A Novel Risk Factor for a Novel Virus: Obesity and 2009 Pandemic Influenza A (H1N1)
A Novel Risk Factor for a Novel Virus: Obesity and 2009 Pandemic Influenza A (H1N1)
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DOI：
10.1093/cid/ciq152
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发表时间：
2011-02-01
影响因子：
11.8
通讯作者：
Matyas, Bela T.
中科院分区：
文献类型：
--
作者：
Louie, Janice K.;Acosta, Meileen;Matyas, Bela T.
背景资料。许多感染2009年甲型H1N1流感(H1N1)的危重患者都是肥胖的，但肥胖(而不是其相关的共病)是否是严重感染的独立危险因素尚不清楚。利用公共卫生监测数据，我们分析了2009年H1N1感染住院的加州居民的人口学和临床特征，以评估肥胖(身体质量指数[BMI]=30)和极端肥胖(BMI=40)是否是20岁病例患者死亡的独立危险因素。在2009年4月20日至8月11日期间，观察了534例有BMI信息的2009年H1N1感染成人病例。228名患者(43%)的年龄为50岁，378名患者(72%)有流感相关的高危疾病，被免疫做法咨询委员会确认为严重流感的危险因素。274人(51%)的体重指数和体重指数=30，是加州成年人肥胖率(23%)的2.2倍，是美国总人口(33%)肥胖率的1.5倍。在92例死亡患者(17%)中，56例(61%)BMI>；=30，28(30%)BMI>；=40。在多因素分析中，BMI和GT；=40(优势比[OR]，2.8；95%可信区间[CI]，1.4-5.9)和BMI>；=45(OR，4.2；95%CI，1.9-9.4)，年龄=50岁(OR，2.1；95%CI，1.2-3.7)，其他免疫抑制状况(OR，3.9；95%CI，1.6-9.5)，以及哮喘(OR，0.5；95%可信区间(0.3~0.9)与死亡相关。在因2009年甲型H1N1流感而住院的20岁加州人中，有一半肥胖。极端肥胖与死亡几率的增加有关。2009年感染甲型H1N1流感的肥胖成年人应得到及时治疗，并在短缺期间优先考虑疫苗和抗病毒药物。
Background. Many critically ill patients with 2009 pandemic influenza A (H1N1) (2009 H1N1) infection were noted to be obese, but whether obesity, rather than its associated co-morbidities, is an independent risk factor for severe infection is unknown.Methods. Using public health surveillance data, we analyzed demographic and clinical characteristics of California residents hospitalized with 2009 H1N1 infection to assess whether obesity (body mass index [BMI] >= 30) and extreme obesity (BMI >= 40) were an independent risk factor for death among case patients >= 20 years old.Results. During the period 20 April-11 August 2009, 534 adult case patients with 2009 H1N1 infection for whom BMI information was available were observed. Two hundred twenty-eight patients (43%) were >= 50 years of age, and 378 (72%) had influenza-related high-risk conditions recognized by the Advisory Committee on Immunization Practices as risk factors for severe influenza. Two hundred and seventy-four (51%) had BMI >= 30, which is 2.2 times the prevalence of obesity among California adults (23%) and 1.5 times the prevalence among the general population of the United States (33%). Of the 92 case patients who died (17%), 56 (61%) had BMI >= 30 and 28 (30%) had BMI >= 40. In multivariate analysis, BMI >= 40 (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.4-5.9) and BMI >= 45 (OR, 4.2; 95% CI, 1.9-9.4), age >= 50 years (OR, 2.1; 95% CI, 1.2-3.7), miscellaneous immunosuppressive conditions (OR, 3.9; 95% CI, 1.6-9.5), and asthma (OR, 0.5; 95% CI, 0.3-0.9) were associated with death.Conclusion. Half of Californians >= 20 years of age hospitalized with 2009 H1N1 infection were obese. Extreme obesity was associated with increased odds of death. Obese adults with 2009 H1N1 infection should be treated promptly and considered in prioritization of vaccine and antiviral medications during shortages.