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. 2020 May 6;70(10):2121-2130.
doi: 10.1093/cid/ciz638.

Outcomes of Immunocompromised Adults Hospitalized With Laboratory-confirmed Influenza in the United States, 2011-2015

Jennifer P Collins  1   2 , Angela P Campbell  3 , Kyle Openo  2 , Monica M Farley  2   4 , Charisse Nitura Cummings  3 , Mary Hill  5 , William Schaffner  6 , Mary Lou Lindegren  6 , Ann Thomas  7 , Laurie Billing  8 , Nancy Bennett  9 , Nancy Spina  10 , Marisa Bargsten  11 , Ruth Lynfield  12 , Seth Eckel  13 , Patricia Ryan  14 , Kimberly Yousey-Hindes  15 , Rachel Herlihy  16 , Pam Daily Kirley  17 , Shikha Garg  3 , Evan J Anderson  1   2   4
Affiliations

Outcomes of Immunocompromised Adults Hospitalized With Laboratory-confirmed Influenza in the United States, 2011-2015

Jennifer P Collins et al. Clin Infect Dis. .

Abstract

Background: Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-IC adults.

Methods: We identified adults hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had human immunodefiency virus (HIV)/AIDS, cancer, stem cell or organ transplantation, nonsteroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, and/or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics. Multivariable logistic regression and Cox proportional hazards models controlled for confounding by patient demographic characteristics, pre-existing medical conditions, influenza vaccination, and other factors.

Results: Among 35 348 adults, 3633 (10%) were IC; cancer (44%), nonsteroid immunosuppressive therapy (44%), and HIV (18%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs 46%; P < .001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.20-1.76). Intensive care was more likely among IC patients 65-79 years (aOR, 1.25; 95% CI, 1.06-1.48) and those >80 years (aOR, 1.35; 95% CI, 1.06-1.73) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge, 0.86; 95% CI, .83-.88) and more likely to require mechanical ventilation (aOR, 1.19; 95% CI, 1.05-1.36).

Conclusions: Substantial morbidity and mortality occurred among IC adults hospitalized with influenza. Influenza vaccination and antiviral administration could be increased in both IC and non-IC adults.

Keywords: HIV; cancer; immunosuppression; immunosuppressive; influenza.

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Figures

Figure 1.
Figure 1.
Flow chart of included/excluded cases of adults hospitalized with laboratory-confirmed influenza in FluSurv-NET, 2011–2015. Abbreviation: FluSurv-NET, Centers for Disease Control and Prevention Influenza Hospitalization Surveillance Network.
Figure 2.
Figure 2.
Frequency of various immunocompromising conditions* among immunocompromised adults hospitalized with laboratory-confirmed influenza in the US Influenza Hospitalization Surveillance Network, 2011–2015. *Conditions are not mutually exclusive. **Nonsteroidal immunosuppressive therapy included chemotherapy for cancer (within 2 weeks of admission), antibody-based agents (alemtuzumab, basiliximab, daclizumab, trastuzumab, rituximab, infliximab, and/or muromonab-CD3), immunosuppressants (cyclosporine, azathioprine, and/or leflunomide), and antirejection medications (tacrolimus, sirolimus, mycophenolate mofetil, and/or antithymocyte globulin).
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