Factors associated with poor outcomes among adults hospitalized for influenza in France: A three-year prospective multicenter study
Factors associated with poor outcomes among adults hospitalized for influenza in France: A three-year prospective multicenter study
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DOI：
10.1016/j.jcv.2016.04.005
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发表时间：
2016-06-01
影响因子：
8.8
通讯作者：
Launay, Odile
中科院分区：
文献类型：
--
作者：
Loubet, Paul;Samih-Lenzi, Nezha;Launay, Odile
背景：流感是严重疾病和死亡的重要原因，特别是在老年人和高危人群中。目的：本研究的目的是确定在法国因实验室确认的季节性流感而住院的成年人中与不良预后相关的因素。研究设计：在法国医院连续三个流感季节(2012-2015)进行的前瞻性多中心研究中，确定了因流感住院的患者。逆转录-聚合酶链式反应证实流感病毒感染。根据病毒类型和亚型比较社会人口学和临床变量。结果：566例患者中，56%的患者年龄大于65岁，82%的患者有基础慢性病。甲型流感病毒感染了422名患者(75%)，其中239名患者(57%)感染了H3N2亚型。既往疫苗接种率为38%。发生并发症255例(45%)，主要为肺炎143例(30%)和呼吸衰竭116例(20%)。83例患者(15%)住进ICU，住院死亡率为4%(n=21)。66名患者(12%)接受了奥司他韦治疗。年龄超过65岁是唯一已确定的并发症危险因素。ICU入院的危险因素是没有接种疫苗，入院前没有服用奥司他韦，既往有慢性呼吸道疾病，以及目前吸烟。年龄大于65岁和住ICU是死亡的危险因素。结论：老年人和有基础条件的患者是流感并发症的高危人群。建议这些患者接种疫苗和早期使用奥司他韦，似乎可以减少ICU的入院率。(C)2016爱思唯尔B.V.保留所有权利。
Background: Influenza is an important cause of serious illness and death, particularly in elderly and high risk groups.Objectives: Aim of this study was to identify factors associated with poor outcomes among adults hospitalized in France for laboratory-confirmed seasonal influenza.Study design: Patients hospitalized for influenza were identified in a prospective, multicenter study carried out in French hospitals during three consecutive influenza seasons (2012-2015). Influenza virus infection was confirmed by reverse transcription polymerase chain reaction. Sociodemographic and clinical variables were compared according to the virus type and subtype. Risk factors for complications, intensive care unit (ICU) admission and death were analyzed by backward stepwise logistic regression.Results: The study population consisted of 566 patients, of whom 56% were older than 65 years and 82% had underlying chronic illnesses. Type A influenza viruses infected 422 patients (75%), including subtype H3N2 in 239 patients (57%). The prior vaccine coverage rate was 38%. Complications occurred in 255 patients (45%), consisting mainly of pneumonia (n = 143, 30%) and respiratory failure (n=116, 20%). Eighty-three patients (15%) were admitted to an ICU, and the in-hospital mortality rate was 4% (n = 21). Sixty-six patients (12%) received oseltamivir. Age over 65 years was the only identified risk factor for complications. Risk factors for ICU admission were an absence of vaccination, no oseltamivir administration before admission, pre-existing chronic respiratory disease, and current smoking. Age over 65 years and ICU admission were risk factors for death.Conclusions: Older individuals and patients with underlying conditions are most at risk of influenza complications. Vaccination and early oseltamivir administration, both of which are recommended for these patients, appear to reduce ICU admissions. (C) 2016 Elsevier B.V. All rights reserved.