missing just 15% of deaths, the median age of survival can be overestimated by 3.5 years (54.4, 95% CI: 54.2, 56.1), and having 25% of patients lost to follow-up can underestimate the median age of survival by 3.3 years (47.6, 95% CI: 46.8-47.7). Conclusions: We present several recommendations to assist national CF registries in calculating and reporting the median age of survival in a standardized fashion. It is imperative to state the statistical method used as well as the proportion lost to follow-up and the treatment of missing data and transplanted patients. Registries must be diligent in their data collection as incomplete data can lead to over and underestimation of survival.
    Journal of clinical epidemiology 10/2015; DOI:10.1016/j.jclinepi.2015.08.026 · 3.42 Impact Factor
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    Gregory S Sawicki · Christopher H Goss ·
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    ABSTRACT: Health outcomes for individuals with cystic fibrosis (CF) have dramatically improved in parallel with better organization of clinical care systems, evolution of novel therapeutics, and improvements in diagnosis and screening for CF and CF-related complications. In parallel with these advances has come an increasing complexity and burden of care, leading to challenges with adherence to treatment regimens. As novel therapeutics continue to be developed and introduced to the CF care regimen, there are clear opportunities to refine and personalize care. This can be done by adding comparative effectiveness research to the CF clinical research paradigm and integrating novel technologies in drug delivery and remote monitoring that can facilitate adherence but also reduce the burden of treatment while maintaining efficacy. This review highlights both the challenges of the increasingly complex treatment regimens in CF and the opportunities to advance care by addressing adherence, implementation science, comparative effectiveness, and integration of novel technologies in CF care. Pediatr Pulmonol. 2015; 50:S74-S79. © 2015 Wiley Periodicals, Inc.
    Pediatric Pulmonology 09/2015; 50 Suppl 40(S40):S74-9. DOI:10.1002/ppul.23244 · 2.70 Impact Factor

  • Journal of Cystic Fibrosis 06/2015; 14. DOI:10.1016/S1569-1993(15)30039-4 · 3.48 Impact Factor
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    Louisa B Goss · Justin R Ortiz · Daryl M Okamura · Kristen Hayward · Christopher H Goss ·
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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; 34(9). 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

  • Journal of Cystic Fibrosis 06/2015; 14:S106. DOI:10.1016/S1569-1993(15)30366-0 · 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
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    ABSTRACT: Cystic fibrosis is an autosomal recessive, monogenetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The gene defect was first described 25 years ago and much progress has been made since then in our understanding of how CFTR mutations cause disease and how this can be addressed therapeutically. CFTR is a transmembrane protein that transports ions across the surface of epithelial cells. CFTR dysfunction affects many organs; however, lung disease is responsible for the vast majority of morbidity and mortality in patients with cystic fibrosis. Prenatal diagnostics, newborn screening and new treatment algorithms are changing the incidence and the prevalence of the disease. Until recently, the standard of care in cystic fibrosis treatment focused on preventing and treating complications of the disease; now, novel treatment strategies directly targeting the ion channel abnormality are becoming available and it will be important to evaluate how these treatments affect disease progression and the quality of life of patients. In this Primer, we summarize the current knowledge, and provide an outlook on how cystic fibrosis clinical care and research will be affected by new knowledge and therapeutic options in the near future. For an illustrated summary of this Primer, visit:
    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

Publication Stats

4k Citations
900.33 Total Impact Points


  • 2015
    • Seattle Children’s Research Institute
      Seattle, Washington, United States
  • 2012-2015
    • Seattle Children's Hospital
      • Department of Pediatrics
      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
  • 2008
    • Virginia Mason Medical Center
      Seattle, Washington, United States