Risk parameters of fulminant acute respiratory distress syndrome and avian influenza (H5N1) infection in Vietnamese children

Abstract

A clinical picture of patients with acute respiratory distress syndrome (ARDS) induced by highly pathogenic avian influenza A (H5N1) has been reported. We reviewed 37 sets of clinical data for pediatric patients with ARDS at the National Hospital of Pediatrics (Hanoi, Vietnam); 12 patients with H5N1-positive and 25 with H5N1-negative ARDS were enrolled. The H5N1-negative patients had a clinical picture and mortality rate similar to that for the pediatric ARDS patients. However, the H5N1-positive patients had ARDS with normal ventilation capacity at the time of hospital admission, then rapidly proceeded to severe respiratory failure. The survival probability and days until final outcome in groups of H5N1-positive (n=12) vs. H5N1-negative (n=25) patients were 17% versus 52% and 12.3+/-5.7 days (median, 11 days) versus 21.5+/-13.8 days (median, 22 days), respectively. Our observations clarified the clinical picture of H5N1-induced fulminant ARDS and also confirmed that relatively older age (approximately 6 years of age), high fever at onset, and leukopenia and/or thrombocytopenia at the time of hospital admission are risk parameters for H5N1-induced fulminant ARDS.

Table 1

Clinical Features of H5N1-Positive and H5N1-Negative Patients

Table 2

Summary of All Clinical Data

Figure 1

Survival probability for H5N1-positive (solid line) and H5N1-negative (dashed line) patients. For differences between 2 groups, P=.022 (by log-rank test) and P=.038 (Tarone-Ware test). The duration (± standard deviation) with disease until final outcome was 12.3±5.7 days (median, 11 days) for the H5N1-positive group and 21.5±13.8 days (median, 22 days) for the H5N1-negative group