1887

Abstract

This study assessed clinical manifestations and prognostic factors of critically ill patients with severe influenza admitted to the intensive care unit (ICU) in Taiwan’s recent outbreak.

Patients admitted to ICU for severe influenza between January 1, 2015, and March 31, 2016, were identified and their medical records were retrospectively reviewed. The primary endpoints were outcomes and predictors of in-hospital mortality.

There were 125 patients with an average Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 20.8. Hypertension (62.4 %) and diabetes mellitus (40.8 %) were the two most common underlying diseases. Ninety-eight (78.4 %) patients had at least one organ failure: the lungs were the most common (71.2 %), followed by the heart (53.6 %). Two of the most common symptoms of patients at ICU admission were fever (68.0 %) and cough (78.4 %). Thirty-three patients (26.4 %) died; most (40.9 %) were middle-aged (50–65 years old). A Cox regression analysis showed that multiple organ failure (MOF) [hazard ratio (HR)=3.618; 95 % CI=1.058–13.662] was significantly associated with higher risk of death. In contrast, a fluid-negative balance within 7 days of admission (HR=0.362; 95 % CI=0.140–0.934) was significantly associated with a lower risk of death.

The mortality rate of severe influenza patients admitted to the ICU was high, especially in middle-aged adults. The risk of mortality was associated with ≥2 organ failures. A negative fluid balance predicts survival.

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2017-10-01
2024-12-13
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References

  1. Rothberg MB, Haessler SD, Brown RB. Complications of viral influenza. Am J Med 2008; 121:258–264 [View Article][PubMed]
    [Google Scholar]
  2. Gabriel LE, Webb SA. Preparing ICUs for pandemics. Curr Opin Crit Care 2013; 19:467–473 [View Article][PubMed]
    [Google Scholar]
  3. Webb SA, Pettilä V, Seppelt I, Bellomo R, Bailey M et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med 2009; 361:1925–1934 [View Article][PubMed]
    [Google Scholar]
  4. Taylor G, Abdesselam K, Pelude L, Fernandes R, Mitchell R et al. Epidemiological features of influenza in Canadian adult intensive care unit patients. Epidemiol Infect 2016; 144:741–750 [View Article][PubMed]
    [Google Scholar]
  5. Ortiz JR, Neuzil KM, Shay DK, Rue TC, Neradilek MB et al. The burden of influenza-associated critical illness hospitalizations. Crit Care Med 2014; 42:2325–2332 [View Article][PubMed]
    [Google Scholar]
  6. Bonmarin I, Belchior E, Bergounioux J, Brun-Buisson C, Mégarbane B et al. Intensive care unit surveillance of influenza infection in France: the 2009/10 pandemic and the three subsequent seasons. Euro Surveill 2015; 20:pii=30066 [View Article][PubMed]
    [Google Scholar]
  7. Shah NS, Greenberg JA, Mcnulty MC, Gregg KS, Riddell J et al. Severe influenza in 33 US hospitals, 2013–2014: complications and risk factors for death in 507 patients. Infect Control Hosp Epidemiol 2015; 36:1251–1260 [View Article][PubMed]
    [Google Scholar]
  8. Ayscue P, Murray E, Uyeki T, Zipprich J, Harriman K et al. Influenza-associated intensive-care unit admissions and deaths – California, September 29, 2013-January 18, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:143–147[PubMed]
    [Google Scholar]
  9. Catania J, Que LG, Govert JA, Hollingsworth JW, Wolfe CR. High intensive care unit admission rate for 2013–2014 influenza is associated with a low rate of vaccination. Am J Respir Crit Care Med 2014; 189:485–487 [View Article][PubMed]
    [Google Scholar]
  10. Ciuraszkiewicz K, Sielski J, Janion-Sadowska A, Stern A, Zychowicz J et al. Influenza infection in intensive cardiac care unit patients. Pol Merkur Lekarski 2014; 36:203–205[PubMed]
    [Google Scholar]
  11. Hlavinkova L, Kristufkova Z, Mikas J. Risk factors for severe outcome of cases with pandemic influenza A(H1N1)pdm09. Bratisl Lek Listy 2015; 116:389–393 [View Article][PubMed]
    [Google Scholar]
  12. Nermin KG, Remzi I, Zeynep A, Ilker C, Meltem OT et al. A retrospective evaluation of critically ill patients infected with H1N1 influenza A virus in Bursa, Turkey, during the 2009–2010 pandemic. Afr Health Sci 2015; 15:352–359 [View Article][PubMed]
    [Google Scholar]
  13. Placzek HE, Madoff LC. Association of age and comorbidity on 2009 influenza A pandemic H1N1-related intensive care unit stay in Massachusetts. Am J Public Health 2014; 104:e118-e125 [View Article][PubMed]
    [Google Scholar]
  14. Poulikakos P, Tsispara A, Vartzeli P, Zakka M. Critically ill cancer patients with influenza (H1N1) infection in the intensive care unit in Greece. Acta Oncol 2015; 54:1081–1082 [View Article][PubMed]
    [Google Scholar]
  15. Rohani P, Jude CM, Chan K, Barot N, Kamangar N. Chest radiological findings of patients with severe h1n1 pneumonia requiring intensive care. J Intensive Care Med 2016; 31:51–60 [View Article][PubMed]
    [Google Scholar]
  16. Töpfer L, Menk M, Weber-Carstens S, Spies C, Wernecke KD et al. Influenza A (H1N1) vs non-H1N1 ARDS: analysis of clinical course. J Crit Care 2014; 29:340–346 [View Article][PubMed]
    [Google Scholar]
  17. Chiu SC, Lin JH, Wang HC, Wu HS, Chang HW et al. Molecular epidemiologic and clinical characteristics of influenza B-associated complications among hospitalized patients during an outbreak in Taiwan. Int J Infect Dis 2014; 23:94–100 [View Article][PubMed]
    [Google Scholar]
  18. Wu UI, Wang JT, Ho YC, Pan SC, Chen YC et al. Factors associated with development of complications among adults with influenza: a 3-year prospective analysis. J Formos Med Assoc 2012; 111:364–369 [View Article][PubMed]
    [Google Scholar]
  19. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307:2526–2533 [View Article][PubMed]
    [Google Scholar]
  20. Chen CM, Chan KS, Yu WL, Cheng KC, Chao HC et al. The outcomes of patients with severe dengue admitted to intensive care units. Medicine 2016; 95:e4376 [View Article][PubMed]
    [Google Scholar]
  21. Álvarez-Lerma F, Marín-Corral J, Vila C, Masclans JR, González de Molina FJ et al. Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome. Crit Care 2016; 20:337 [View Article][PubMed]
    [Google Scholar]
  22. Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006; 354:909–2575 [View Article][PubMed]
    [Google Scholar]
  23. Silversides JA, Major E, Ferguson AJ, Mann EE, McAuley DF et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med 2017; 43:155–170 [View Article][PubMed]
    [Google Scholar]
  24. Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 2014; 46:361–380 [View Article][PubMed]
    [Google Scholar]
  25. Seethala RR, Hou PC, Aisiku IP, Frendl G, Park PK et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann Intensive Care 2017; 7:11 [View Article][PubMed]
    [Google Scholar]
  26. Martin-Loeches I, J Schultz M, Vincent JL, Alvarez-Lerma F, Bos LD et al. Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med 2017; 43:48–58 [View Article][PubMed]
    [Google Scholar]
  27. Shah NS, Greenberg JA, McNulty MC, Gregg KS, Riddell J et al. Bacterial and viral co-infections complicating severe influenza: Incidence and impact among 507 U.S. patients, 2013–14. JClin Virol 2016; 80:12–19 [View Article]
    [Google Scholar]
  28. Crum-Cianflone NF. Invasive aspergillosis associated with severe influenza infections. Open Forum Infect Dis 2016; 3:ofw171 [View Article][PubMed]
    [Google Scholar]
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