Baldwin Laboratory

Research Overview

Matthew R. Baldwin, MD, MS
Assistant Professor of Medicine at Columbia University Medical Center
Critical Care Director, Pulmonary & Intensive Care Translational Outcomes Research Group (PICTOR)
Co-leader, Geriatrics section of Integrating Special Populations Research, Columbia University Institute for Clinical and Translational Medicine   
Faculty Research Fellow, Columbia University Aging Center, Columbia University Mailman School of Public Health 

 

Dr. Baldwin’s research focuses on the clinical and translational investigation of frailty in survivors of acute respiratory failure. His ultimate goal is to use the geriatric construct of frailty as a means to risk-stratify and identify critical illness survivors for targeted palliative, rehabilitative, and therapeutic interventions across the ICU to post-hospitalization care continuum.

 Dr. Baldwin has a K23 award from the National Institute on Aging and a research fellowship from the Columbia Aging Center at the Columbia University Mailman School of Public Health. He is  the PI of the Frailty and Outcomes in Critical Illness Survivors-I (FOCIS-I) study, a K23-funded prospective cohort study of 165 survivors of acute respiratory failure with assessments of frailty, function, and banked serum samples, and repeated measurements of patient-reported outcomes after hospital discharge.

 

Using Frailty to Risk-Stratify Survivors of Critical Illness

My work to derive and externally validate the first post-discharge mortality prediction model for older survivors of critical illness showed that we need a paradigm shift in the timing and type of predictors measured to risk-stratify these patients for post-hospitalization interventions. I showed that pre-hospitalization estimates of disability and frailty, and surrogate markers of frailty and disability near the time of hospital discharge predict outcomes better than traditional critical illness severity scores that rely heavily on physiologic and laboratory variables in the ICU. I then went on to demonstrate that Fried’s frailty phenotype can be reliably measured in older survivors of acute respiratory failure just prior to discharge, and I refined the frailty measurement of low physical activity in order to improve the construct and predictive validity of the frailty phenotype for critical illness survivors. We can now quickly identify a frail phenotype among older survivors of acute respiratory failure, who compared to non-frail older survivors of acute respiratory failure, have a nearly six-fold increased risk of death in the first 6-months after hospital discharge, independent of critical illness severity and comorbidity burden. 

Baldwin MR, Narain WR, Wunsch H, Schluger NW, Cooke JT, Maurer MS, Rowe JW, Lederer DJ, Bach PB. A prognostic model for 6-month mortality in elderly survivors of critical illness. Chest. 2013;143(4):910-9. PMID: 23632902; PMCID: PMC3616685

Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H, Dam T, Rabinowitz D, Goldstein N, Maurer MS, Lederer DJ. The feasibility of measuring frailty to predict disability and mortality in older medical-ICU survivors. J Crit Care. 2014 Jun;29(3):401-8. PMID: 24559575; PMCID: PMC4012557.

Baldwin MR, Sell J, Heyden N, Javaid A, Berlin D, Gonzalez WC, Bach PB, Maurer MS, Lovasi GS, Lederer DJ. Race, ethnicity, insurance, and mortality in older survivors of critical illness. Crit Care Med. 2017 Mar 22. [Epub ahead of print]. PMID: 28333761 ; PMCID Journal – In Process: Pending.

Baldwin MR, Singer JP, Huang DF, Sell J, Gonzalez WC, Pollack LR, Maurer MS, D’Ovidio FF, Bacchetta M, Sonett JR, Arcasoy SM, Shah L, Robbins H, Hays SR, Kukreja J, Greenland JR, Shah RJ, Leard L, Morrell M, Gried C, Katz PP, Christie JD, Diamond JM, Lederer DJ. Refining low physical activity measurement improves frailty assessment in advanced lung disease and survivors of critical illness. Ann Am Thorac Soc. 2017, Apr 11. [Epub ahead of print]. PMID: 28398076; PMCID: Journal – In Process.

 

Palliative Care to Improve Critical Illness Survivorship

My research supports a new focus for palliative care interventions for critically ill individuals. Rather than focusing primarily on end-of-life care interventions in the ICU, our work has established a need for palliative care specialists to provide psychosocial care and symptom management for critical illness survivors after the ICU with the goal of improving critical illness survivorship. 

Baldwin MR, Wunsch H, Reyfman PA, Narain WR, Blinderman CD, Schluger NW, Reid MC, Maurer MS, Goldstein N, Lederer DJ, Bach P. High Burden of Palliative Needs among Older ICU Survivors Transferred to Post-Acute Care Facilities: A Single Center Study. Ann Am Thorac Soc. 2013 Oct;10(5): 458-65. PMID: 23987743; PMCID: PMC3960912.

Berning JB, Poor AD, Buckley SM, Patel KR, Lederer DJ, Goldstein NE, Brodie D, Baldwin MR. A Novel Picture Guide to Improve Spiritual Care and Reduce Anxiety in Mechanically Ventilated Intensive Care Unit Adults. Ann Am Thorac Soc. 2016 Aug;13(8):1333-42. PMID: 27097049; PMCID: Journal – IN Process. (with editorial)

This study was featured in the Wall Street Journal in February 2017: https://www.wsj.com/articles/a-spiritual-board-brings-comfort-to-the-critically-ill-1487695567

Pollack LR, Goldstein NE, Gonzalez WC, Blinderman CD, Maurer MS, Lederer DJ, Baldwin MR. The frailty phenotype and palliative care needs in older survivors of critical illness. J Am Geriatr Soc. 2017 (in press) PMID: 28263377; PMCID: Journal – In Process.

 

Determining the Effects of Frailty on Lung Transplantation Outcomes

I have shown that factors related to frailty (hypoalbuminemia and donor age) are strongly associated with mortality after lung transplantation. Collectively, these studies suggest that the current Lung Allocation Score system may be improved by using frailty measurements to improve lung transplantation candidacy and donor selection.

Baldwin MR, Arcasoy SM, Shah A, Schulze PC, Sze J, Sonett JR, Lederer DJ. Hypoalbuminemia and early mortality after lung transplantation: a cohort study. Am J Transplant. 2012;12(5):1256-67. PMID: 22335491; PMCID: PMC3628840

Baldwin MR, Peterson ER, Easthausen I, Quintanilla I, Colago E, Sonett JR, D'Ovidio F, Costa J, Diamond JM, Christie JD, Arcasoy SM, Lederer DJ. Donor Age and Early Graft Failure After Lung Transplantation: A Cohort Study. Am J Transplant. 2013 Oct;10:2685-95. PMID: 24034167; PMCID 4157369.

 

Other Critical Care Outcomes Research

I assist other Columbia University Critical Care Medicine faculty with study design and analytic methods, with a particular focus on extracorporeal membrane oxygenation therapy and outcomes.

Abrams D*, Baldwin MR*, Campion M, Agerstrand C, Eisenberger A, Bacchetta M, Brodie D. Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: a cohort study. Intensive Care Med. 2016 May:42(5):844-52. PMID: 27007099. PMCID: Pending. *Co-primary authors

 

Treating Vitamin Deficiency to Improve Lung Disease

As a medical student, Fulbright scholar in Public Health, and resident physician I worked with investigators at the Johns Hopkins Bloomberg School of Public Health to study the effects of nutrition and vitamin A and D on Tuberculosis risk and respiratory physiology in undernourished populations. We discovered that vitamin D deficiency due to lack of sunlight exposure is a potentially modifiable risk factor that may explain seasonal variation in TB incidence in temperate climates. We demonstrated that vitamin A supplementation before, during, and after pregnancy significantly improved lung function in offspring, further supporting vitamin A supplementation programs in resource poor settings and providing sentinel clinical data that supports basic research aimed at developing retinoid therapies for various lung diseases. 

Baldwin MR, Yori PP, Ford C, Moore DA, Gilman RH, Vidal C, Ticona E, Evans CA. Tuberculosis and nutrition: disease perceptions and health seeking behavior of household contacts in the Peruvian Amazon. Int J Tuberc Lung Dis. 2004;8(12):1484-91. PMID: 15636496; PMCID: 2912521.

Wingfield T, Schumacher SG, Gurinder S, Tovar M, Zevallos K, Baldwin MR, Montoya R, Ramos E, Jongkaewwattana C, Sampson B, Boccia D, Lewis LJ, Friedland JS, Gilman RH, Evans CE.  Tuberculosis, sunlight, and vitamin D seasonality. J Infect Dis, 2014 Sept 1;210(5):774-83. PMID: 24596279; PMCID: 4130318

Baldwin MR, Checkley W, Wise RA, Khatry SK, LeClerq SC, West KP, Jr. A cleaning and calibration method for the SpiroPro portable spirometer's pneumotachometer tube in a remote field study. Respir Care. 2010;55(4):443-52. PMID: 20406512.

Checkley W, West KP, Jr., Wise RA, Baldwin MR, Wu L, LeClerq SC, Christian P, Katz J, Tielsch JM, Khatry S, Sommer A. Maternal vitamin A supplementation and lung function in offspring. N Engl J Med. 2010;362(19):1784-94. PMID: 20463338.

 

Complete List of Published Work in MyBibliography