#Haematological characteristics and #risk #factors in the #classification and #prognosis evaluation of #COVID19: a retrospective cohort study (Lancet Hematol., abstract)

[Source: Lancet Hematology, full page: (LINK). Abstract, edited.]

Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study

Danying Liao, MD *, Prof Fen Zhou, MD *, Lili Luo, MS, Min Xu, BS, Prof Hongbo Wang, MD, Prof Jiahong Xia, MD, Prof Yong Gao, MD, Prof Liqiong Cai, MD, Zhihui Wang, BS, Prof Ping Yin, PhD, Prof Yadan Wang, MD, Lu Tang, BS, Jun Deng, MD, Prof Heng Mei, MD †, Prof Yu Hu, MD  †

Published: July 10, 2020 | DOI: https://doi.org/10.1016/S2352-3026(20)30217-9

 

Summary

Background

COVID-19 is an ongoing global pandemic. Changes in haematological characteristics in patients with COVID-19 are emerging as important features of the disease. We aimed to explore the haematological characteristics and related risk factors in patients with COVID-19.

Methods

This retrospective cohort study included patients with COVID-19 admitted to three designated sites of Wuhan Union Hospital (Wuhan, China). Demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records and compared between patients with moderate, severe, and critical disease (defined according to the diagnosis and treatment protocol for novel coronavirus pneumonia, trial version 7, published by the National Health Commission of China). We assessed the risk factors associated with critical illness and poor prognosis. Dynamic haematological and coagulation parameters were investigated with a linear mixed model, and coagulopathy screening with sepsis-induced coagulopathy and International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation scoring systems was applied.

Findings

Of 466 patients admitted to hospital from Jan 23 to Feb 23, 2020, 380 patients with COVID-19 were included in our study. The incidence of thrombocytopenia (platelet count <100 × 109 cells per L) in patients with critical disease (42 [49%] of 86) was significantly higher than in those with severe (20 [14%] of 145) or moderate (nine [6%] of 149) disease (p<0·0001). The numbers of lymphocytes and eosinophils were significantly lower in patients with critical disease than those with severe or moderate disease (p<0·0001), and prothrombin time, D-dimer, and fibrin degradation products significantly increased with increasing disease severity (p<0·0001). In multivariate analyses, death was associated with increased neutrophil to lymphocyte ratio (≥9·13; odds ratio [OR] 5·39 [95% CI 1·70–17·13], p=0·0042), thrombocytopenia (platelet count <100 × 109 per L; OR 8·33 [2·56–27·15], p=0·00045), prolonged prothrombin time (>16 s; OR 4·94 [1·50–16·25], p=0·0094), and increased D-dimer (>2 mg/L; OR 4·41 [1·06–18·30], p=0·041). Thrombotic and haemorrhagic events were common complications in patients who died (19 [35%] of 55). Sepsis-induced coagulopathy and International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation scores (assessed in 12 patients who survived and eight patients who died) increased over time in patients who died. The onset of sepsis-induced coagulopathy was typically before overt disseminated intravascular coagulation.

Interpretation

Rapid blood tests, including platelet count, prothrombin time, D-dimer, and neutrophil to lymphocyte ratio can help clinicians to assess severity and prognosis of patients with COVID-19. The sepsis-induced coagulopathy scoring system can be used for early assessment and management of patients with critical disease.

Funding

National Key Research and Development Program of China.

Keywords: SARS-CoV-2; COVID-19; Immunopathology; Thrombocytopenia; Coagulopathy; Sepsis.

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#Cytokine #Storms: Understanding #COVID19 (Immunity, abstract)

[Source: Immunity, full page: (LINK). Abstract, edited.]

Cytokine Storms: Understanding COVID-19

Nilam Mangalmurti, Christopher A. Hunter

Published: June 28, 2020 | DOI: https://doi.org/10.1016/j.immuni.2020.06.017

 

Summary

The elevated circulating levels of cytokines associated with a variety of infectious and immune-mediated conditions are frequently termed a cytokine storm. Here, we explain the protective functions of cytokines in “ideal” responses; the multi-factorial origins that can drive these responses to become pathological; and how this ultimately leads to vascular damage, immunopathology, and worsening clinical outcomes.

Keywords: SARS-CoV-2; COVID-19; Cytokines; Immunopathology.

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Characteristics and #outcomes of #patients hospitalized for #COVID19 and #cardiac disease in Northern #Italy (Eur Heart J., abstract)

[Source: European Heart Journal, full page: (LINK). Abstract, edited.]

Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy

Riccardo M Inciardi, Marianna Adamo, Laura Lupi, Dario S Cani, Mattia Di Pasquale, Daniela Tomasoni, Leonardo Italia, Gregorio Zaccone, Chiara Tedino, Davide Fabbricatore, Antonio Curnis, Pompilio Faggiano, Elio Gorga, Carlo M Lombardi, Giuseppe Milesi, Enrico Vizzardi, Marco Volpini, Savina Nodari, Claudia Specchia, Roberto Maroldi, Michela Bezzi, Marco Metra

European Heart Journal, ehaa388, https://doi.org/10.1093/eurheartj/ehaa388

Published: 08 May 2020

 

Abstract

Aims

To compare demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for COVID-19 in Brescia, Lombardy, Italy.

Methods and results

The study population includes 99 consecutive patients with COVID-19 pneumonia admitted to our hospital between 4 March and 25 March 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and non-cardiac patients except for higher values of serum creatinine, N-terminal probrain natriuretic peptide, and high sensitivity troponin T in cardiac patients. During hospitalization, 26% patients died, 15% developed thrombo-embolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank P = 0.019; relative risk 2.35; 95% confidence interval 1.08–5.09). The rate of thrombo-embolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively).

Conclusions

Hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease, with higher mortality, thrombo-embolic events, and septic shock rates.

COVID-19, Cardiovascular disease, Pneumonia, Mortality

Issue Section: FAST TRACK CLINICAL RESEARCH

Keywords: SARS-CoV-2; COVID-19; Italy; Cardiology; ARDS; Sepsis; Coagulopathy.

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Late-Onset #Neonatal #Sepsis in a Patient with #Covid19 (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Late-Onset Neonatal Sepsis in a Patient with Covid-19

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To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations for evaluation or treatment. In the interest of timeliness, these reports are evaluated by in-house editors, with peer review reserved for key points as needed.

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A 3-week-old boy presented with a 2-day history of nasal congestion, tachypnea, and reduced feeding. He was born at 36 weeks of gestation to a 21-year-old woman (gravida 3, para 1) who had received antenatal treatment for carriage of group B streptococci. He had previously received a 48-hour course of antibiotics for suspected neonatal sepsis because of a fever (temperature, 38.5°C), but the workup for sepsis was negative, and he was discharged home.

(…)

Keywords: SARS-CoV-2; COVID-19; Pediatrics; Sepsis; Antivirals; Chloroquine; Azithromycin.

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#SARS-CoV-2 and #viral #sepsis: observations and hypotheses (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

SARS-CoV-2 and viral sepsis: observations and hypotheses

Hui Li, MD, Prof Liang Liu, MD, Prof Dingyu Zhang, MD, Jiuyang Xu, MD, Prof Huaping Dai, MD, Nan Tang, PhD, Prof Xiao Su, PhD, Prof Bin Cao, MD

Published: April 17, 2020 | DOI: https://doi.org/10.1016/S0140-6736(20)30920-X

 

Summary

Since the outbreak of coronavirus disease 2019 (COVID-19), clinicians have tried every effort to understand the disease, and a brief portrait of its clinical features have been identified. In clinical practice, we noticed that many severe or critically ill COVID-19 patients developed typical clinical manifestations of shock, including cold extremities and weak peripheral pulses, even in the absence of overt hypotension. Understanding the mechanism of viral sepsis in COVID-19 is warranted for exploring better clinical care for these patients. With evidence collected from autopsy studies on COVID-19 and basic science research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV, we have put forward several hypotheses about SARS-CoV-2 pathogenesis after multiple rounds of discussion among basic science researchers, pathologists, and clinicians working on COVID-19. We hypothesise that a process called viral sepsis is crucial to the disease mechanism of COVID-19. Although these ideas might be proven imperfect or even wrong later, we believe they can provide inputs and guide directions for basic research at this moment.

Keywords: SARS-CoV-2; COVID-19; Sepsis.

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#Care for Critically Ill #Patients With #COVID19 (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

Care for Critically Ill Patients With COVID-19

Srinivas Murthy, MD, CM, MHSc1; Charles D. Gomersall, MBBS2; Robert A. Fowler, MD, CM, MSc3

Author Affiliations: 1 University of British Columbia, Vancouver, British Columbia, Canada; 2 Chinese University of Hong Kong, Hong Kong; 3 Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada

JAMA. Published online March 11, 2020. doi:10.1001/jama.2020.3633

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Initial reports suggest that COVID-19 is associated with severe disease that requires intensive care in approximately 5% of proven infections.1 Given how common the disease is becoming, as in prior major severe acute respiratory infection outbreaks—SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), avian influenza A(H7N9), and influenza A(H1N1)pdm09—critical care will be an integral component of the global response to this emerging infection.

(…)

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Corresponding Author: Srinivas Murthy, MD, CM, MHSc, University of British Columbia, 4500 Oak St, Vancouver, BC V6H 3V4, Canada (srinivas.murthy@cw.bc.ca).

Published Online: March 11, 2020. doi:10.1001/jama.2020.3633

Conflict of Interest Disclosures: Dr Gomersall reported that his department has received funding to develop educational material from Getinge, Draeger Medical, Hamilton Medical, and Fisher & Paykel. No other disclosures were reported.

Additional Contributions: We thank the International Forum of Acute Care Trialists (InFACT) for assistance.

Keywords: SARS-COV-2; COVID-19; Intensive care.

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#Clinical and #Laboratory Factors Predicting the #Prognosis of Patients with #COVID19: An Analysis of 127 Patients in #Wuhan, #China (SSRN, abstract)

[Source: SSRN, full page: (LINK). Abstract, edited.]

Clinical and Laboratory Factors Predicting the Prognosis of Patients with COVID-19: An Analysis of 127 Patients in Wuhan, China

30 Pages Posted: 5 Mar 2020

Tao Bai, Huazhong University of Science and Technology (Formerly Tongi Medical University) – Division of Gastroenterology; Shengjin Tu, Wuhan Jinyintan Hospital – Department of Tuberculosis and Respiratory; Yuan Wei, Wuhan Jinyintan Hospital – Department of Tuberculosis and Respiratory; Li Xiao, Huazhong University of Science and Technology (Formerly Tongi Medical University) – Division of Gastroenterology; Yan Jin, Huazhong University of Science and Technology (Formerly Tongi Medical University) – Division of Gastroenterology; Lei Zhang, Huazhong University of Science and Technology (Formerly Tongi Medical University) – Division of Gastroenterology; Jun Song, Huazhong University of Science and Technology (Formerly Tongi Medical University) – Division of Gastroenterology; Weihua Liu, Wuhan Jinyintan Hospital – Department of Tuberculosis and Respiratory; Qingjing Zhu, Wuhan Jinyintan Hospital – Liver and Infectious Diseases Department; Ling Yang, Huazhong University of Science and Technology (Formerly Tongi Medical University) – Division of Gastroenterology; Hua Chen, Wuhan Jinyintan Hospital – Department of Tuberculosis and Respiratory; Xiaohua Hou, Huazhong University of Science and Technology (Formerly Tongi Medical University) – Division of Gastroenterology

 

Abstract

BACKGROUND:

Corona virus infective disease 2019(COVID-19) is an emerging infectious disease that first outbreak in humans in China in December 2020 and has subsequently spread worldwide. This study aimed to describe and evaluate the clinical and laboratory indexes to predict the outcome of COVID-19.

METHODS:

Consecutive patients with confirmed COVID-19 admitted to Jinyintan hospitals in Wuhan, China were included from December 26 to January31 2020. All patients had definite clinical outcome (discharge or death) before February 10. The area under the receiver operating characteristic curve (AUC) of subjects was used to evaluate the prediction efficiency of laboratory parameters. Multiple logistic regression was used to evaluate the independent prognostic factors.

FINDINGS:

The study included 127 hospitalized patients with confirmed COVID-19, with 91 cured and 36 died patients. The most common complications of COVID-19 death were acute cardiac injury (21 patients, 58.3%), ARDS (20 patients, 55.6%), coagulation dysfunction (14 patients, 38.9%), and acute kidney injury (12 patients, 33.3%). Died patients was more likely to have multiple organ dysfunction syndrome (p<0.001). The died patients had deteriorated at-admission liver and kidney function, tissue damage related biomarkers (lactate dehydrogenase, creatine kinase and troponin I) , prolonged prothrombin time. The inflammatory biomarkers, including c-reactive protein, ferritin, procalcitonin and interleukin-6 (IL-6) levels also significantly increased. The area under the receiver operating characteristic curve (AUC) showed that at-admission CD3 positive-, CD4 positive- and CD8 positive- lymphocyte counts had good prognostic values for clinical outcomes (AUC=0.915, 0.886 and 0.870, respectively) while lymphocyte counts in blood routine test was moderate (AUC=0.732). Moreover, the prognostic values of lactate dehydrogenase, troponin I, prothrombin time, and procalcitonin were good (AUC=0.928, =0.939, =0.920, and =0.900, respectively. Multiple regression model showed that CD3+ lymphocyte counting ≤470/ µl, prothrombin time≥13.5 s and procalcitonin≥0.15 ng/ml were independent prognostic factors for death.

INTERPRETATION:

The predictive effect of CD3+ lymphocyte typing count on the clinical outcome of COVID-19 was better than that of routine lymphocyte count. Elevated at-admission procalcitonin and prothrombin time were independent prognostic factors for death.

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FUNDING STATEMENT: Urgent projects of scientific and technological research on COVID funded by Hubei province

DECLARATION OF INTERESTS: The authors declare no competing interests.

ETHICS APPROVAL STATEMENT: This study was approved by the Institutional Ethics Board of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology and Jinyintan Hospital.

Keywords: Novel coronavirus disease 2019; SARS-CoV-2;outcome; prognostic value;laboratory Parameters

Suggested Citation: Bai, Tao and Tu, Shengjin and Wei, Yuan and Xiao, Li and Jin, Yan and Zhang, Lei and Song, Jun and Liu, Weihua and Zhu, Qingjing and Yang, Ling and Chen, Hua and Hou, Xiaohua, Clinical and Laboratory Factors Predicting the Prognosis of Patients with COVID-19: An Analysis of 127 Patients in Wuhan, China (2/26/2020). Available at SSRN: https://ssrn.com/abstract=3546118

Keywords: SARS-CoV-2; COVID-19; Sepsis; Septic shock; ARDS.

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#Sepsis-associated #ARDS in individuals of #European #ancestry: a #genome-wide association study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Sepsis-associated acute respiratory distress syndrome in individuals of European ancestry: a genome-wide association study

Beatriz Guillen-Guio, MSc, Jose M Lorenzo-Salazar, MSc, Shwu-Fan Ma, PhD, Pei-Chi Hou, PhD, Tamara Hernandez-Beeftink, MSc, Almudena Corrales, LT, M Isabel García-Laorden, PhD, Jonathan Jou, MD, Elena Espinosa, MD, Arturo Muriel, MD, David Domínguez, MD, Leonardo Lorente, MD, María M Martín, MD, Carlos Rodríguez-Gallego, MD, Jordi Solé-Violán, MD, Alfonso Ambrós, MD, Demetrio Carriedo, MD, Jesús Blanco, MD, José M Añón, MD, John P Reilly, MD, Tiffanie K Jones, MD, Caroline AG Ittner, PhD, Rui Feng, PhD, Franziska Schöneweck, MSc, Michael Kiehntopf, MD, Imre Noth, MD, Markus Scholz, PhD, Frank M Brunkhorst, MD, André Scherag, PhD, Nuala J Meyer, MD, Jesús Villar, MD, Carlos Flores, PhD

Published: January 23, 2020 / DOI: https://doi.org/10.1016/S2213-2600(19)30368-6

 

Summary

Background

Acute respiratory distress syndrome (ARDS) is a lung inflammatory process caused mainly by sepsis. Most previous studies that identified genetic risks for ARDS focused on candidates with biological relevance. We aimed to identify novel genetic variants associated with ARDS susceptibility and to provide complementary functional evidence of their effect in gene regulation.

Methods

We did a case-control genome-wide association study (GWAS) of 1935 European individuals, using patients with sepsis-associated ARDS as cases and patients with sepsis without ARDS as controls. The discovery stage included 672 patients admitted into a network of Spanish intensive care units between January, 2002, and January, 2017. The replication stage comprised 1345 individuals from two independent datasets from the MESSI cohort study (Sep 22, 2008–Nov 30, 2017; USA) and the VISEP (April 1, 2003–June 30, 2005) and MAXSEP (Oct 1, 2007–March 31, 2010) trials of the SepNet study (Germany). Results from discovery and replication stages were meta-analysed to identify association signals. We then used RNA sequencing data from lung biopsies, in-silico analyses, and luciferase reporter assays to assess the functionallity of associated variants.

Findings

We identified a novel genome-wide significant association with sepsis-associated ARDS susceptibility (rs9508032, odds ratio [OR] 0·61, 95% CI 0·41–0·91, p=5·18 × 10 −8) located within the Fms-related tyrosine kinase 1 ( FLT1) gene, which encodes vascular endothelial growth factor receptor 1 (VEGFR-1). The region containing the sentinel variant and its best proxies acted as a silencer for the FLT1 promoter, and alleles with protective effects in ARDS further reduced promoter activity (p=0·0047). A literature mining of all previously described ARDS genes validated the association of vascular endothelial growth factor A ( VEGFA; OR 0·55, 95% CI 0·41–0·73; p=4·69 × 10 −5).

Interpretation

A common variant within the FLT1 gene is associated with sepsis-associated ARDS. Our findings support a role for the vascular endothelial growth factor signalling pathway in ARDS pathogenesis and identify VEGFR-1 as a potential therapeutic target.

Funding

Instituto de Salud Carlos III, European Regional Development Funds, Instituto Tecnológico y de Energías Renovables.

Keywords: ARDS; Sepsis; Genetics.

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#Incidence, #trends, and #outcomes of #infection sites among #hospitalizations of #sepsis: A nationwide study (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study

Eric H. Chou, Shaynna Mann, Tzu-Chun Hsu, Wan-Ting Hsu, Carolyn Chia-Yu Liu, Toral Bhakta, Dahlia M. Hassani, Chien-Chang Lee

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Published: January 13, 2020 / DOI: https://doi.org/10.1371/journal.pone.0227752

 

Abstract

Purpose

To determine the trends of infection sites and outcome of sepsis using a national population-based database.

Materials and methods

Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.

Results

During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).

Conclusions

The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.

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Citation: Chou EH, Mann S, Hsu T-C, Hsu W-T, Liu CC-Y, Bhakta T, et al. (2020) Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study. PLoS ONE 15(1): e0227752. https://doi.org/10.1371/journal.pone.0227752

Editor: Florian B. Mayr, University of Pittsburgh, UNITED STATES

Received: June 5, 2019; Accepted: December 27, 2019; Published: January 13, 2020

Copyright: © 2020 Chou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Sepsis; USA.

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#Epidemiology and clinical #outcomes of hospitalizations for acute respiratory or febrile illness and laboratory-confirmed #influenza among #pregnant women during six influenza seasons, 2010-2016 (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Epidemiology and clinical outcomes of hospitalizations for acute respiratory or febrile illness and laboratory-confirmed influenza among pregnant women during six influenza seasons, 2010-2016

Fatimah S Dawood, Shikha Garg, Rebecca V Fink, Margaret L Russell, Annette K Regan, Mark A Katz, Stephanie Booth, Hannah Chung, Nicola P Klein, Jeffrey C Kwong, Avram Levy, Allison Naleway, Dan Riesel, Mark G Thompson, Brandy E Wyant, Deshayne B Fell on behalf of the PREVENT workgroup

The Journal of Infectious Diseases, jiz670, https://doi.org/10.1093/infdis/jiz670

Published: 26 December 2019

 

Abstract

Background

Pregnant women are at increased risk of seasonal influenza hospitalizations, but data about the epidemiology of severe influenza among pregnant women remain largely limited to pandemics.

Methods

To describe the epidemiology of hospitalizations for acute respiratory infection or febrile illness (ARFI) and influenza-associated ARFI among pregnant women, administrative and electronic health record data were analyzed from retrospective cohorts of pregnant women hospitalized with ARFI who had testing for influenza viruses by RT-PCR in Australia, Canada, Israel and the United States during 2010-2016.

Results

Of 18,048 ARFI-coded hospitalizations, 1,064 (6%) included RT-PCR testing for influenza viruses, of which 614 (58%) were influenza-positive. Of 614 influenza-positive ARFI hospitalizations, 35% were in women with low socioeconomic status, 20% with underlying conditions, and 67% in their third trimesters. The median length of influenza-positive hospitalizations was 2 days (IQR 1-4), 18% (95% confidence interval (CI) 15-21%) resulted in delivery, 10% (95% CI 8-12%) included a pneumonia diagnosis, 5% (95% CI 3-6%) required intensive care, 2% (95% CI 1-3%) included a sepsis diagnosis, and <1% (95% CI 0-1%) resulted in respiratory failure.

Conclusions

Our findings characterize seasonal influenza hospitalizations among pregnant women and can inform assessments of the public health and economic impact of seasonal influenza on pregnant women.

Influenza, Pregnant, Hospitalization

This content is only available as a PDF.

Published by Oxford University Press for the Infectious Diseases Society of America 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US.

This work is written by (a) US Government employee(s) and is in the public domain in the US.

Keywords: Seasonal Influenza; Pregnancy; Pneumonia; Intensive care; Sepsis.

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