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. 2022 Nov 24;23(1):323.
doi: 10.1186/s12931-022-02245-w.

Derivation and external validation of a simple prediction rule for the development of respiratory failure in hospitalized patients with influenza

Blanca Ayuso  1 , Antonio Lalueza  2 , Estibaliz Arrieta  1 , Eva María Romay  3 , Álvaro Marchán-López  1 , María José García-País  3 , Dolores Folgueira  4 , María José Gude  5 , Cecilia Cueto  6 , Antonio Serrano  7 , Carlos Lumbreras  1   8
Affiliations

Derivation and external validation of a simple prediction rule for the development of respiratory failure in hospitalized patients with influenza

Blanca Ayuso et al. Respir Res. .

Abstract

Background: Influenza viruses cause seasonal epidemics worldwide with a significant morbimortality burden. Clinical spectrum of Influenza is wide, being respiratory failure (RF) one of its most severe complications. This study aims to elaborate a clinical prediction rule of RF in hospitalized Influenza patients.

Methods: A prospective cohort study was conducted during two consecutive Influenza seasons (December 2016-March 2017 and December 2017-April 2018) including hospitalized adults with confirmed A or B Influenza infection. A prediction rule was derived using logistic regression and recursive partitioning, followed by internal cross-validation. External validation was performed on a retrospective cohort in a different hospital between December 2018 and May 2019.

Results: Overall, 707 patients were included in the derivation cohort and 285 in the validation cohort. RF rate was 6.8% and 11.6%, respectively. Chronic obstructive pulmonary disease, immunosuppression, radiological abnormalities, respiratory rate, lymphopenia, lactate dehydrogenase and C-reactive protein at admission were associated with RF. A four category-grouped seven point-score was derived including radiological abnormalities, lymphopenia, respiratory rate and lactate dehydrogenase. Final model area under the curve was 0.796 (0.714-0.877) in the derivation cohort and 0.773 (0.687-0.859) in the validation cohort (p < 0.001 in both cases). The predicted model showed an adequate fit with the observed results (Fisher's test p > 0.43).

Conclusion: we present a simple, discriminating, well-calibrated rule for an early prediction of the development of RF in hospitalized Influenza patients, with proper performance in an external validation cohort. This tool can be helpful in patient's stratification during seasonal Influenza epidemics.

Keywords: Clinical prediction rules; Human; Influenza; Mechanical ventilation; Pneumonia; Respiratory failure; Viral.

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Conflict of interest statement

All authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

Figures

Fig. 1
Fig. 1
Patient inclusion flowchart
Fig. 2
Fig. 2
Derivation cohort risk scores receiver operating characteristic (ROC) curves. A original score (9 points). B simplified score (7 points). AUC area under curve, SD standard deviation
Fig. 3
Fig. 3
receiver operating characteristic (ROC) curves for risk categories and respiratory failure distribution in both cohorts. A Derivation cohort. B Validation cohort. AUC area under the curve, RF respiratory failure
See this image and copyright information in PMC

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