Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico
Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico
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DOI：
10.1001/jama.2009.1536
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发表时间：
2009-11-04
影响因子：
120.7
通讯作者：
Fowler, Robert A.
中科院分区：
文献类型：
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作者：
Dominguez-Cherit, Guillermo;Lapinsky, Stephen E.;Fowler, Robert A.
背景信息 2009 年 3 月，美国西南部和墨西哥首次报告了 2009 年新型甲型 H1N1 流感。墨西哥城的人口和医疗保健系统经历了最早也是最严重的危重疾病早期负担。目的描述墨西哥医院连续危重患者的基线特征、治疗和结果，这些医院治疗的大多数患者患有确诊、疑似或疑似 2009 年甲型流感 (H1N1)。设计、设置和患者对 58 名 2009 流感危重患者进行观察性研究 2009 年 3 月 24 日至 6 月 1 日期间，6 家医院发生了甲型 H1N1 流感。使用试点病例报告表收集了人口统计数据、症状、合并症、疾病进展、治疗和临床结果。 主要结果指标 主要结果指标是死亡率。次要结局包括 2009 年甲型 H1N1 流感相关危重病发生率、机械通气率以及重症监护病房 (ICU) 和住院时间。 结果 入院的 899 名确诊、疑似或疑似 2009 年甲型 H1N1 流感患者中，有 58 名 (6.5%) 发生危重病。患者年轻（中位年龄 44.0 [范围，10-83] 岁）；所有人均出现发烧症状，除 1 人外均出现呼吸道症状。很少有患者患有呼吸系统疾病，但 21 名患者 (36%) 患有肥胖症。从入院到入住 ICU 的时间很短（中位时间为 1 天 [四分位数范围 {IQR}，0-3 天]），除 2 名患者外，所有患者均因严重急性呼吸窘迫综合征和难治性低氧血症而接受机械通气（第 1 天 PaO2 与吸入氧分数的中位比率为 83 [IQR，59-145] mm Hg）。到 60 天时，24 名患者死亡（41.4%；95% 置信区间，28.9%-55.0%）。死亡患者的初始疾病严重程度更高、低氧血症更严重、肌酸激酶水平更高、肌酐水平更高以及持续的器官功能障碍。在对接受神经氨酸酶抑制剂治疗的患者提前死亡的机会减少进行调整后，神经氨酸酶抑制剂治疗（与不治疗相比）与生存率的提高相关（优势比为 8.5；95% 置信区间为 1.2-62.8）。结论 墨西哥 2009 年甲型 H1N1 流感引起的危重疾病发生在年轻人中，与严重急性呼吸窘迫综合征和休克相关， 并且病死率很高。贾马。 2009;302(17):1880-1887
Context In March 2009, novel 2009 influenza A(H1N1) was first reported in the southwestern United States and Mexico. The population and health care system in Mexico City experienced the first and greatest early burden of critical illness.Objective To describe baseline characteristics, treatment, and outcomes of consecutive critically ill patients in Mexico hospitals that treated the majority of such patients with confirmed, probable, or suspected 2009 influenza A(H1N1).Design, Setting, and Patients Observational study of 58 critically ill patients with 2009 influenza A(H1N1) at 6 hospitals between March 24 and June 1, 2009. Demographic data, symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form.Main Outcome Measures The primary outcome measure was mortality. Secondary outcomes included rate of 2009 influenza (A) H1N1-related critical illness and mechanical ventilation as well as intensive care unit (ICU) and hospital length of stay.Results Critical illness occurred in 58 of 899 patients (6.5%) admitted to the hospital with confirmed, probable, or suspected 2009 influenza (A) H1N1. Patients were young (median, 44.0 [range, 10-83] years); all presented with fever and all but 1 with respiratory symptoms. Few patients had comorbid respiratory disorders, but 21 (36%) were obese. Time from hospital to ICU admission was short (median, 1 day [inter-quartile range {IQR}, 0-3 days]), and all patients but 2 received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia (median day 1 ratio of PaO2 to fraction of inspired oxygen, 83 [IQR, 59-145] mm Hg). By 60 days, 24 patients had died (41.4%; 95% confidence interval, 28.9%-55.0%). Patients who died had greater initial severity of illness, worse hypoxemia, higher creatine kinase levels, higher creatinine levels, and ongoing organ dysfunction. After adjusting for a reduced opportunity of patients dying early to receive neuraminidase inhibitors, neuraminidase inhibitor treatment (vs no treatment) was associated with improved survival (odds ratio, 8.5; 95% confidence interval, 1.2-62.8).Conclusion Critical illness from 2009 influenza A(H1N1) in Mexico occurred in young individuals, was associated with severe acute respiratory distress syndrome and shock, and had a high case-fatality rate. JAMA. 2009;302(17):1880-1887