The Potential Influence of Common Viral Infections Diagnosed during Hospitalization among Critically Ill Patients in the United States
The Potential Influence of Common Viral Infections Diagnosed during Hospitalization among Critically Ill Patients in the United States
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DOI：
10.1371/journal.pone.0018890
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发表时间：
2011-04-29
期刊：
影响因子：
3.7
通讯作者：
Ang, Darwin
中科院分区：
文献类型：
--
作者：
Miggins, Makesha;Hasan, Anjum;Ang, Darwin
病毒是免疫功能正常的个体中最常见的感染源，但它们并不被认为是危重患者中有临床意义的风险因素。这项工作检查了住院期间诊断的病毒感染或入院时未记录的病毒感染与入院时无免疫抑制证据的ICU患者结局的相关性。这是一项基于人群的回顾性队列研究，在美国的大学健康系统联盟（UHC）学术中心进行。S.从2006年到2009年。UHC是美国90%以上的非营利性学术医疗中心的联盟。S.本分析共使用了209，695例危重患者。检查了8例医院并发症。将患者分为四个队列：无感染、仅细菌感染、仅病毒感染以及同一住院期间的细菌和病毒感染。住院期间诊断的病毒感染显著增加了所有并发症的风险。病毒感染也有季节性模式。与不良结局相关的特定病毒包括流感病毒、RSV、CMV和HSV。在同一住院期间同时发生病毒和细菌感染的患者的死亡风险最高，RR 6.58，95% CI（5.47，7.91）;多器官衰竭RR 8.25，95% CI（7.50，9.07）;感染性休克RR 271.2，95% CI（188.0，391.3）。病毒感染可能在ICU患者的结局中发挥重要但未被认识的作用。它们可以作为生物标记物，或通过与并发细菌感染相互作用在某些不良并发症的发展中发挥积极作用。
Viruses are the most common source of infection among immunocompetent individuals, yet they are not considered a clinically meaningful risk factor among the critically ill. This work examines the association of viral infections diagnosed during the hospital stay or not documented as present on admission to the outcomes of ICU patients with no evidence of immunosuppression on admission. This is a population-based retrospective cohort study of University HealthSystem Consortium (UHC) academic centers in the U. S. from the years 2006 to 2009. The UHC is an alliance of over 90% of the non-profit academic medical centers in the U. S. A total of 209,695 critically ill patients were used in this analysis. Eight hospital complications were examined. Patients were grouped into four cohorts: absence of infection, bacterial infection only, viral infection only, and bacterial and viral infection during same hospital admission. Viral infections diagnosed during hospitalization significantly increased the risk of all complications. There was also a seasonal pattern for viral infections. Specific viruses associated with poor outcomes included influenza, RSV, CMV, and HSV. Patients who had both viral and bacterial infections during the same hospitalization had the greatest risk of mortality RR 6.58, 95% CI (5.47, 7.91); multi-organ failure RR 8.25, 95% CI (7.50, 9.07); and septic shock RR 271.2, 95% CI (188.0, 391.3). Viral infections may play a significant yet unrecognized role in the outcomes of ICU patients. They may serve as biological markers or play an active role in the development of certain adverse complications by interacting with coincident bacterial infection.