Influenza virus and factors that are associated with ICU admission, pulmonary co-infections and ICU mortality

Abstract

a b s t r a c t a r t i c l e i n f oPurpose: While most influenza patients have a self-limited respiratory illness, 5-10% of hospitalized patients develop severe disease requiring ICU admission. The aim of this study was to identify influenza-specific factors associated with ICU admission and mortality. Furthermore, influenza-specific pulmonary bacterial, fungal and viral co-infections were investigated. Methods: 199 influenza patients, admitted to two academic hospitals in the Netherlands between 01-10-2015 and 01-04-2016 were investigated of which 45/199 were admitted to the ICU. Results: A history of Obstructive/Central Sleep Apnea Syndrome, myocardial infarction, dyspnea, influenza type A, BMI N 30, the development of renal failure and bacterial and fungal co-infections, were observed more frequently in patients who were admitted to the ICU, compared with patients at the normal ward. Co-infections were evident in 55.6% of ICU-admitted patients, compared with 20.1% of patients at the normal ward, mainly caused by Staphylococcus aureus, Streptococcus pneumoniae, and Aspergillus fumigatus. Non-survivors suffered from diabetes mellitus and (pre-existent) renal failure more often. Conclusions: The current study indicates that a history of OSAS/CSAS, myocardial infarction and BMI N 30 might be related to ICU admission in influenza patients. Second, ICU patients develop more pulmonary co-infections. Last, (pre-existent) renal failure and diabetes mellitus are more often observed in non-survivors.

Influenza virus-related critical illness: prevention, diagnosis, treatment

“…Bacterial coinfection was identified in approximately one third of fatal influenza A(H1N1)pdm09 cases in the largest autopsy case series [31]. Bacterial co-infections in the interpandemic period are also common in critically ill influenza patients [32]. One study identified past or current tobacco use as a risk factor associated with ICU admission [33].…”

The presence of Pneumocystis jirovecii in critically ill patients with COVID-19

“… 3 Since pneumocystosis is usually reported in patients with T-cell immunodepression, 4 less attention has been paid to Pneumocystis jirovecii in non-immunocompromised ICU patients although it accounts for 7% of the co-infections reported in those admitted with Influenza. 5 Interestingly, COVID-19 patients may develop lymphocytopenia and acute respiratory distress syndrome (ARDS) requiring adjunctive steroids and/or immunomodulatory therapies, well-known susceptibility factors for developing pneumocystosis. 5 We designed this observational cohort study to investigate the prevalence of P. jirovecii acid nucleic detection in respiratory specimens sampled to identify co-infections in COVID-19 patients in the ICU.…”

“… 5 Interestingly, COVID-19 patients may develop lymphocytopenia and acute respiratory distress syndrome (ARDS) requiring adjunctive steroids and/or immunomodulatory therapies, well-known susceptibility factors for developing pneumocystosis. 5 We designed this observational cohort study to investigate the prevalence of P. jirovecii acid nucleic detection in respiratory specimens sampled to identify co-infections in COVID-19 patients in the ICU.…”

“…We found an unexpectedly high proportion of critically ill COVID-19 patients detected with P. jirovecii (10/108 patients; 9.3%), similarly to previous findings in influenza patients (3/45; ∼7%). 5 …”

Higher body mass index is not a protective risk factor for 28-days mortality in critically ill patients with acute kidney injury undergoing continuous renal replacement therapy

“…This may be due to the following reasons: (1) At the beginning of statistical analysis, all cases with missing BMI data and outliers were excluded from the study; (2) The first study by Seung Hyeok Han enrolled 212 patients with AKI undergone CRRT, which was significantly smaller compared to our study, thus the conclusion of our study was more reliable. (3) The second study by Seung Hyeok Han adjusted the following variables: age, sex, CCI score, septic AKI, MAP, eGFR, SOFA score, WBC, Alb and CRRT dose, but did not adjust for the following variables: myocardial infarction, diabetes, congestive heart failure and hypertension, CRP, AKI cause, mechanical ventilation and phosphate which had been reported to occur in critically ill patients [13][14][15][16][17]. (4) We tested the collinearity of the variables included in the statistical analysis, and found that VIF of all variables was less than 2, hence there was no statistical collinearity in the included variables.…”