Influenza A-Associated In-Hospital Mortality in Very Older People: Does Inflammation Also Play a Role?

Abstract

<b><i>Background:</i></b> The aim of the study was to analyze the clinical manifestations and outcome of the oldest old (people aged ≥85 years) who were admitted to the hospital with a confirmed influenza A virus infection in comparison with younger patients and to assess the role of inflammation in the outcome of influenza infection in this population. <b><i>Methods:</i></b> This is an observational prospective study including all adult patients with influenza A virus infection hospitalized in a tertiary teaching hospital in Madrid, in 2 consecutive influenza seasons (2016–17 and 2017–18). <b><i>Results:</i></b> Five hundred nine hospitalized patients with influenza A infection were included, of whom 117 (23%) were older than 85 years (median age: 89.3 ± 3.2). We compared the clinical characteristics and outcome with those of the rest of the population (median age: 72.8 ± 15.7). Overall, mortality was higher in older patients (10% vs. 4%; <i>p</i> = 0.03) with no differences in clinical presentation. Patients older than 85 years who ultimately died (12 out of 117) showed increased systemic inflammation expressed by higher levels of C-reactive protein (CRP) and ferritin compared to survivors who were discharged (odds ratio [OR] of CRP >20 mg/dL: 5.16, 95% confidence interval [CI]: 1.29–20.57, and OR of ferritin >500 mg: 4.3, 95% CI: 1.04–17.35). <b><i>Conclusions:</i></b> Patients aged 85 and older with influenza A virus infection presented a higher in-hospital mortality than younger subjects. CRP and ferritin levels were higher in the oldest old who died, suggesting that inflammation could play a key role in the outcome of this subset of patients.

The Hypothiocyanite and Amantadine Combination Treatment Prevents Lethal Influenza A Virus Infection in Mice

“…We intentionally chose lethal doses of the influenza viruses tested in vivo because they represent an appropriate animal model for those, mainly immunocompromised, human patients who are hospitalized or even die following influenza infection worldwide. While influenza infections leading to death or admittance to the hospital make up only a minor portion of the total influenza cases, they represent the clinically most severe symptoms and need effective treatment options the most ( 44 – 47 ). Most of our outcomes in this study support the combined hypothesis, which declares that for any type of susceptible or resistant circulating influenza virus, at least two, and in some combinations all three, compounds in combined treatment will be effective.…”