Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 12;229(4):999-1009.
doi: 10.1093/infdis/jiad303.

Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN)

Lily E Cohen  1   2 , Chelsea L Hansen  3   4   5 , Melissa K Andrew  6 , Shelly A McNeil  6 , Philippe Vanhems  7 , Jan Kyncl  8   9 , Javier Díez Domingo  10 , Tao Zhang  11 , Ghassan Dbaibo  12 , Victor Alberto Laguna-Torres  13 , Anca Draganescu  14 , Elsa Baumeister  15 , Doris Gomez  16 , Sonia M Raboni  17 , Heloisa I G Giamberardino  17 , Marta C Nunes  18   19 , Elena Burtseva  20 , Anna Sominina  21 , Snežana Medić  22   23 , Daouda Coulibaly  24 , Afif Ben Salah  25   26 , Nancy A Otieno  27 , Parvaiz A Koul  28 , Serhat Unal  29   30 , Mine Durusu Tanriover  30   31 , Marie Mazur  1 , Joseph Bresee  1 , Cecile Viboud  3 , Sandra S Chaves  32
Affiliations

Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN)

Lily E Cohen et al. J Infect Dis. .

Abstract

Background: The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions.

Methods: We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level.

Results: The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P = .01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2.

Conclusions: Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs.

Keywords: disease severity; global health; influenza epidemiology; lower middle-income countries; surveillance.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest . All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Geographic distribution of sites collaborating in the Global Influenza Hospital Surveillance Network (GIHSN), 2012–2019 influenza seasons.
Figure 2.
Figure 2.
A, Median proportion (dots) and range (bars) of the percent positivity for influenza by season (A) or month (B) and country income level. Data from the Global Influenza Hospital Surveillance Network (GIHSN), 2012–2019.
Figure 3.
Figure 3.
A, Distribution of influenza-positive hospitalizations by coordinating site and country income level, along with influenza type (A), number of patient comorbid conditions (B), and age group (C). Data from the Global Influenza Hospital Surveillance Network (GIHSN), 2012–2019.
Figure 4.
Figure 4.
Severity outcomes among patients hospitalized with laboratory-confirmed influenza, by age group, influenza type, and country income level, Global Influenza Hospital Surveillance Network (GIHSN), 2012–2019. The y-axis depicts the percentage of patients with severe clinical outcomes.
Figure 5.
Figure 5.
Risk factors for intensive care unit (ICU) admission (A), mechanical ventilation (including extracorporeal membrane oxygenation) (B), and in-hospital death (C) among patients hospitalized with laboratory-confirmed influenza. Abbreviations: CI, confidence interval; OR, odds ratio.
See this image and copyright information in PMC

References

    1. Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet 2018; 391:1285–300. - PMC - PubMed
    1. World Health Organization. Influenza (seasonal). https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal). Accessed 13 June 2022.
    1. Neuzil KM, Wright PF, Jr ME, Griffin MR. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr 2000; 137:856–64. - PubMed
    1. Chow EJ, Rolfes MA, O’Halloran A, et al. Respiratory and nonrespiratory diagnoses associated with influenza in hospitalized adults. JAMA Netw Open 2020; 3:e201323. - PMC - PubMed
    1. Derqui N, Nealon J, Mira-Iglesias A, Díez-Domingo J, Mahé C, Chaves SS. Predictors of influenza severity among hospitalized adults with laboratory confirmed influenza: analysis of nine influenza seasons from the Valencia region, Spain. Influenza Other Respi Viruses 2022; 16:862–72. - PMC - PubMed

Publication types