Predictors of mortality and length of stay in hospitalized cases of 2009 influenza A (H1N1): Experiences of a tertiary care center

Abstract

Aim:To study the clinical characteristics and outcome of admitted patients of H1N1 (hemagglutinin -H neuraminidase -N) influenza in a tertiary level hospital, from Oct 2009 to Dec 2010.Materials and Methods:A retrospective analysis of 77 confirmed patients admitted in this unit with H1N1 infection.Results:Of the 77 patients studied, 33 (42.8%) were female. Mean age was 40.88 ± 13.45 years, majority (70.13%) being less than 50 years. Thirty eight (49.3%) patients had at least one co-morbidity, diabetes mellitus being the most common (n = 15, 19.5%). The most common presenting symptom was fever in 75 (97.4%) patients, cough in 67 (87%) and dyspnoea in 59 (76.6%) patients. At admission, mean PaO2/FiO2 ratio was 213.16 ± 132.75 mmHg (n = 60) while mean PaCO2 was 40.14 ± 14.86 mmHg. One or more organ failure was present in 45 (58.4%) patients. Nineteen (24.60%) patients required invasive mechanical ventilation. Circulatory failure was observed in 10 (13%) patients while 2 patients required hemodialysis. Overall, 13% mortality (n = 10) was observed. PaCO2 level at admission (OR 1.093; 95% confidence interval: 1.002-1.193; P = 0.044) and number of organ failure (OR 8.089; 95% confidence interval: 1.133-57.778; P = 0.037) were identified as independent risk- factors for mortality.Conclusion:Increased duration of dyspnoea prior to admission, pneumonia, low PaO2/FiO2 ratio at admission and 24 hours later, higher PaCO2 values on admission, higher O2 requirement, number of organ failures and use of corticosteroids and delay in specialized treatment were associated with a poorer outcome.

Predictors of Prolonged Hospitalization in Patients with Fever

“…This is possibly because both of these studies looked only at specific causes of fever that can be related to lower platelet counts in advanced stages. Respiratory conditions like pneumonia are among the top conditions associated with prolonged hospitalization [ 19 - 20 ], which was also found in our study.…”

Use of corticosteroids in influenza-associated acute respiratory distress syndrome and severe pneumonia: a systemic review and meta-analysis

“…Fourteen studies assessed individuals with H1N1pdm09 virus infection, 1 study assessed individuals with H7N9 virus infection, and 4 study assessed individuals with inter-pandemic influenza virus infection. Eight studies (1956 individuals) had useable data related to patients with ARDS 9,10, [14][15][16][17][18][19] . Fourteen studies (n = 6335) reported mortality associated with adults only.…”

“…Overall mortality in the included studies. Mortality data were reported in 15 studies [8][9][10][14][15][16][17][18][19][20][23][24][25][26][27] .…”

“…Li et al reported that corticosteroid use was associated with a decreased risk of mortality in patients with ARDS (PaO 2 /FiO 2 < 300 mmHg) (aHR 0.67, 95% CI [0.46, 0.98]) 15 . However, Brun-Buisson et al 14 and Chawla et al 18 suggested that the risk of mortality was higher in corticosteroid group in the patients with ARDS. Cao et al reported that a low-to-moderate dose of corticosteroids had no statistically significant association with the risk of mortality in patients with ARDS (OR 1.69, 95% CI [0.78, 3.64]), whereas a high dose was associated with greater mortality (OR 2.89, 95% CI [1.10, 7.56]) 10 .…”

Correlation between Infection with Multiple Respiratory Viruses and Length of Hospital Stay in Patients from Cheonan, Korea

“…However, controversy exists regarding whether these viruses increase the severity of illness and LOS [2]. It has been reported that, while co-infections do not affect LOS or mortality, influenza virus (INF) infection is associated with increased LOS and mortality [3,4]. Nonetheless, the impact of co-infections is, in general, still unclear [2,[5][6][7].…”