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Multicenter Study
. 2020 Mar 2;3(3):e201323.
doi: 10.1001/jamanetworkopen.2020.1323.

Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults

Eric J Chow  1   2 , Melissa A Rolfes  2 , Alissa O'Halloran  2 , Nisha B Alden  3 , Evan J Anderson  4   5   6 , Nancy M Bennett  7 , Laurie Billing  8 , Elizabeth Dufort  9 , Pam D Kirley  10 , Andrea George  11 , Lourdes Irizarry  12 , Sue Kim  13 , Ruth Lynfield  14 , Patricia Ryan  15 , William Schaffner  16 , H Keipp Talbot  16 , Ann Thomas  17 , Kimberly Yousey-Hindes  18 , Carrie Reed  2 , Shikha Garg  2
Affiliations
Multicenter Study

Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults

Eric J Chow et al. JAMA Netw Open. .

Abstract

Importance: Seasonal influenza virus infection is a major cause of morbidity and mortality and may be associated with respiratory and nonrespiratory diagnoses.

Objective: To examine the respiratory and nonrespiratory diagnoses reported for adults hospitalized with laboratory-confirmed influenza between 2010 and 2018 in the United States.

Design, setting, and participants: This cross-sectional study used data from the US Influenza Hospitalization Surveillance Network (FluSurv-NET) from October 1 through April 30 of the 2010-2011 through 2017-2018 influenza seasons. FluSurv-NET is a population-based, multicenter surveillance network with a catchment area that represents approximately 9% of the US population. Patients are identified by practitioner-ordered influenza testing. Adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza were included in the study.

Exposures: FluSurv-NET defines laboratory-confirmed influenza as a positive influenza test result by rapid antigen assay, reverse transcription-polymerase chain reaction, direct or indirect fluorescent staining, or viral culture.

Main outcomes and measures: Acute respiratory or nonrespiratory diagnoses were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) discharge diagnosis codes. The analysis included calculation of the frequency of acute respiratory and nonrespiratory diagnoses with a descriptive analysis of patient demographic characteristics, underlying medical conditions, and in-hospital outcomes by respiratory and nonrespiratory diagnoses.

Results: Of 89 999 adult patients hospitalized with laboratory-confirmed influenza, 76 649 (median age, 69 years; interquartile range, 55-82 years; 55% female) had full medical record abstraction and at least 1 ICD code for an acute diagnosis. In this study, 94.9% of patients had a respiratory diagnosis and 46.5% had a nonrespiratory diagnosis, including 5.1% with only nonrespiratory diagnoses. Pneumonia (36.3%), sepsis (23.3%), and acute kidney injury (20.2%) were the most common acute diagnoses. Fewer patients with only nonrespiratory diagnoses received antiviral therapy for influenza compared with those with respiratory diagnoses (81.4% vs 88.9%; P < .001).

Conclusions and relevance: Nonrespiratory diagnoses occurred frequently among adults hospitalized with influenza, further contributing to the burden of infection in the United States. The findings suggest that during the influenza season, practitioners should consider influenza in their differential diagnosis for patients who present to the hospital with less frequently recognized manifestations and initiate early antiviral treatment for patients with suspected or confirmed infection.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Alden reported receiving grants from the Centers for Disease Control and Prevention (CDC) during the conduct of the study and outside the submitted work. Dr Anderson reported receiving personal fees from AbbVie and Pfizer and grants from MedImmune, Regeneron, PaxVax, Pfizer, GlaxoSmithKline, Merck, Novavax, Sanofi-Pasteur, and Micron outside the submitted work. Mss Billing and George reported receiving grants from the Council of State and Territorial Epidemiologists during the conduct of the study. Dr Lynfield reported receiving grants from the CDC during the conduct of the study, serving as a coeditor on an infectious disease surveillance textbook and the American Academy of Pediatrics Red Book, and receiving royalties and funds donated to the Minnesota Department of Health. Ms Ryan reported receiving grants from the CDC and the Maryland Department of Health during the conduct of the study. Dr Schaffner reported receiving grants from the CDC during the conduct of the study and personal fees from Pfizer and Roche Diagnostics outside the submitted work. Dr Talbot reported receiving grants from the CDC during the conduct of the study and personal fees from Seqirus outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram of Adults in the US Influenza Hospitalization Surveillance Network (FluSurv-NET), 2010-2018
ICD indicates International Classification of Diseases.
Figure 2.
Figure 2.. Nonrespiratory Diagnoses Among 76 649 Adults Hospitalized With Laboratory-Confirmed Influenza in the US Influenza Hospitalization Surveillance Network (FluSurv-NET), United States, 2010-2018
Diagnoses are not mutually exclusive.
See this image and copyright information in PMC

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