Clinical features, treatments and outcomes of influenza A (H1N1) 2009 among the hospitalized patients in the Clinic for Infectious Diseases in Novi Sad
Clinical features, treatments and outcomes of influenza A (H1N1) 2009 among the hospitalized patients in the Clinic for Infectious Diseases in Novi Sad
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DOI：
10.2298/vsp1302155c
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发表时间：
2013-02-01
影响因子：
0.2
通讯作者：
Potkonjak, Aleksandar
中科院分区：
文献类型：
--
作者：
Canak, Grozdana;Kovacevic, Nadica;Potkonjak, Aleksandar
背景/目标。由甲型H1N1流感病毒引起的大多数感染都表现为轻微的呼吸道症状。然而，一些患者需要进入重症监护室（ICU）。本文旨在描述2009年甲型H1N1流感患者的临床和实验室特征、抗病毒治疗使用情况、疾病转归以及与重症相关的危险因素。方法.对诺维萨德传染病诊所收治的有2009年新型甲型H1N1流感症状和体征的患者进行了评估。该研究包括2009年10月至2010年2月期间住院的293名患者。基本的人口统计学数据，潜在的医疗条件，临床体征和症状，入院前的疾病持续时间，实验室检查，放射学检查结果，治疗和最终结果（存活，死亡）都记录了下来。通过比较ICU病例与入院但未进入ICU的对照组患者，确定与需要ICU的严重疾病相关的因素。结果患者平均年龄32.72岁。共有114例（38.9%）患者存在基础疾病。44例（15.01%）患者患有哮喘和慢性阻塞性肺病，28例（9.56%）患有慢性心血管疾病，16例（5.46%）患有糖尿病，15例（4.44%）患有恶性肿瘤，11例（3.75%）患者怀孕。发热282例（96.24%），肌痛119例（40.61%），头痛48例（16.38%），咳嗽240例（81.91%），咽痛25例（8.53%），流涕、打喷嚏17例（5.8%），呼吸困难110例（37.54%）。共有192例（65.53%）的放射学结果与肺炎一致。154例（56.61%）患者在48 h内接受了抗病毒治疗。280例（96.24%）患者出院，13例（4.44%）患者转入ICU。2/13例（15.3%）ICU治疗患者出现致死性结局，11/13例（84.7%）患者存活。从发病到开始抗病毒治疗的中位时间，入住ICU的患者为7.1天，非ICU患者为3.2天（p < 0.05）。ICU患者血氧饱和度（SaO 2）<200 mg/L者9/13（69.23%），非ICU患者85/280（30.35%），两组比较差异有显著性（P < 0.05）。结论大多数2009年新型甲型H1N1流感感染者表现为轻度呼吸道疾病。对甲型H1N1流感病毒感染患者及时进行抗病毒治疗似乎是避免疾病严重形式的最佳方法。对于外周血氧饱和度低、CRP升高的患者应特别注意。
Background/Aim. Most infections caused by influenza A (H1N1) 2009 virus are presented by mild respiratory symptoms. However, some patients required admission to the intensive care unit (ICU). In this article we aimed to describe the clinical and laboratory characteristics of the patients with influenza A (H1N1) 2009, antiviral therapy use, the disease outcome and risk factors associated with the severe disease. Methods. The patients with the signs and simptoms of novel influenza A (H1N1) 2009, admitted to the Clinic for Infectious Disease in Novi Sad, were evaluated. The study included 293 patients hospitalized between October 2009 and February 2010. Basic demographic data, underlying medical conditions, clinical signs and symptoms, duration of the disease before the admission, laboratory tests, radiographic findings, treatment, and the final outcome (survived, died) were all noted. Factors associated with severe disease requiring ICU admission were determined by comparing the ICU cases with control groups of the patients admitted to the hospital but not to ICU. Results. The average age of the patients was 32.72 years. A total of 114 (38.9%) of the patients had an underlying medical condition. Asthma and chronic obstructive pulmonary disease were present in 44 (15.01%) of the patients, chronic cardiovascular diseases in 28 (9.56%), diabetes mellitus in 16 (5.46%), malignity in 15 (4.44%) of the patients and 11 (3.75%) of the patients were pregnant. Fever was registered in 282 (96.24%), myalgias in 119 (40.61%), headache in 48 (16.38%), cough in 240 (81.91%), sore throat in 25 (8.53%), runny nose and sneezing in 17 (5.8%) and dyspnea in 110 (37.54%) of the patients. A total of 192 (65.53%) had radiological findings that were consistent with pneumonia. A total of 154 (56.61%) of the patients received antiviral therapy within 48 h. A total of 280 (96.24%) patients were discharged and 13 (4.44%) were transferred to ICU. Fatal outcome was noticed in 2/13 (15.3%) ICU treated patients and 11/13 (84.7%) patients survived. The median time from the onset of illness to the initiation of antiviral treatment was 7.1 days for the patients admitted to ICU and 3.2 days for non-ICU patients (p < 0.05). Low blood oxygen saturation (SaO(2) 200 mg/L were noticed in 9/13 (69.23%) patients admitted to ICU and 85/280 (30.35%) patients who were not (p < 0.05). Conclusion. Most novel influenza A (H1N1) 2009 infections presented mild respiratory disease. Prompt antiviral therapy in patients with A (H1N1) virus infection seem to be the best approach to avoid serious form of the disease. Special attention should be payed to patients having low level of peripheral oxygen saturation and raised CRP serum level.