Complications and Outcomes of Pandemic 2009 Influenza A (H1N1) Virus Infection in Hospitalized Adults: How Do They Differ From Those in Seasonal Influenza?
Complications and Outcomes of Pandemic 2009 Influenza A (H1N1) Virus Infection in Hospitalized Adults: How Do They Differ From Those in Seasonal Influenza?
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DOI：
10.1093/infdis/jir187
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发表时间：
2011-06-15
影响因子：
6.4
通讯作者：
Hui, David. S. C.
中科院分区：
文献类型：
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作者：
Lee, Nelson;Chan, Paul K. S.;Hui, David. S. C.
方法。一项前瞻性观察性研究对 2009 年 6 月至 2010 年 5 月期间在 2 家急诊综合医院因聚合酶链反应确诊的 pH1N1 感染而住院的成人进行了研究（n = 382）。描述了并发症和结果，并与季节性流感队列（2007-2008 年，同一家医院；n = 754）进行了比较。结果。住院的 pH1N1 流感患者比季节性流感患者更年轻（平均年龄 +/- 标准差，47 +/- 20 岁 vs 70 +/- 19 岁），并且患有合并症的患者更少（48% vs 64%）。免疫荧光检测阳性率较低（54% vs 84%），抗病毒药物使用频繁（96% vs 52%）。两个队列中的大多数患者均出现复杂疾病（67.8% vs 77.1%），但 pH1N1 流感患者的肺外并发症发生率较高（23% vs 16%；P = .004），入住重症监护室和/或死亡的比率较高（患者年龄 < 35 岁，2.3% vs 0%；35-65 岁，12.4% vs 3.2%；> 65 岁， 13.5% 与 8.5%；调整后的比值比 [OR] 2.13；95% 置信区间 [CI]，1.25-3.62；P = .005）。发病后 96 小时内接受抗病毒治疗的患者生存率更高（对数秩检验，P < .001）。然而，如果不及时治疗，pH1N1 感染的死亡风险较高（季节性流感为 9.0% vs 5.8%；调整后 OR，6.85；95% CI，1.64-28.65；P = .008]。细菌重复感染使预后恶化。结论。因 pH1N1 流感住院的成人尽管比季节性流感患者年轻，但仍存在显着的并发症和死亡率。96 小时内进行抗病毒治疗可能会提高生存率。
Methods. A prospective, observational study was conducted in adults hospitalized with polymerase chain reaction-confirmed pH1N1 infection in 2 acute-care general hospitals from June 2009 to May 2010 (n = 382). Complications and outcomes were described and compared with those in a seasonal influenza cohort (2007-2008, same hospitals; n = 754).Results. Hospitalized patients with pH1N1 influenza were younger than those with seasonal influenza (mean age +/- standard deviation, 47 +/- 20 vs 70 +/- 19 years) and fewer had comorbid conditions (48% vs 64%). The rate of positive immunofluorescence assay results was low (54% vs 84%), and antiviral use was frequent (96% vs 52%). Most patients in both cohorts developed complicated illnesses (67.8% vs 77.1%), but patients with pH1N1 influenza had higher rates of extrapulmonary complications (23% vs 16%; P = .004) and intensive care unit admission and/or death (patient age < 35 years, 2.3% vs 0%; 35-65 years, 12.4% vs 3.2%; > 65 years, 13.5% vs 8.5%; adjusted odds ratio [OR] 2.13; 95% confidence interval [CI], 1.25-3.62; P = .005). Patients who received antiviral treatment within 96 h after onset had better survival (log-rank test, P < .001). However, without timely treatment, the mortality risk was higher with pH1N1 infection (9.0% vs 5.8% for seasonal influenza; adjusted OR, 6.85; 95% CI, 1.64-28.65; P = .008]. Bacterial superinfection worsened outcomes.Conclusions. Adults hospitalized for pH1N1 influenza had significant complications and mortality despite being younger than patients with seasonal influenza. Antiviral treatment within 96 h may improve survival.