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Multicenter Study
. 2011;15(6):R286.
doi: 10.1186/cc10573. Epub 2011 Nov 28.

Pandemic and post-pandemic influenza A (H1N1) infection in critically ill patients

Ignacio Martin-Loeches  1 , Emili Díaz, Loreto Vidaur, Antoni Torres, Cesar Laborda, Rosa Granada, Juan Bonastre, Mar Martín, Josu Insausti, Angel Arenzana, Jose Eugenio Guerrero, Ines Navarrete, Jesus Bermejo-Martin, David Suarez, Alejandro Rodriguez; H1N1 SEMICYUC/REIPI/CIBERES Working group
Collaborators, Affiliations
Multicenter Study

Pandemic and post-pandemic influenza A (H1N1) infection in critically ill patients

Ignacio Martin-Loeches et al. Crit Care. 2011.

Abstract

Background: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described.

Methods: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period.

Results: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period.

Conclusion: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection.

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Figures

Figure 1
Figure 1
Pandemic and post-pandemic age-specific influenza ICU admission.
See this image and copyright information in PMC

References

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