Critically ill patients with 2009 pandemic influenza A (H1N1) infection in Spain: Factors associated with death, April 2009-January 2010
Critically ill patients with 2009 pandemic influenza A (H1N1) infection in Spain: Factors associated with death, April 2009-January 2010
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DOI：
10.1590/s1135-57272010000500008
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发表时间：
2010-10-01
期刊：
影响因子：
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通讯作者：
Sierra Moros, Mª José
中科院分区：
文献类型：
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作者：
Santa-Olalla Peralta, Patricia;Cortes García, Marta;Sierra Moros, Mª José
背景：有必要分析大流行性流感感染的严重病例，以便确定脆弱人群，并相应调整预防和控制政策。我们分析了2009年4月24日至2010年1月31日在西班牙重症监护病房(ICU)报告的2009年大流行性甲型流感(H I-NI)感染患者的临床和流行病学特征以及与死亡相关的危险因素。方法：作为国家大流行性流感住院病例监测战略的一部分，收集全国范围内所有2009年大流行性流感(H IN I)感染患者的临床和流行病学信息。结果：在1231例ICU住院病例中，271例死亡(病死率22%)。中位年龄40岁(范围0~90岁)。共有838名患者(76.3%)有潜在的危险状况，成人中最常报告的是呼吸系统疾病(34.1%)，其次是病态肥胖(18.8%)。93.1%的患者接受了抗病毒治疗，25.6%(n=231)的患者在症状出现后48小时内开始治疗。在多因素分析中，癌症(OR 2.71，95%CI 1.44~5.1)、免疫缺陷(OR 2.25，95%CI 1.29~3.92)和病态肥胖(OR 1.79，95%CI 1.13~2.85)与成人死亡显著相关。结论：重症大流行性流感病例的特征对于确定癌症和免疫缺陷的存在以及首次发现病态肥胖为流感并发症和死亡的危险因素至关重要。
Background: It is necessary to analyse the severe cases of pandemic influenza infection in order to identify vulnerable populations and adapt prevention and control policies accordingly. We analysed the clinical and epidemiological characteristics and risk factors associated with death in patients with 2009 pandemic influenza A (H I NI) infection hospitalised in intensive care units (ICUs) in Spain and reported from 24 April 2009 to 31 January 2010.Methods: As part of the national strategy for surveillance of hospitalized cases with pandemic influenza, cased-based clinical and epidemiological information on all cases admitted to an ICU with 2009 pandemic virus (H IN I) infection was collected nationwide.Results: Of 1,231 cases admitted to ICU, 271 died (case fatality ratio, 22%). The median age was 40 years (range: 0-90). A total of 838(76.3%) patients had an underlying risk condition, being respiratory disease the most frequently reported (34.1%), followed by morbid obesity (18.8%), in adults. Antiviral treatment was given in 93.1% patients and in 25.6% (n = 231) it was initiated within 48 hours of symptoms onset. In a multivariate analysis, cancer (OR 2.71, 95%CI 1.44 to 5.1), immunodeficiency (OR 2.25, 95%CI 1.29 - 3.92) and morbid obesity (OR 1.79, 95%CI 1.13 to 2.85) were significantly associated with death in adults.Conclusions: The characterization of severe pandemic influenza cases has been crucial in identifying as risk factors of complications and death from influenza the presence of cancer and immunodeficiencies and for the first time, morbid obesity in adults.