Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection
Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection
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DOI：
10.1378/chest.09-2517
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发表时间：
2010-04-01
期刊：
影响因子：
9.6
通讯作者：
Dean, Nathan C.
中科院分区：
文献类型：
--
作者：
Miller, Russell R., III;Markewitz, Boaz A.;Dean, Nathan C.
背景：2009年新型甲型H1N1流感对icu患者有显著影响。我们试图描述我们地区的临床表现和因新型甲型H1N1流感而入院ICU的人口统计学关联。方法：我们于2009年5月19日至2009年6月30日进行了一项观察性研究，对ICU队列的描述性临床过程、住院患者死亡率、财务数据和人口统计学特征进行了研究。一项病例对照研究用于比较ICU队列与盐湖城县居民。结果：ICU队列47例流感患者中位年龄34岁，急性生理和慢性健康评估II评分21分，BMI为35 kg/m(2)。死亡率为17%（8/47）。所有8例死亡均发生在64%的ARDS患者（n = 30）中，其中26例（87%）并发多器官功能衰竭。与盐湖县人群相比，新型甲型H1N1流感患者更容易肥胖（22%比74%，P < 0.001），无医疗保险（14%比45%，P < 0.001），西班牙裔（13%比23%，P < 0.01）或太平洋岛民（1%比26%，P < 0.001）。在盐湖城县，经年龄和性别调整后，BMI为40 kg/m(2)者的ICU入院率比预期高15倍（标准化发病率为15.8,95% CI为8.3-23.4），BMI为30 - 39 kg/m(2)者的ICU入院率比预期高1.5倍。结论：无细菌感染的严重ARDS合并多器官功能障碍是常见的临床表现。在这个队列中，没有医疗保险的年轻非白人需要ICU护理的可能性不成比例。肥胖患者特别容易因新型甲型H1N1流感感染而患上危重疾病。胸部2010;137 (4): 752 - 758
Background: Novel 2009 influenza A(H1N1) infection has significantly affected ICUs. We sought to characterize our region's clinical findings and demographic associations with ICU admission due to novel A(H1N1).Methods: We conducted an observational study from May 19, 2009, to June 30, 2009, of descriptive clinical course, inpatient mortality, financial data, and demographic characteristics of an ICU cohort. A case-control study was used to compare the ICU cohort to Salt Lake County residents.Results: The ICU cohort of 47 influenza patients had a median age of 34 years, Acute Physiology and Chronic Health Evaluation II score of 21, and BMI of 35 kg/m(2). Mortality was 17% (8/47). All eight deaths occurred among the 64% of patients (n = 30) with ARDS, 26 (87%) of whom also developed multiorgan failure. Compared with the Salt Lake County population, patients with novel A(H1N1) were more likely to be obese (22% vs 74%; P < .001), medically uninsured (14% vs 45%; P < .001), and Hispanic (13% vs 23%; P < .01) or Pacific Islander (1% vs 26%; P < .001). Observed ICU admissions were 15-fold greater than expected for those with BMI 40 kg/m(2) (standardized morbidity ratio 15.8, 95% CI, 8.3-23.4) and 1.5-fold greater than expected among those with BMI of 30 to 39 kg/m(2) for age-adjusted and sex-adjusted rates for Salt Lake County.Conclusions: Severe ARDS with multiorgan dysfunction in the absence of bacterial infection was a common clinical presentation. In this cohort, young nonwhites without medical insurance were disproportionately likely to require ICU care. Obese patients were particularly susceptible to critical illness due to novel A(H1N1) infection. CHEST 2010; 137(4):752-758