C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection

Zimmerman, Ofer; Rogowski, Ori; Aviram, Galit; Mizrahi, Michal; Zeltser, David; Justo, Dan; Dahan, Esther; Arad, Roy; Touvia, Oholi; Tau, Luba; Tarabeia, Jalal; Berliner, Shlomo; Paran, Yael

doi:10.1186/1471-2334-10-288

Cited by 48 publications

(37 citation statements)

References 12 publications

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“…Our results showed that H7N9-infected patients in critical conditions had higher C-reactive protein level and more severe renal insufficiency and myocardium injury. C-reactive protein level might be used as an early marker for clinical prognosis in H7N9 patients based on results from our logistic regression analyses, which was in agreement with previous studies showing that C-reactive protein level might serve as a marker for severity of illness in influenza infections [18,19]. Since multivariate analysis was not performed in our small sample study, further research is needed to verify this.…”

Section: Discussionsupporting

confidence: 91%

Clinical Features and Factors Associated with Outcomes of Patients Infected with a Novel Influenza A (H7N9) Virus: A Preliminary Study

Chen

Yang

et al. 2013

PLoS ONE

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ObjectiveThe present study aimed to analyze clinical features and factors associated with treatment outcomes of H7N9 influenza A virus infection.MethodsThe clinical progress in 18 H7N9-infected patients was monitored and recorded. The clinical features of H7N9 infection were noted and factors associated with treatment outcomes were analyzed by univariate analyses.ResultsThe average ages of patients in recovered and critical conditions were 67.0±10.83 years and 72.75±12.0 years, respectively. Renal insufficiency developed more frequently in critically ill patients (P = 0.023). The duration of traditional Chinese medicine (TCM) therapy was longer in recovered patients than in critically ill patients (P = 0.01). Laboratory tests showed that levels of C-reactive protein, serum creatinine, and myoglobin were significantly higher in critically ill patients than in recovered patients (P = 0.011, 0.04, and 0.016, respectively). Meanwhile, levels of all T cell subsets examined including total CD3+, CD4+, CD8+, and CD45+ T cells were lower in critically ill patients than in recovered patients (P = 0.033, 0.059, 0.015, and 0.039, respectively). Logistic regression analysis demonstrated that C-reactive protein level, myoglobin level and TCM therapy duration were likely associated with treatment outcomes of H7N9 infection (P = 0.032, 0.041 and 0.017, respectively).ConclusionElderly people may have increased risk for H7N9 virus infection. T cell-mediated responses play an important role in defense against the H7N9 virus. C-reactive protein level, myoglobin level and TCM duration may be associated with treatment outcomes of H7N9 infection.

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Section: Discussionsupporting

confidence: 91%

Clinical Features and Factors Associated with Outcomes of Patients Infected with a Novel Influenza A (H7N9) Virus: A Preliminary Study

Chen

Yang

et al. 2013

PLoS ONE

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“…Serum levels of complement 3, prostaglandin E 2 , H 2 O 2 , and C-reactive protein (CRP) did not indicate a potential as a biomarker for influenza virus disease progression in BALB/c mice. These results are surprising as particularly CRP is a major acute-phase protein in humans and is used as an inflammatory marker of virus infections (Nakayama et al, 1993; Zimmerman et al, 2010) and other disease states (Kushner et al, 1978). Its usefulness in the mouse model is still debated though (Torzewski et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Serum amyloid A (SAA) is an early biomarker of influenza virus disease in BALB/c, C57BL/2, Swiss-Webster, and DBA.2 mice

2016

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Assessment of influenza virus disease progression and efficacy of antiviral therapy in the widely used mouse models relies mostly on body weight loss and lung virus titers as markers of disease. However, both parameters have their shortcomings. Therefore, the aim of our study was to find non-invasive markers in the murine model of severe influenza that could detect disease early and predict disease outcome. BALB/c mice were lethally infected with influenza A(H1N1)pdm09 virus and serum samples were collected at various time points. Enzyme-linked immunosorbent assays were performed to quantify amounts of serum amyloid A (SAA), C-reactive protein, complement 3, transferrin, corticosterone, prostaglandin E2, H2O2, and alpha-2,6-sialyltransferase. We found that SAA was the most promising candidate with levels acutely and temporarily elevated by several hundred-fold 3 days post virus inoculation. Upon treatment with oseltamivir phosphate, levels of SAA were significantly decreased. High levels of SAA were associated with poor disease prognosis, whereas body weight loss was not as a reliable predictor of disease outcome. SAA levels were also transiently increased in BALB/c mice infected with influenza A(H3N2) and influenza B virus, as well as in C57BL/2, Swiss-Webster, and DBA.2 mice infected with influenza A(H1N1)pdm09 virus. High levels of SAA often, but not always, were associated with disease outcome in these other influenza virus mouse models. Therefore, SAA represents a valid biomarker for influenza disease detection in all tested mouse strains but its prognostic value is limited to BALB/c mice infected with influenza A(H1N1)pdm09 virus.

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“…During seasonal epidemics from 3 to 5 million severe cases and about 250.000-500.000 lethal cases are registered worldwide [2]. Until now there has not been a laboratory test which has served as a potential marker for identification of patients with a high risk of developing severe clinical forms of influenza and lethal outcome [3,4]. It is known that patients with different comorbid conditions such as diabetes mellitus, chronic cardiovascular and pulmonary diseases, immunosuppressive conditions, adult patients and other conditions are at higher risk of developing severe clinical course of the disease and lethal outcome [5].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Lethal Outcome in Patients with Severe Form of Influenza

Cvetanovska¹,

Milenkovik²,

Uroshevik³

et al. 2016

Prilozi

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Introduction: Clinical manifestations of influenza range from relatively mild and self-limiting respiratory infections to severe clinical manifestations with significant morbidity and mortality. The awareness of predictive indicators for the lethal outcome of influenza is of particular significance in making timely and exact decision for adequate treatment. The aim of this study was to identify the factors in patients with a severe form of influenza, resulting in lethal outcome. Materials and methods:The investigation was a prospective group comparison conducted at the University Clinic for Infectious Diseases in Skopje, R. Macedonia in the period from January 01, 2012 to January 01, 2015. The study included adult patients with a severe form of influenza who were further categorized into a group of either survived patients or a group of deceased patients. Demographic, clinical and biochemical data were noted in all patients included in the study on admission. The variables of the univariate analysis that showed a significant difference in terms of the outcome were used for creating multivariate logistic and regression analysis of the outcome as dependent factors. The independent predictors for lethal outcome in severe cases of influenza were identified by using logistic regression. Results: The study included 87 patients with a severe form of clinical and laboratory confirmed influenza. The patients were divided in two groups: survived (n = 75) and deceased (n = 75). The overall mortality was 13.79%. Multivariate analysis conducted on admission to hospital identified cardiovascular comorbid diseases (p = 0.014), urea values higher than 8.3 U/L (p = 0.045) and SAPS score (p = 0.048) as independent predictors of the outcome in patients with severe form of influenza. Influenza patients with cardiovascular diseases had 2.024 times greater risk of death from influenza in comparison to the patients having influenza without history of such a disease (OR = 2.024 95% CI 1.842-17.337). Patients with serum urea values higher than 8.3 U/L had 1.89 times higher chance of death compared to patients with normal values (OR = 1.89 95% CI 1.091-11.432). The increase of the SAPS score in one point increased the chance of death in patients with influenza by 1.2% (OR = 1.12 95% CI 1.01-2.976). The ROC analysis indicated that cardiovascular diseases, increased urea values and SAPS score in combination act as a good prognostic model for the fatal outcome. The global authenticity of this predictive model to foresee lethal outcome amounts to 80%, sensitivity being 82%, and specificity 70%. Conclusion: Cardiovascular diseases, increased values of urea over 8.3 mmol/l and SAPS score are independent predictive indicators for lethal outcome in severe influenza. Early identification of the outcome predictors in patients with severe influenza will allow implementation of adequate medical treatment and will contribute to decreasing of mortality in patients with severe form of influenza.

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C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection

Cited by 48 publications

References 12 publications

Clinical Features and Factors Associated with Outcomes of Patients Infected with a Novel Influenza A (H7N9) Virus: A Preliminary Study

Clinical Features and Factors Associated with Outcomes of Patients Infected with a Novel Influenza A (H7N9) Virus: A Preliminary Study

Serum amyloid A (SAA) is an early biomarker of influenza virus disease in BALB/c, C57BL/2, Swiss-Webster, and DBA.2 mice

Factors Associated with Lethal Outcome in Patients with Severe Form of Influenza

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