Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults
Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults
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DOI：
10.1001/jamanetworkopen.2020.1323
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发表时间：
2020-03-20
影响因子：
13.8
通讯作者：
Garg, Shikha
中科院分区：
文献类型：
--
作者：
Chow, Eric J.;Rolfes, Melissa A.;Garg, Shikha
问题：自2009年流感大流行以来，住院成人患者中哪些类型的呼吸系统和非呼吸系统诊断与流感相关？在这项对2010年至2018年期间在美国因实验室确诊的流感住院的80000多名成年人的横断面分析中，95%的患者有呼吸系统诊断，46%的患者有非呼吸系统诊断，其中5%的患者完全是非呼吸系统诊断。意义流感病毒感染可能与呼吸道和非呼吸道疾病有关，突出了流感疾病负担的广泛范围。重要性季节性流感病毒感染是发病和死亡的主要原因，可能与呼吸道和非呼吸道疾病有关。目的检查2010年至2018年美国因实验室确诊流感住院的成人报告的呼吸道和非呼吸道诊断。这项横断面研究使用了美国流感住院监测网络（FluSurv-NET）从2010-2011年10月1日至2017-2018年流感季节的4月30日的数据。FluSurv-NET是一个基于人群的多中心监测网络，其集水区约占美国人口的9%。患者通过医生安排的流感检测进行识别。研究纳入了因实验室确诊流感住院的成人（年龄≥ 18岁）。FluSurv-NET将实验室确认的流感定义为通过快速抗原检测、逆转录聚合酶链反应、直接或间接荧光染色或病毒培养获得的阳性流感检测结果。主要结果和测量急性呼吸或非呼吸诊断使用国际疾病分类，第9次修订，临床修改（ICD-9-CM）和国际疾病和相关健康问题统计分类，第10次修订（ICD-10）出院诊断代码定义。该分析包括计算急性呼吸和非呼吸诊断的频率，并对患者人口统计学特征、基础医学状况和呼吸和非呼吸诊断的住院结局进行描述性分析。结果在89999例实验室确诊的流感住院成人患者中，76649例（中位年龄69岁;四分位距55-82岁; 55%女性）有完整的病历摘要和至少1个急性诊断的ICD代码。在这项研究中，94.9%的患者有呼吸系统诊断，46.5%的患者有非呼吸系统诊断，包括5.1%的患者只有非呼吸系统诊断。肺炎（36.3%）、脓毒症（23.3%）和急性肾损伤（20.2%）是最常见的急性诊断。仅非呼吸系统疾病诊断的患者接受抗病毒治疗的人数少于呼吸系统疾病诊断的患者（81.4% vs 88.9%; P <0.001）。结论和相关性非呼吸道疾病诊断在因流感住院的成人中频繁发生，进一步增加了美国的感染负担。研究结果表明，在流感季节，医生应该考虑流感在他们的鉴别诊断的病人谁目前到医院不太常见的表现和启动早期抗病毒治疗的病人与疑似或确诊感染。这项横断面研究审查了呼吸和非呼吸诊断报告的美国成年人住院与实验室-2010年至2018年期间确诊的流感。
Question Which types of respiratory and nonrespiratory diagnoses were associated with influenza in hospitalized adult patients since the 2009 influenza pandemic? Findings In this cross-sectional analysis of more than 80 & x202f;000 adults hospitalized with laboratory-confirmed influenza between 2010 and 2018 in the United States, 95% of patients had a respiratory diagnosis, and 46% had a nonrespiratory diagnosis, including 5% with exclusively nonrespiratory diagnoses. Meaning Influenza virus infection may be associated with both respiratory and nonrespiratory diagnoses, highlighting the broad scope of influenza burden of disease.Importance Seasonal influenza virus infection is a major cause of morbidity and mortality and may be associated with respiratory and nonrespiratory diagnoses. Objective To examine the respiratory and nonrespiratory diagnoses reported for adults hospitalized with laboratory-confirmed influenza between 2010 and 2018 in the United States. Design, Setting, and Participants This cross-sectional study used data from the US Influenza Hospitalization Surveillance Network (FluSurv-NET) from October 1 through April 30 of the 2010-2011 through 2017-2018 influenza seasons. FluSurv-NET is a population-based, multicenter surveillance network with a catchment area that represents approximately 9% of the US population. Patients are identified by practitioner-ordered influenza testing. Adults (aged >= 18 years) hospitalized with laboratory-confirmed influenza were included in the study. Exposures FluSurv-NET defines laboratory-confirmed influenza as a positive influenza test result by rapid antigen assay, reverse transcription-polymerase chain reaction, direct or indirect fluorescent staining, or viral culture. Main Outcomes and Measures Acute respiratory or nonrespiratory diagnoses were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) discharge diagnosis codes. The analysis included calculation of the frequency of acute respiratory and nonrespiratory diagnoses with a descriptive analysis of patient demographic characteristics, underlying medical conditions, and in-hospital outcomes by respiratory and nonrespiratory diagnoses. Results Of 89 999 adult patients hospitalized with laboratory-confirmed influenza, 76 649 (median age, 69 years; interquartile range, 55-82 years; 55% female) had full medical record abstraction and at least 1 ICD code for an acute diagnosis. In this study, 94.9% of patients had a respiratory diagnosis and 46.5% had a nonrespiratory diagnosis, including 5.1% with only nonrespiratory diagnoses. Pneumonia (36.3%), sepsis (23.3%), and acute kidney injury (20.2%) were the most common acute diagnoses. Fewer patients with only nonrespiratory diagnoses received antiviral therapy for influenza compared with those with respiratory diagnoses (81.4% vs 88.9%; P < .001). Conclusions and Relevance Nonrespiratory diagnoses occurred frequently among adults hospitalized with influenza, further contributing to the burden of infection in the United States. The findings suggest that during the influenza season, practitioners should consider influenza in their differential diagnosis for patients who present to the hospital with less frequently recognized manifestations and initiate early antiviral treatment for patients with suspected or confirmed infection.This cross-sectional study examines the respiratory and nonrespiratory diagnoses reported for US adults hospitalized with laboratory-confirmed influenza between 2010 and 2018.