[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]
J Clin Virol. 2019 May 8;116:62-68. doi: 10.1016/j.jcv.2019.05.003. [Epub ahead of print]
Excess mortality is associated with influenza A (H1N1) in patients with severe acute respiratory illness.
Lobo SM1, Watanabe ASA2, Salomão MLM3, Queiroz F3, Gandolfi JV4, de Oliveira NE4, Covello LHS4, Sacillotto GH4, de Godoy LG4, Simões ES4, Frini ICM4, Da Silva Teixeira RER4, Furlan NP4, Dutra KR4, Nogueira ML2.
Author information: 1 Intensive Care Division – Hospital De Base -FAMERP, São José Do Rio Preto, SP – Brasil. Electronic address: firstname.lastname@example.org. 2 Virology Laboratory – Famerp, São José Do Rio Preto SP – Brasil; Epidemiology Department – FAMERP, São José Do Rio Preto, SP – Brasil. 3 Department Of Epidemiology – FAMERP, São José Do Rio Preto SP – Brasil; Intensive Care Division – Hospital De Base – Famerp, São José Do Rio Preto, SP – Brasil. 4 Intensive Care Division – Hospital De Base -FAMERP, São José Do Rio Preto, SP – Brasil.
Acute respiratory infections caused by viruses are among the leading causes of morbidity and mortality. The inflammatory response that follows viral infection is important for the control of virus proliferation. However, if overwhelming, may be associated with complicated outcomes.
We assessed the clinical characteristics of patients with severe acute respiratory illness (SARI) evolving to acute respiratory distress syndrome (ARDS) and the factors related to death.
Prospective study in 273 adult patients with SARI performed in a university-affiliated 800-bed hospital serving an area of epidemiologic vigilance of 102 municipalities and more than 2 million inhabitants. Influenza A (H1N1) 2009 (A/H1N1), influenza A H3N2, and influenza B were tested in all patients by RT-PCR.
The overall hospital mortality rate was 17.6%. A total of 30.4% of patients tested positive for influenza A/H1N1. Patients with SARI that evolved to ARDS took significantly longer to take the first dose of oseltamivir (6.0 vs 1.0 days, p=0.002). Patients with H1N1 positive tests had almost 3 times higher probability of death, despite having significantly less comorbidities (p=0.027). The influenza A/H1N1 pdm09 vaccine reduced the odds of death by 78%. Nonsurvivors had a more intense inflammatory response than did survivors at 48 h (C-reactive protein: 31.0 ± 17.5 vs. 14.6 ± 8.9 mg/dl, p=0.001) as well as a more positive fluid balance.
Hospital mortality associated with influenza H1N1-associated SARI and ARDS continued to be high years after the 2009 pandemic in a population with low vaccine coverage. Antiviral treatment started more than two days after onset of symptoms was more frequently associated with ARDS and death and, having had vaccine against influenza A (H1N1) was a factor independently related to survival.
Copyright © 2019 Elsevier B.V. All rights reserved.
KEYWORDS: Acute respiratory distress syndrome; C-reactive protein; Influenza A virus; Severe acute respiratory illness; Viral pneumonia
PMID: 31103803 DOI: 10.1016/j.jcv.2019.05.003
Keywords: Seasonal Influenza; H1N1pdm09; ARDS; SARI.