Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study.
Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study.
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DOI：
10.1371/journal.pone.0046816
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Gottfredsson M
中科院分区：
文献类型：
--
作者：
Bjarnason A;Thorleifsdottir G;Löve A;Gudnason JF;Asgeirsson H;Hallgrimsson KL;Kristjansdottir BS;Haraldsson G;Baldursson O;Kristinsson KG;Gottfredsson M
2009年甲型流感（H1N1）引起的社区获得性肺炎（CAP）患者的特征与其他呼吸道病原体引起的CAP相比不充分。CAP的预测规则的性能在一个新的传染性病原体的流行病是未知的。2008年11月至2009年11月在代表冰岛70%医院床位的中心进行的前瞻性、基于人群的研究。CAP患者接受评估和病原学检测，包括流感的聚合酶链反应（PCR）。收集了社区流感样疾病和总体住院率的数据。临床和实验室数据，包括肺炎严重程度指数（PSI）和CURB-65的患者由于H1N1的CAP与其他因素引起的比较。在338例连续合格患者中，313例（93%）入组。在大流行高峰期，2009年甲型流感（H1N1）患者占因CAP住院的38%。这些患者更年轻，更呼吸困难，更频繁地报告咯血。他们的严重程度评分明显低于其他CAP患者（CURB-65为1.23 vs. 1.61，P = 0.02，PSI为2.05 vs. 2.87，P<0.001），更可能需要重症监护住院（41% vs. 5%，P<0.001）和接受机械通气（14% vs. 2%，P = 0.01）。 在23%的2009年甲型H1N1流感CAP患者中检测到细菌合并感染。由甲型流感2009（H1N1）引起的CAP的临床特征与其他病原体引起的CAP明显不同。常用的CAP预测规则通常无法预测由甲型H1N1流感病毒引起的CAP的重症监护或辅助通气需求，强调了在这些情况下临床敏锐性的重要性。
Characteristics of patients with community-acquired pneumonia (CAP) due to pandemic influenza A 2009 (H1N1) have been inadequately compared to CAP caused by other respiratory pathogens. The performance of prediction rules for CAP during an epidemic with a new infectious agent are unknown. Prospective, population-based study from November 2008–November 2009, in centers representing 70% of hospital beds in Iceland. Patients admitted with CAP underwent evaluation and etiologic testing, including polymerase chain reaction (PCR) for influenza. Data on influenza-like illness in the community and overall hospital admissions were collected. Clinical and laboratory data, including pneumonia severity index (PSI) and CURB-65 of patients with CAP due to H1N1 were compared to those caused by other agents. Of 338 consecutive and eligible patients 313 (93%) were enrolled. During the pandemic peak, influenza A 2009 (H1N1) patients constituted 38% of admissions due to CAP. These patients were younger, more dyspnoeic and more frequently reported hemoptysis. They had significantly lower severity scores than other patients with CAP (1.23 vs. 1.61, P = .02 for CURB-65, 2.05 vs. 2.87 for PSI, P<.001) and were more likely to require intensive care admission (41% vs. 5%, P<.001) and receive mechanical ventilation (14% vs. 2%, P = .01). Bacterial co-infection was detected in 23% of influenza A 2009 (H1N1) patients with CAP. Clinical characteristics of CAP caused by influenza A 2009 (H1N1) differ markedly from CAP caused by other etiologic agents. Commonly used CAP prediction rules often failed to predict admissions to intensive care or need for assisted ventilation in CAP caused by the influenza A 2009 (H1N1) virus, underscoring the importance of clinical acumen under these circumstances.
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DOI：
10.1086/591708
发表时间：
2008-10-01
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Morens DM;Taubenberger JK;Fauci AS
通讯作者：
Fauci AS
影响因子：
11.8
作者：
Koon, Kassi;Sanders, Catherine M.;Han, Jian
通讯作者：
Han, Jian
影响因子：
11.8
作者：
Johansson, Niclas;Kalin, Mats;Hedlund, Jonas
通讯作者：
Hedlund, Jonas
影响因子：
11.8
作者：
Jain, Seema;Benoit, Stephen R.;Finelli, Lyn
通讯作者：
Finelli, Lyn
影响因子：
158.5
作者：
Fine, MJ;Auble, TE;Kapoor, WN
通讯作者：
Kapoor, WN