Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients

Abstract

Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using two variables with statistically significant associations with mortality. Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 h after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 3.7 mmol/L with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels 3.7 mmol/L and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. We identified clinical and laboratory predictors of mortality that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.

Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea

“…This may be explained by the different ICU capacities or triage among hospitals or countries. Besides, the rate of MV use in our cohort (0.4~1.6% among hospitalized patients) seems lower, compared to that of the US (15.6~25.0%), Spain (8.9%), Canada (8.6%) and Germany (3.4~6.7%) [ 6 , 9 , 27 , 29 , 30 ]. This different rate could be linked to different disease severities or proportions of do-not-intubate orders among countries.…”

“…Epidemics of influenza and its disease burden vary by different regions [ 2 , 3 , 4 , 5 , 6 ]. Hence, nationwide data from countries with different healthcare systems are needed to establish global strategies and prepare for future epidemics or pandemics.…”

Admission Lactate Concentration, Base Excess, and Alactic Base Excess Predict the 28-Day Inward Mortality in Shock Patients

“…A direct comparison of our findings with other studies is problematic. Lactate and BE are routinely measured in critically ill patients suffering from various diseases, and both serve as mortality predictors in ICU (for example, in post-cardiac surgery patients or those with cardiogenic shock, ruptured abdominal aortic aneurysms, or trauma) [ 4 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Whether BE or lactate concentrations serve as better predictors of mortality in critical care patients has not yet been determined [ 4 , 33 , 34 , 35 , 36 ], with no studies reporting with certainty whether these predictors are both independent and/or additive.…”

Early Warning Factors of Death in COVID-19 Patients

“…Studies have shown that routine measurement of lactate in patients with infection can impact clinical assessment of mortality risk [26] . Hsu et al found that high lactate levels were independent predictors of death in critically ill influenza patients [27] . We performed lactate test for patients at admission, which can identify critically ill patients earlier and create conditions for reducing mortality.…”