Host response dysregulations amongst adults hospitalized by influenza A H1N1 virus pneumonia: A prospective multicenter cohort study.

Autor: Valenzuela-Méndez B; Gynecology and Obstetrics Department, Hospital Municipal de Badalona, Spain. Universitat Autonòma de Barcelona, Barcelona, Spain., Valenzuela-Sánchez F; Critical Care Medicine Unit, University Hospital of Jerez, Jerez de la Frontera, Spain; Hematology Department, University Hospital of Jerez, Jerez de la Frontera, Spain. Electronic address: pacovaes@yahoo.es., Rodríguez-Gutiérrez JF; Hematology Department, University Hospital of Jerez, Jerez de la Frontera, Spain., Bohollo-de-Austria R; Critical Care Medicine Unit, University Hospital of Jerez, Jerez de la Frontera, Spain., Estella Á; Critical Care Medicine Unit, University Hospital of Jerez, Jerez de la Frontera, Spain; Department of Medicine Faculty of Medicine University of Cádiz, Spain., Martínez-García P; Critical Care Medicine Unit, University Hospital Puerto Real, Puerto Real, Spain., Ángela González-García M; Department of Clinical Analysis. University Hospital of Jerez, Jerez de la Frontera, Spain., Waterer G; Respiratory Department, University of Western Australia, Royal Perth Hospital, Australia., Rello J; Clinical Research, CHU Nîmes, Nîmes, France; Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.
Jazyk: angličtina
Zdroj: European journal of internal medicine [Eur J Intern Med] 2022 Oct; Vol. 104, pp. 89-97. Date of Electronic Publication: 2022 Jul 30.
DOI: 10.1016/j.ejim.2022.07.010
Abstrakt: Background: Limited knowledge exists on how early host response impacts outcomes in influenza pneumonia.
Methods: This study assessed what was the contribution of host immune response at the emergency department on hospital mortality amongst adults with influenza A H1N1pdm09 pneumonia and whether early stratification by immune host response anticipates the risk of death. This is a secondary analysis from a prospective, observational, multicenter cohort comparing 75 adults requiring intensive care with 38 hospitalized in medical wards. Different immune response biomarkers within 24 h of hospitalization and their association with hospital mortality were assessed.
Results: Fifty-three were discharged alive. Non-survivors were associated (p<0.05) with lower lymphocytes (751 vs. 387), monocytes (450 vs. 220) expression of HLA-DR (1,662 vs. 962) and higher IgM levels (178 vs. 152;p<0.01). Lymphocyte subpopulations amongst non-survivors showed a significantly (p<0.05) lower number of TCD3+ (247.2 vs. 520.8), TCD4+ (150.3 vs. 323.6), TCD8+ (95.3 vs. 151.4) and NKCD56+ (21.9 vs. 91.4). Number of lymphocytes, monocytes and NKCD56+ predicted hospital mortality (AUC 0.854). Hospital mortality was independently associated with low HLA-DR values, low number of NKCD56+ cells, and high IgM levels, in a Cox-proportional hazard analysis. A second model, documented that hospital mortality was independently associated with a phenotype combining immunoparalysis with hyperinflammation (HR 5.53; 95%CI 2.16-14.14), after adjusting by predicted mortality.
Conclusions: We conclude that amongst influenza pneumonia, presence of immunoparalysis was a major mortality driver. Influenza heterogeneity was partly explained by early specific host response dysregulations which should be considered to design personalized approaches of adjunctive therapy.
(Copyright © 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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