FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients

Abstract

Background The pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) score have been shown to predict mortality in community-acquired pneumonia. Their ability to predict influenza-related pneumonia, however, is less well-established. Methods A total of 693 laboratory-confirmed FluA-p patients diagnosed between Jan 2013 and Dec 2018 and recruited from five teaching hospitals in China were included in the study. The sample included 494 patients in the derivation cohort and 199 patients in the validation cohort. The prediction rule was established based on independent risk factors for 30-day mortality in FluA-p patients from the derivation cohort. Results The 30-day mortality of FluA-p patients was 19.6% (136/693). The FluA-p score was based on a multivariate logistic regression model designed to predict mortality. Results indicated the following significant predictors (regression statistics and point contributions toward total score in parentheses): blood urea nitrogen > 7 mmol/L ( OR 1.604, 95% CI 1.150-4.492, p = 0.040; 1 points), pO 2 /F i O 2 ≤ 250 mmHg ( OR 2.649, 95% CI 1.103-5.142, p = 0.022; 2 points), cardiovascular disease ( OR 3.967, 95% CI 1.269-7.322, p <0.001; 3 points), arterial PH < 7.35 ( OR 3.959, 95% CI 1.393-7.332, p < 0.001; 3 points), smoking history ( OR 5.176, 95% CI 2.604-11.838, p = 0.001; 4 points), lymphocytes < 0.8×10 9 /L ( OR 8.391, 95% CI 3.271-16.212, p <0.001; 5 points), and early neurominidase inhibitor therapy ( OR 0.567, 95% CI 0.202-0.833, p = 0.005; -2 points). Seven points was used as the cut-off value for mortality risk stratification. The model showed a sensitivity of 0.941, a specificity of 0.762, and overall better predictive performance than the PSI risk class (AUROC = 0.908 vs 0.560, p < 0.001) and the CURB-65 score (AUROC = 0.908 vs 0.777, p < 0.001). Conclusions Our results showed that a FluA-p score was easy to derive and that it served as a reliable prediction rule for 30-day mortality in FluA-p patients. The score could also effectively stratify FluA-p patients into relevant risk categories and thereby help treatment providers to make more rational clinical decisions.

Burden of primary influenza and respiratory syncytial virus pneumonia in hospitalised adults: insights from a 2‐year multi‐centre cohort study (2017–2018)

“…Our data on overall IHD (16%) were consistent with evidence ranging from 5.6% to 44.4% according to disease severity and care level, 1,10,[13][14][15][16][17][18][19][20] and identified patients submitted to NIV at higher risk for a fatal outcome. This finding is probably partial because our study did not assess severity of organ dysfunction on pneumonia presentation but seemed to be more relevant than both viral aetiology and comorbidities.…”

“…Therefore, it should encourage clinicians to implement a more defined predictive tool for choosing who and how to ventilate. 10,[17][18][19][20] The present study had limitations. Since respiratory viruses can be present in the upper airways without causing illness, our study using PCR with nasopharyngeal swabs may have overestimated the frequency of influenza and RSV as a cause of CAP.…”

“…[2][3][4][5][6] The choice of timing and type of ventilation in patients suffering from CAP with respiratory failure is also an open debate, as benefit from non-invasive ventilation (NIV) seems to be more evident in selected patients. 7,8 However, there is limited evidence of the uselfulness of both these predictive rules and NIV in patients suffering from viral CAP [9][10][11] and new data might aid clinicians to grasp priorities and timely manage care level. The aims of the present study were to describe the clinical features of hospitalised adults admitted for influenza A/B and RSV pneumonia and to analyse, according to aetiology, factors associated with NIV failure and inhospital death (IHD).…”