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. 2016 Oct 23;20(1):337.
doi: 10.1186/s13054-016-1512-1.

Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

Francisco Álvarez-Lerma  1   2   3 , Judith Marín-Corral  4   5 , Clara Vila  4 , Joan Ramón Masclans  4   5   6   7 , Francisco Javier González de Molina  8 , Ignacio Martín Loeches  9 , Sandra Barbadillo  10 , Alejandro Rodríguez  6   11 ; H1N1 GETGAG/SEMICYUC Study Group
Collaborators, Affiliations

Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

Francisco Álvarez-Lerma et al. Crit Care. .

Abstract

Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU.

Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis.

Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001).

Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.

Keywords: Critically ill; Early diagnosis; ICU; Influenza A (H1N1)pdm09 virus infection; Late diagnosis; Mortality; Outcome.

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Figures

Fig. 1
Fig. 1
Distribution of patients with influenza A (H1N1)pdm09 virus infection admitted to the ICU according to the date of diagnosis
Fig. 2
Fig. 2
Kaplan–Meier survival curves for critically ill patients admitted to the ICU with confirmed influenza A (H1N1)pdm09 in the early and late diagnostic groups
Fig. 3
Fig. 3
Relationship between severity of illness on ICU admission (APACHE II score) and mortality in the early and late diagnosis of influenza A (H1N1)pdm09 virus infection. APACHE Acute Physiology and Chronic Health Evaluation
See this image and copyright information in PMC

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