Excess mortality is associated with influenza A (H1N1) in patients with severe acute respiratory illness
| Autor: | Flavia Queiroz, Livia Gonçalez de Godoy, Nathália Pimentel Furlan, Maria Lúcia Machado Salomão, Estela Silva Simões, Guilherme Hirassawa Sacillotto, Rayane Estefani Ribas Da Silva Teixeira, Inara Cristina Marciano Frini, Maurício Lacerda Nogueira, Luis Henrique Simões Covello, Aripuanã Sakurada Aranha Watanabe, Neymar Elias de Oliveira, Suzana Margareth Lobo, Joelma Vilafanha Gandolfi, Karina Rocha Dutra |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty ARDS Oseltamivir 030106 microbiology Population Antiviral Agents Virus Time-to-Treatment 03 medical and health sciences chemistry.chemical_compound Influenza A Virus H1N1 Subtype 0302 clinical medicine Risk Factors Virology Internal medicine Influenza Human Pandemic Humans Medicine Hospital Mortality 030212 general & internal medicine Respiratory system education Prospective cohort study Respiratory Tract Infections Aged Inflammation Respiratory Distress Syndrome education.field_of_study business.industry virus diseases Influenza a Middle Aged medicine.disease Infectious Diseases chemistry Influenza Vaccines Female business |
| Zdroj: | Journal of Clinical Virology. 116:62-68 |
| ISSN: | 1386-6532 |
| DOI: | 10.1016/j.jcv.2019.05.003 |
| Popis: | Background 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. Objectives 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. Study design. 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. Results 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. Conclusions 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. |
| Databáze: | OpenAIRE |
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