Virus-associated hemophagocytic syndrome as a major contributor to death in patients with 2009 influenza A (H1N1) infection
Virus-associated hemophagocytic syndrome as a major contributor to death in patients with 2009 influenza A (H1N1) infection
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DOI：
10.1186/cc10073
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发表时间：
2011-01-01
期刊：
影响因子：
15.1
通讯作者：
Hoeper, Marius M.
中科院分区：
文献类型：
--
作者：
Beutel, Gernot;Wiesner, Olaf;Hoeper, Marius M.
简介：病毒相关噬血细胞综合征（VAHS）是多种病毒感染的严重并发症，常导致多器官衰竭和死亡。本研究的目的是描述连续确诊的2009年甲型H1N1流感（H1N1）感染并呼吸衰竭的危重患者的基线特征、VAHS的发展、相关治疗和相关死亡率。方法：我们于2009年10月5日至4日在德国单中心重症监护病房对25名感染2009年甲型H1N1流感的危重患者进行了前瞻性观察研究。 2010 年 1 月。收集了人口统计数据、合并症、VAHS 诊断、疾病进展、治疗和生存数据。主要结局指标是 VAHS 的发生和相关死亡率。次要结果变量包括机械通气持续时间、体外膜肺氧合支持和病毒脱落持续时间。 结果：25 名确诊感染 2009 年甲型流感 (H1N1) 的危重患者中，有 9 名 (36%) 出现 VAHS，其中 8 名 (89%) 死亡。相比之下，其余 16 名不患有 VAHS 的患者的死亡率为 25%（通过时序分析，患有或不患有 VAHS 的患者的生存差异 P = 0.004）。患者相对年轻（中位年龄为 45 岁；四分位距 (IQR) 为 35 至 56 岁）；然而，18 名患者 (72%) 存在一种或多种导致严重病程的危险因素。所有25名患者均因严重急性呼吸窘迫综合征和难治性低氧血症接受机械通气，机械通气中位持续时间为19天（IQR，13至26天）。另外 17 名患者 (68%) 需要体外膜肺氧合，中位时间为 10 天（IQR，6 至 19 天）。 结论：这项研究的结果提出了 VAHS 可能是 2009 年严重甲型流感 (H1N1) 感染的常见并发症的可能性，并且是导致多器官衰竭和死亡的重要因素。
Introduction: Virus-associated hemophagocytic syndrome (VAHS) is a severe complication of various viral infections often resulting in multiorgan failure and death. The purpose of this study was to describe baseline characteristics, development of VAHS, related treatments and associated mortality rate of consecutive critically ill patients with confirmed 2009 influenza A (H1N1) infection and respiratory failure.Methods: We conducted a prospective observational study of 25 critically ill patients with 2009 influenza A (H1N1) infection at a single-center intensive care unit in Germany between 5 October 2009 and 4 January 2010.Demographic data, comorbidities, diagnosis of VAHS, illness progression, treatments and survival data were collected. The primary outcome measure was the development of VAHS and related mortality. Secondary outcome variables included duration of mechanical ventilation, support of extracorporeal membrane oxygenation and duration of viral shedding.Results: VAHS developed in 9 (36%) of 25 critically ill patients with confirmed 2009 influenza A (H1N1) infection, and 8 (89%) of them died. In contrast, the mortality rate in the remaining 16 patients without VAHS was 25% (P = 0.004 for the survival difference in patients with or without VAHS by log-rank analysis). The patients were relatively young (median age, 45 years; interquartile range (IQR), 35 to 56 years of age); however, 18 patients (72%) presented with one or more risk factors for a severe course of illness. All 25 patients received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia, with a median duration of mechanical ventilation of 19 days (IQR, 13 to 26 days). An additional 17 patients (68%) required extracorporeal membrane oxygenation for a median of 10 days (IQR, 6 to 19 days).Conclusions: The findings of this study raise the possibility that VAHS may be a frequent complication of severe 2009 influenza A (H1N1) infection and represents an important contributor to multiorgan failure and death.