Browse > Article
http://dx.doi.org/10.4046/trd.2010.68.3.162

Associated Factor Related to Major Complications of Patients with Hospitalized for 2009 H1N1 Influenza Pneumonia  

Choi, Sang-Sik (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Kim, Won-Young (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Kim, Sung-Han (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine)
Hong, Sang-Bum (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Lim, Chae-Man (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Koh, Youn-Suck (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Kim, Won (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Lim, Kyung-Su (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
Publication Information
Tuberculosis and Respiratory Diseases / v.68, no.3, 2010 , pp. 162-167 More about this Journal
Abstract
Background: To date, there are few data on the risk factors for severe cases and deaths associated with the 2009 pandemic H1N1 influenza A. Here, we describe the clinical and epidemiologic characteristics of patients hospitalized for pneumonia and identify those factors associated with the development of major complications (MC). Methods: We reviewed the medical records of 41 cases of pneumonia admitted to a university-affiliated tertiary hospital between Aug 26 and Dec 10, 2009, and who had confirmed H1N1 influenza A based on real-time reverse transcriptase-polymerase-chain-reaction assay. There were 7,962 patients that fit these criteria. We compared the clinical features and demographic characteristics of patients who developed MC to with those who did not develop MC. Results: During the study period, 10 patients developed MC (required admission to the intensive care unit, n=10; required ventilator therapy, n=6; death, n=4). Patients with MC were significantly older than those without MC and more frequently had underlying medical conditions (90.0% vs 41.9%, p-value <0.01). In the patients with developed MC, the median $PaO_2/FiO_2$ ratio of 230.0 (145.0~347.3) at admission and pneumonia severity index (PSI) score of 141.5 (88.3~158.5) were higher than patients without MC. However, no differences were observed in laboratory findings or in viral shedding between the 2 groups. Conclusion: In hospitalized pneumonia patients of 2009 H1N1 influenza, old age, a history of malignancy, initial hypoxemia, $PaO_2/FiO_2$ ratio, and PSI score appear to be risk factor significantly related to developing MC. These findings might be the basis to influence strategies for admitting patients to an intensive or intermediate care unit and for pre-emptive antiviral therapy.
Keywords
Influenza A Virus, H1N1 Subtype; Pneumonia; Critical Illness; Risk Factors;
Citations & Related Records

Times Cited By SCOPUS : 3
연도 인용수 순위
1 Marchiori E, Zanetti G, Hochhegger B, Rodrigues RS, Fontes CA, Nobre LF, et al. High-resolution computed tomography findings from adult patients with influenza A (H1N1) virus-associated pneumonia. Eur J Radiol 2009 Dec 3. [Epub ahead of print]
2 Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California. JAMA 2009;302:1896-902.   DOI   ScienceOn
3 Morris AE, Stapleton RD, Rubenfeld GD, Hudson LD, Caldwell E, Steinberg KP. The association between body mass index and clinical outcomes in acute lung injury. Chest 2007;131:342-8.   DOI   ScienceOn
4 Centers for Disease Control and Prevention. Intensivecare patients with severe novel influenza A (H1N1) virus infection: Michigan, June 2009. MMWR Morb Mortal Wkly Rep 2009;58:749-52.
5 Source OECD. OECD Factbook 2009: economic, environmental and social statistics [Internet]. Paris: Organisation for Economic Co-operation and Development; c2009 [cited 2009 Dec 20]. Available from: http://puck.sourceoecd.org/vl=18173601/cl=11/nw=1/rpsv/factbook2009/11/01/04/index.htm.
6 Chien YS, Su CP, Tsai HT, Huang AS, Lien CE, Hung MN, et al. Predictors and outcomes of respiratory failure among hospitalized pneumonia patients with 2009 H1N1 influenza in Taiwan. J Infect 2010;60:168-74.   DOI   ScienceOn
7 Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72.
8 Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA 2009;302:1872-9.   DOI   ScienceOn
9 Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify lowrisk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.   DOI   ScienceOn
10 Marras TK, Gutierrez C, Chan CK. Applying a prediction rule to identify low-risk patients with community-acquired pneumonia. Chest 2000;118:1339-43.   DOI   ScienceOn
11 Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003;289:179-86.
12 World Health Organization. CDC protocol of realtime RTPCR for influenza A (H1N1) [Internet]. Geneva: World Health Organization; 2009 [updated 2009 Oct 6; cited 2009 Dec 28]. Available from: http://www.who. int/csr/resources/publications/swineflu/realtimeptpcr/en/index.html.
13 Vaillant L, La Ruche G, Tarantola A, Barboza P. Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009. Euro Surveill 2009;14.pii:19309.
14 Simonsen L, Clarke MJ, Schonberger LB, Arden NH, Cox NJ, Fukuda K. Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. J Infect Dis 1998;178:53-60.   DOI   ScienceOn
15 World Health Organization. New influenza A (H1N1) virus infections: global surveillance summary, may 2009. [Internet]. Geneva: World Health Organization; c2009 [Updated 2009 May 15; cited 2009 Dec 28]. Available from: http://www.who.int/wer/2009/wer8420.pdf.
16 Dolin R. Chapter 180. Influenza. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, editors. Harrison's principles of internal medicine. 17th ed. New York: McGraw-Hill Co., Inc.; 2008. p. 1127-32.
17 Korea Centers for Disease Control and Prevention. H1N1 influenza A (H1N1) press release [Internet].Seoul: Korea center for Disease Control and Prevention; c2009 [Cited 2009 Dec 28]. Available from: http://flu.cdc.go.kr.
18 Centers for Disease Control and Prevention (CDC). Swine influenza A (H1N1) infection in two children: Southern California, March-April 2009. MMWR Morb Mortal Wkly Rep 2009;58:400-2.
19 World Health Organization. H1N1 influenza press release [Internet]. Geneva: World Health Organization; c2009 [updated 2009 Dec 23; cited 2009 Dec 28]. Availabe from: http://www.who.int/csr/don/2009_12_23/en/index. html.