Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients
Open Access
- 8 April 2020
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 9 (4), 1073
- https://doi.org/10.3390/jcm9041073
Abstract
Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using two variables with statistically significant associations with mortality. Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 h after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 3.7 mmol/L with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels 3.7 mmol/L and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. We identified clinical and laboratory predictors of mortality that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.Keywords
Funding Information
- Kaohsiung Chang Gung Memorial Hospital (CMRPG8H0241)
This publication has 38 references indexed in Scilit:
- Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus InfectionThe Journal of Infectious Diseases, 2012
- Critically Ill Children During the 2009–2010 Influenza Pandemic in the United StatesPEDIATRICS, 2011
- Hospitalized Patients with 2009 H1N1 Influenza in the United States, April–June 2009The New England Journal of Medicine, 2009
- Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress SyndromePublished by American Medical Association (AMA) ,2009
- Critically Ill Patients With 2009 Influenza A(H1N1) Infection in CanadaPublished by American Medical Association (AMA) ,2009
- Severe Human Influenza Infections in Thailand: Oseltamivir Treatment and Risk Factors for Fatal OutcomePLOS ONE, 2009
- Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in HumansThe New England Journal of Medicine, 2009
- Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in SpainCritical Care, 2009
- Influenza-Associated Hospitalizations in the United StatesJama-Journal Of The American Medical Association, 2004
- InfluenzaThe Lancet, 2003