Delayed Mortality in a Cohort of Persons Hospitalized with West Nile Virus Disease in Colorado in 2003
Delayed Mortality in a Cohort of Persons Hospitalized with West Nile Virus Disease in Colorado in 2003
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DOI：
10.1089/vbz.2011.0721
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发表时间：
2012-03-01
影响因子：
2.1
通讯作者：
Campbell, Grant L.
中科院分区：
文献类型：
--
作者：
Lindsey, Nicole P.;Sejvar, James J.;Campbell, Grant L.
与西尼罗河病毒（WNV）疾病相关的大多数死亡发生在疾病的急性或早期康复阶段。然而，一些报告表明，急性疾病后死亡率可能会升高数月或更长时间。本研究的目的是评估2003年在科罗拉多因西尼罗河病毒病住院的一组患者发病后4年的生存率。我们计算了年龄调整的标准化死亡率（SMR），以评估超额死亡率，评估了死亡者报告的死亡原因，并分析了延迟死亡的潜在协变量。在发病后1年，201例患者中有4%死亡（SMR，2.7; 95%置信区间[CI]，1.3-5.2），12%在发病后4年死亡（SMR，2.0; 95% CI，1.3-3.0）。在那些已经死亡的人中，最常见的直接和促成死亡的原因包括肺部疾病和心血管疾病;癌症，肝脏疾病和肾脏疾病较少被提及。在多变量分析中，年龄（风险比[HR]，每10年增加2.0; 95% CI，1.4-2.7），自身免疫性疾病（HR，3.0; 95% CI，1.1-7.9），曾吸烟（HR，3.0; 95% CI，1.3-7.0），急性西尼罗河病毒疾病期间的脑炎（HR，2.6; 95% CI，1.1-6.4）和急性疾病期间气管插管（HR 4.8; 95% CI，1.9-12.1）与死亡率独立相关。我们发现急性疾病后3年内死亡率增加约两倍，这加强了在高危人群中采取预防西尼罗河病毒感染措施的必要性，以减少急性和长期不良后果。
Most mortality associated with West Nile virus (WNV) disease occurs during the acute or early convalescent phases of illness. However, some reports suggest mortality may be elevated for months or longer after acute illness. The objective of this study was to assess the survival of a cohort of patients hospitalized with WNV disease in Colorado in 2003 up to 4 years after illness onset. We calculated age-adjusted standardized mortality ratios (SMRs) to evaluate excess mortality, evaluated reported causes of death in those who died, and analyzed potential covariates of delayed mortality. By 1 year after illness onset, 4% of the 201 patients had died (SMR, 2.7; 95% confidence interval [CI], 1.3-5.2), and 12% had died by 4 years after onset (SMR, 2.0; 95% CI, 1.3-3.0). Among those who had died, the most common immediate and contributory causes of death included pulmonary disease and cardiovascular disease; cancer, hepatic disease, and renal disease were mentioned less frequently. In multivariate analysis, age (hazard ratio [HR], 2.0 per 10-year increase; 95% CI, 1.4-2.7), autoimmune disease (HR, 3.0; 95% CI, 1.1-7.9), ever-use of tobacco (HR, 3.0; 95% CI, 1.3-7.0), encephalitis during acute WNV illness (HR, 2.6; 95% CI, 1.1-6.4), and endotracheal intubation during acute illness (HR 4.8; 95% CI, 1.9-12.1) were found to be independently associated with mortality. Our finding of an approximate twofold increase in mortality for up to 3 years after acute illness reinforces the need for prevention measures against WNV infection among at-risk groups to reduce acute as well as longer-term adverse outcomes.