Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain
Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain
复制标题
DOI：
10.1111/j.1469-0691.2010.03362.x
复制
发表时间：
2011-05-01
影响因子：
14.2
通讯作者：
Carratala, J.
中科院分区：
文献类型：
--
作者：
Viasus, D.;Pano-Pardo, J. R.;Carratala, J.
甲型H1N1流感病毒感染患者并发症的危险因素尚未完全阐明。我们对2009年6月12日至11月10日期间在西班牙13家医院确诊为甲型H1N1流感病毒感染的住院成人前瞻性队列进行了观察性分析，以确定与严重疾病相关的因素。严重疾病定义为重症监护室（ICU）入院或住院死亡率的复合结局。在研究期间，585名成人患者（中位年龄40岁）因2009年H1N1流感大流行而需要住院治疗。318例（54.4%）患者至少存在一种共病。234例（43.2%）患者诊断为肺炎，45例（7.6%）患者诊断为细菌合并感染。75例（12.8%）患者发生严重疾病，其中71例需要入住ICU，13例（2.2%）死亡。年龄< 50岁为病情严重的独立因素（OR，2.39; 95% CI，1.05-5.47），慢性共病（OR，2.93; 95%CI，1.41-6.09），病态肥胖（OR，6.7; 95%CI，2.25-20.19）、伴随和继发细菌合并感染（OR，2.78; 95%CI，1.11-7）和早期奥司他韦治疗（OR，0.32; 95%CI 0.16-0.63）。总之，尽管因2009年H1N1流感大流行而住院的成年人发病率很高，但死亡率低于最早的研究报告。年轻、慢性共病、病态肥胖和细菌合并感染是严重疾病的独立危险因素，而早期奥司他韦治疗是保护因素。
P>The risk factors for complications in patients with influenza A (H1N1)v virus infection have not been fully elucidated. We performed an observational analysis of a prospective cohort of hospitalized adults with confirmed pandemic influenza A (H1N1)v virus infection at 13 hospitals in Spain, between June 12 and November 10, 2009, to identify factors associated with severe disease. Severe disease was defined as the composite outcome of intensive-care unit (ICU) admission or in-hospital mortality. During the study period, 585 adult patients (median age 40 years) required hospitalization because of pandemic (H1N1) 2009. At least one comorbid condition was present in 318 (54.4%) patients. Pneumonia was diagnosed in 234 (43.2%) patients and bacterial co-infection in 45 (7.6%). Severe disease occurred in 75 (12.8%) patients, of whom 71 required ICU admission and 13 (2.2%) died. Independent factors for severe disease were age < 50 years (OR, 2.39; 95% CI, 1.05-5.47), chronic comorbid conditions (OR, 2.93; 95% CI, 1.41-6.09), morbid obesity (OR, 6.7; 95% CI, 2.25-20.19), concomitant and secondary bacterial co-infection (OR, 2.78; 95% CI, 1.11-7) and early oseltamivir therapy (OR, 0.32; 95% CI 0.16-0.63). In conclusion, although adults hospitalized for pandemic (H1N1) 2009 suffer from significant morbidity, mortality is lower than that reported in the earliest studies. Younger age, chronic comorbid conditions, morbid obesity and bacterial co-infection are independent risk factors for severe disease, whereas early oseltamivir therapy is a protective factor.