Clinical and laboratory features distinguishing pandemic H1N1 influenza-related pneumonia from interpandemic community-acquired pneumonia in adults.
Clinical and laboratory features distinguishing pandemic H1N1 influenza-related pneumonia from interpandemic community-acquired pneumonia in adults.
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DOI：
10.1136/thx.2010.151522
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发表时间：
2011-03
期刊：
影响因子：
10
通讯作者：
Influenza Clinical Information Network
中科院分区：
文献类型：
--
作者：
Bewick T;Myles P;Greenwood S;Nguyen-Van-Tam JS;Brett SJ;Semple MG;Openshaw PJ;Bannister B;Read RC;Taylor BL;McMenamin J;Enstone JE;Nicholson KG;Lim WS;Influenza Clinical Information Network
对H1N1流感相关肺炎患者的早期识别对于早期使用抗病毒药物是可取的。进行了一项研究，以调查是否可以区分入院的成人H1N1流感相关肺炎与非H1N1社区获得性肺炎（CAP）患者。2009年5月至2010年1月，流感临床信息网络（FLU-CIN）收集了英国75家医院确诊的H1N1流感感染患者的临床和流行病学数据。确定患有H1N1流感相关肺炎的成人，并与2008年9月至2010年6月期间住院的成人CAP前瞻性研究队列进行比较，不包括在大流行期间入院的患者。在流感cin队列中1046例确诊H1N1流感感染的成年人中，254例（25%）在入院时患有H1N1流感相关肺炎。这些患者的住院死亡率为11.4%，而大流行间CAP患者的住院死亡率为14.0% （n=648）。年龄≤65岁、心理取向、体温≥38°C、白细胞计数≤12×109/l和双侧x线片实变等5项临床标准各赋1分，形成多因素logistic回归模型。4分或5分预测H1N1流感相关肺炎，阳性似然比为9.0。如果得分为0或1，排除它的可能性比为75.7。H1N1流感相关肺炎与大流行间CAP之间存在显著的临床差异。基于五个简单临床标准的模型能够早期识别入院的H1N1流感相关肺炎成人。
Early identification of patients with H1N1 influenza-related pneumonia is desirable for the early instigation of antiviral agents. A study was undertaken to investigate whether adults admitted to hospital with H1N1 influenza-related pneumonia could be distinguished clinically from patients with non-H1N1 community-acquired pneumonia (CAP). Between May 2009 and January 2010, clinical and epidemiological data of patients with confirmed H1N1 influenza infection admitted to 75 hospitals in the UK were collected by the Influenza Clinical Information Network (FLU-CIN). Adults with H1N1 influenza-related pneumonia were identified and compared with a prospective study cohort of adults with CAP hospitalised between September 2008 and June 2010, excluding those admitted during the period of the pandemic. Of 1046 adults with confirmed H1N1 influenza infection in the FLU-CIN cohort, 254 (25%) had H1N1 influenza-related pneumonia on admission to hospital. In-hospital mortality of these patients was 11.4% compared with 14.0% in patients with inter-pandemic CAP (n=648). A multivariate logistic regression model was generated by assigning one point for each of five clinical criteria: age ≤65 years, mental orientation, temperature ≥38°C, leucocyte count ≤12×109/l and bilateral radiographic consolidation. A score of 4 or 5 predicted H1N1 influenza-related pneumonia with a positive likelihood ratio of 9.0. A score of 0 or 1 had a positive likelihood ratio of 75.7 for excluding it. There are substantial clinical differences between H1N1 influenza-related pneumonia and inter-pandemic CAP. A model based on five simple clinical criteria enables the early identification of adults admitted with H1N1 influenza-related pneumonia.
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