Predictors and outcomes of respiratory failure among hospitalized pneumonia patients with 2009 H1N1 influenza in Taiwan
Predictors and outcomes of respiratory failure among hospitalized pneumonia patients with 2009 H1N1 influenza in Taiwan
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DOI：
10.1016/j.jinf.2009.12.012
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发表时间：
2010-02-01
影响因子：
28.2
通讯作者：
Chang, Shan-Chwen
中科院分区：
文献类型：
--
作者：
Chien, Yu-San;Su, Chia-Ping;Chang, Shan-Chwen
目的：2009年4月，甲型H1N1流感病毒开始在全球范围内爆发。我们的特点是在台湾的2009年H1N1流感住院肺炎患者的临床特征，并阐明这些患者发展为呼吸衰竭的风险。方法：严重的复杂性流感感染是一种须呈报的疾病，在台湾和住院肺炎患者2009年H1N1流感相应的报告。我们回顾了2009年9月8日合格病例的医疗记录;呼吸衰竭的发展是主要终点。结果：在我们研究的96例患者中，22例（23%）发生呼吸衰竭。其中10例（45%）死亡，所有非呼吸衰竭患者均存活。单因素分析显示，两组患者的年龄分布、呼吸困难、淋巴细胞减少、白细胞减少、PaO 2/FiO 2比值、PaCO 2、SOFA评分、入院时胸部X线片浸润情况存在差异。临床病程也不同，呼吸衰竭患者从出现症状到使用奥司他韦的持续时间更长，住院时间更长，住院期间并发症更多。多因素Logistic回归分析显示呼吸衰竭的发生与入院时SOFA评分>= 4，初始淋巴细胞计数48 h之间存在相关性。结论：2009年H1N1流感患者呼吸衰竭导致预后不良，包括并发症和死亡。临床医师可以在入院时应用这三个预测因子来识别发生呼吸衰竭的高危肺炎患者。需要进一步的研究来验证这项研究在其他环境中的结果。(C)2009年，英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: The worldwide outbreak of a pandemic influenza A (H1N1) virus began in April 2009. We characterized the clinical features of the hospitalized pneumonia patients with 2009 H1N1 influenza in Taiwan and elucidated the risk of those patients for developing respiratory failure.Methods: Severe complicated influenza infection is a notifiable disease in Taiwan and the hospitalized pneumonia patients with 2009 H1N1 influenza were reported accordingly. We reviewed the medical records of the eligible cases by September 8, 2009; development of respiratory failure was the primary endpoint.Results: Of the 96 patients we studied, 22 (23%) developed respiratory failure. Among those, 10 (45%) died and all of the non-respiratory failure patients survived. Age distribution, presence of dyspnea, lymphopenia, leukopenia, PaO2/FiO(2) ratio, PaCO2, SOFA score, infiltration on chest x-ray at admission were different between two groups by univariate analysis. The clinical course was also different, with longer duration from onset of symptoms to use of oseltamivir, longer hospital stay, and more complications during hospitalization in patients with respiratory failure. A multivariate logistic regression showed an association between development of respiratory failure and SOFA score >= 4 at admission, initial lymphocyte count 48 h.Conclusions: Respiratory failure in patients with 2009 H1N1 influenza leads to poor outcomes, including complications and death. Clinicians could apply the three predictors at admission to identify the high-risk pneumonic patients for developing respiratory failure. Further study is needed to validate the findings of this study in other settings. (C) 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved.