The clinical research of the Wagner lab focuses on biomarkers and early detection of organ injury. In the past we conducted an NIH-funded study of SPECT-CT imaging to detect lung injury in patients with COPD and with ventilator-associated lung injury (in collaboration with Jeanine D’Armiento, MD, PhD and Taylor Johnson, MD (NHLBI 2016-19: 1R01HL131960-01).
Other areas of biomarker research include markers for renal injury such as neutrophil gelatinase-associated lipocalin (NGAL), a novel and sensitive marker for renal injury. We previously studied NGAL in patients undergoing cardiac, general, and liver transplant surgery. A large study of cardiac surgical patients found that urinary NGAL had intermediate predictive power. Furthermore, recent studies found that urinary NGAL was actually elevated only in patients who developed sustained increases of serum creatinine after surgery consistent with intrinsic renal injury but not in those patients with only transient increases; i.e., prerenal azotemia. An ongoing study will assess the utility of NGAL to detect acute kidney injury in the medical ICU.
Another focus of our research involves liver function and hepatic blood flow including the effect of vasopressin and other medications on liver blood flow during liver transplantation. We previously demonstrated that patients with liver diseases exhibit an endogenous vasopressin deficiency similar to what has been described in septic shock. Administration of vasopressin in these patients will lead to an increase of blood pressure due to splanchnic vasoconstriction, which is potentially beneficial for patients with cirrhosis and for patients undergoing liver transplantation.
Further research projects include coagulation studies and detection of hypercoagulability using rotational thrombelastometry (ROTEM) and clinical outcome studies in liver transplantation and cardiac surgery.
During the COVID-19 surge we demonstrated that COVID-19 is associated with fibrinogen-mediated hypercoagulability detected using ROTEM and we developed and validated a simple laboratory score that predicted the risk for development of severe COVID-19 complications.
Roh DJ, Eiseman K, Kirsch H, Yoh N, Boehme A, Agarwal S, Park S, Connolly ES, Claassen J, Wagener G. Hypercoagulable viscoelastic blood clot characteristics in critically ill coronavirus disease 2019 patients and associations with thrombotic complications. J Trauma Acute Care Surg. 2021 Jan 1;90(1):e7-e12. doi: 10.1097/TA.0000000000002963. PMID: 33009340; PMCID: PMC8630999.
Wagener G. Serum Glycomics, a Novel Biomarker That Opens Doors to a Better Understanding of Graft Failure. Transplantation. 2021 Nov 1;105(11):2344-2345. doi: 10.1097/TP.0000000000003506. PMID: 33560722.