Prognostic factors for fatal adult influenza pneumonia

Ho, Ya Chi; Wang, Jiun‐Ling; Wang, Jann-Tay; Wu, Un‐In; Chang, Cuiqing; Wu, Ho Sheng; Chen, Chang Hsun; Chuang, Yu Min; Chang, Shan Chwen

doi:10.1016/j.jinf.2009.03.007

Cited by 47 publications

(41 citation statements)

References 23 publications

(19 reference statements)

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“…24 Previous reports revealed that a PaO 2 /FiO 2 ratio below 150 may be a poor prognostic factor in seasonal influenza pneumonia. 25,26 In a Canadian study, however, no significant difference was found in PaO 2 /FiO 2 ratio between survivors and nonsurvivors in critically ill patients with H1N1 infection. 17 In our study, PaO 2 /FiO 2 ratio also had no significant difference between two groups.…”

Section: Discussionmentioning

confidence: 91%

Comparison of Clinical Features and Outcomes of Hospitalized Adult Patients With Novel Influenza A (H1N1) Pneumonia and Other Pneumonia

Sohn

Ryoo

Yoon

et al. 2013

Academic Emergency Medicine

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Objectives: A novel swine-origin influenza A (H1N1) virus caused worldwide outbreaks starting in April 2009. The aim of this study was to evaluate the clinical characteristics and outcomes of pandemic 2009 H1N1 pneumonia by comparing to community-acquired pneumonia (CAP) of other origin. Methods:The authors conducted a prospective cohort study of consecutive adult (over 15 years old) patients with suspected CAP requiring admission to a tertiary university-affiliated hospital during the second wave of pandemic 2009 H1N1 influenza. Based on the results of real-time reverse transcriptasepolymerase chain reaction (RT-PCR) analysis, the staff completed a standard assessment form and managed the patients according to a uniform protocol. Clinical characteristics, as well as laboratory and radiologic findings, were collected and compared between pandemic 2009 H1N1 pneumonia and CAP of other origin. The primary outcome was in-hospital mortality and secondary outcomes were duration of hospitalization, duration of intensive care unit (ICU) stay, and requirement of mechanical ventilation.Results: A total of 135 patients with suspected CAP were included in the study. Of these, 59 patients were RT-PCR positive for H1N1 virus, and 76 patients were RT-PCR negative. Patients with H1N1 pneumonia were significantly younger than those with CAP of other origin (46.0 years vs. 68.0 years, p < 0.01) and more frequently had nonspecific symptoms (p < 0.01), initial leukopenia (8.5% vs. 0.0%, p = 0.01), lymphopenia (45.8% vs. 26.3%, p = 0.02), low values of C-reactive protein (CRP; 5.2 mg/dL vs. 13.4 mg/dL, p = 0.02), bilateral abnormalities (57.7% vs. 29.7%, p < 0.01) on chest radiography, ground glass opacities (43.9% vs. 12.8%, p < 0.01) on chest computed tomography, and low values of pneumonia severity index (PSI) score (56.0 vs. 91.0, p < 0.01) than those with CAP of other origin. However, there were no significant differences in infection severity, clinical outcome, length of ICU stay, requirement for mechanical ventilation, and mortality between the two groups.Conclusions: This study shows that clinical characteristics and outcomes of 2009 H1N1 pneumonia are comparable to those of CAP of other origin. However, some characteristics, including younger age, nonspecific symptoms (including headache, leukopenia, and fatigue), lymphopenia, lower initial CRP and PSI score, and radiologic findings (including bilateral abnormalities and ground glass opacities), may help clinicians to diagnostically differentiate between H1N1 pneumonia and CAP of other origin before the result of RT-PCR are obtained.ACADEMIC EMERGENCY MEDICINE 2013; 20:46-53

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Section: Discussionmentioning

confidence: 91%

Comparison of Clinical Features and Outcomes of Hospitalized Adult Patients With Novel Influenza A (H1N1) Pneumonia and Other Pneumonia

Sohn

Ryoo

Yoon

et al. 2013

Academic Emergency Medicine

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“…A single study of bacterial pneumonic superinfection in influenza from Taiwan identified shock, respiratory rate of over 24 breaths/minute, acidosis, raised creatinine and a pneumonia severity index of class IV or V as indicators of poor prognosis. 39 The SARS outbreaks in South-East Asia and Toronto, Canada, highlighted the importance of developing surge capacity in the hospital and critical care spheres, and of being able to alter institutional priorities. 40 Changes in working pattern were particularly driven by high risks of nosocomial viral transmission.…”

Section: Chaptermentioning

confidence: 99%

Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission: cohort study

Goodacre

Challen²,

Wilson³

et al. 2010

Health Technol Assess

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*Corresponding authorthree survivors who required respiratory support. The five patients with poor outcomes had CURB-65 scores of zero, one (three cases) and two, and PMEWS scores of one, five, six, seven and eight. The swine flu hospital pathway was positive in three out of five cases. The C-statistic for each method was CURB-65 0.78 [95% confidence interval (CI) 0.58 to 0.99], PMEWS 0.77 (95% CI 0.55 to 0.99) and the swine flu hospital pathway 0.70 (95% CI 0.45 to 0.96). Patients with a higher CURB-65 score were more likely to be admitted (p < 0.001): 25 out of 101 (25%) with a score of zero, 11 out of 24 (46%) with a score of one, 7 out of 8 (88%) with a score of two, and the patient with a score of three were admitted. Admitted patients had a higher mean PMEWS score (4.6 vs 2.0, p < 0.001). The C-statistics for CURB-65, PMEWS and the swine flu hospital pathway in adults in terms of discriminating between those admitted and discharged were 0.65 (95% CI 0.54 to 0.76), 0.76 (95% CI 0.66 to 0.86) and 0.62 (95% CI 0.51 to 0.72) respectively. Limitations: The 2009 H1N1 pandemic was much smaller and less severe than predicted and resulted in a lack of sufficient data.

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“…In most of cases, the condition is self-limited, requiring only clinical support measures and general care (10) . However, there are some clinical features, groups and risk factors where the infection by influenza virus may be highly severe, progressing with exuberant respiratory symptoms, probably requiring specific viral therapy on an inpatient basis, with mechanical ventilation, and even so with possibility of progressing to respiratory failure and death (11) . The risk groups include children under two years and elderly above 60 years of age, pregnant women, immunosuppressed individuals (transplant, cancer, AIDS patients, or immunosuppressing drugs users) and individuals with chronic comorbidities (hemoglobinopathies, cardiopathies, pneumopathies, chronic renal diseases, metabolic diseases and morbid obesity) (12) .…”

Section: Introductionmentioning

confidence: 99%

Manifestações da infecção pelo novo vírus influenza A (H1N1) na tomografia computadorizada de tórax

Verrastro

Abreu²,

Hitomi³

et al. 2009

Radiol Bras

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OBJECTIVE: The objective of this study was to describe chest computed tomography findings in confirmed cases of infection by the novel influenza A (H1N1) virus. MATERIALS AND METHODS: Computed tomography studies of nine patients with laboratory-confirmed infection by the novel influenza A (H1N1) virus were consensually evaluated by three observers. The sample of the present study included five male and four female patients with ages ranging from 14 to 64 years (mean, 40 years). Four of the patients were previously healthy, four were kidney transplant recipients and one was pregnant at the time of diagnosis. Presence, extent and distribution of the following findings were evaluated: a) ground-glass opacities; b) centrilobular nodules; c) consolidation; d) interlobular septa thickening; e) pleural effusion; f) lymphadenopathy. RESULTS: The most frequent findings were ground-glass opacities, centrilobular nodules and consolidations, present in nine (100%), five (55%) and four (44%) of cases, respectively. Pleural effusions and lymphadenopathy were less common findings, occurring in only two (22%) of the cases. CONCLUSION: Ground-glass opacities, centrilobular nodules and consolidation were the most frequent findings in cases of infection by the novel influenza A (H1N1) virus. These changes are not typical or unique to this agent and may also occur in other viral or bacterial infections. Keywords: Influenza A virus; Influenza A (H1N1) virus subtype; Viral pneumonia; X-ray computed tomography. OBJETIVO: Descrever as alterações na tomografia computadorizada de tórax de casos comprovados de infecção pelo novo vírus influenza A (H1N1). MATERIAIS E MÉTODOS:Três observadores avaliaram, em consenso, nove tomografias computadorizadas de pacientes com infecção pelo vírus influenza A (H1N1) comprovada laboratorialmente. A idade dos pacientes variou de 14 a 64 anos (média de 40 anos), sendo cinco do sexo masculino e quatro do sexo feminino. Quatro pacientes eram previamente hígidos, quatro eram transplantados renais e uma era gestante à época do diagnóstico. Foram avaliadas a presença, a extensão e a distribuição de: a) opacidades em vidro fosco; b) nódulos centrolobulares; c) consolidações; d) espessamento de septos interlobulares; e) derrame pleural; f) linfonodomegalias. RESULTADOS: As alterações mais frequentemente encontradas foram opacidades em vidro fosco, nódulos centrolobulares e consolidações, presentes em nove (100%), cinco (55%) e quatro (44%) dos casos, respectivamente. Derrames pleurais e linfonodomegalias foram menos comuns, ocorrendo em apenas dois (22%) dos casos estudados. CONCLU-SÃO: Os achados mais comuns nos casos de infecção pelo novo vírus influenza A (H1N1) foram opacidades em vidro fosco, nódulos centrolobulares e consolidações. Estas alterações não são típicas ou únicas a este agente, podendo ocorrer também em outras infecções virais ou bacterianas. Unitermos: Vírus influenza A; Vírus influenza A subtipo H1N1; Pneumonia viral; Tomografia computadorizada por raios X. AbstractResumo

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Prognostic factors for fatal adult influenza pneumonia

Cited by 47 publications

References 23 publications

Comparison of Clinical Features and Outcomes of Hospitalized Adult Patients With Novel Influenza A (H1N1) Pneumonia and Other Pneumonia

Comparison of Clinical Features and Outcomes of Hospitalized Adult Patients With Novel Influenza A (H1N1) Pneumonia and Other Pneumonia

Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission: cohort study

Manifestações da infecção pelo novo vírus influenza A (H1N1) na tomografia computadorizada de tórax

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