Predictors of severity and in-hospital mortality in patients with influenza

Submitted: April 3, 2021
Accepted: July 20, 2021
Published: August 10, 2021
Abstract Views: 1174
PDF: 414
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Influenza virus is a common agent of acute respiratoty infections during epidemic periods. It is a major cause of morbidity and mortality and represent a significant burden on the healthcare system. We aimed to evaluate predictors of severity and of in-hospital mortality in patients hospitalized with influenza infection. We performed a retrospective cohort study of hospitalized, laboratory confirmed cases of influenza disease in Centro Hospitalar de São João between October 2016-May 2017 and October 2017-May 2018. The endpoints being analysed were severity and in-hospital mortality. A multivariate logistic regression analysis was used to determine independent predictors of severity and of in-hospital mortality. We studied 221 hospitalized influenza infection cases. Mean age 66±16 years, 57.9% were male, thirty-seven patients (16.7%) died in-hospital and 101 patients (45.7%) met severity criteria. C-reactive protein (CRP) was the only independent predictor of severity as well as the only independent predictor of higher in-hospital mortality in patients admitted due to influenza infection. Multivariate-adjusted CRP OR for severity was 1.10, 95% CI 1.06-1.15 per each 10 mg/L increase in CPR and for in-hospital mortality risk the OR was of 1.05, 95% CI 1.01-1.09, p=0.01, per each 10 mg/L increase. Concluding, in patients’ hospital-admitted due to influenza infection CRP was the only predictor of severity with a 10% increased risk of inotropic support/ventilatory support/prolonged hospitalization needs and a 5% increase risk of in-hospital death per each 10 mg/l increase.

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Citations

Center for Disease Control and Prevention. Seasonal influenza (flu). Accessed: 01/06/2019. Available from: https://www.cdc.gov/flu/about/index.html
Uyeki TM. Influenza. Ann Intern Med 2017;167:ITC33-48.
Bresee J, Hayden FG. Epidemic influenza-responding to the expected but unpredictable. N Engl J Med 2013;368:589. DOI: https://doi.org/10.1056/NEJMp1300375
European Centre for Disease Prevention and Control. Influenza virus characterisation, summary Europe, September 2018. Stockholm: ECDC; 2018.
Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. [Boletim de Vigilância Epidemiológica da Gripe, Época 2016/2017 - Semana 20].[in Portuguese]. Instituto Nacional de Saúde Doutor Ricardo Jorge I.P., 2017.
Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. [Boletim de Vigilância Epidemiológica da Gripe, Época 2017-2018 - Semana 20].[in Portuguese]. Instituto Nacional de Saúde Doutor Ricardo Jorge I.P., 2018.
Chaves SS, Aragon D, Bennett N, et al. Patients hospitalized with laboratory-confirmed influenza during the 2010-2011 influenza season: exploring disease severity by virus type and subtype. J Infect Dis 2013;208:1305-14. DOI: https://doi.org/10.1093/infdis/jit316
Ribeiro AF, Pellini AC, Kitagawa BY, et al. Risk factors for death from Influenza A(H1N1)pdm09, State of Sao Paulo, Brazil, 2009. PLoS One 2015;10:e0118772.
Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clin Infect Dis 2017;65:1289-97. DOI: https://doi.org/10.1093/cid/cix468
Center for Disease Control and Prevention. Prevent flu. Accessed: 01/06/2019. Available from: https://www.cdc.gov/flu/prevent/vaccinations.htm
Ghebrehewet S, MacPherson P, Ho A. Influenza. BMJ 2016;355:i6258.
Moscona A. Neuraminidase inhibitors for influenza. N Engl J Med 2005;353:1363-73. DOI: https://doi.org/10.1056/NEJMra050740
Cooper NJ, Sutton AJ, Abrams KR, et al. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ 2003;326:1235. DOI: https://doi.org/10.1136/bmj.326.7401.1235
Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet 2015;385:1729. DOI: https://doi.org/10.1016/S0140-6736(14)62449-1
Jefferson T, Demicheli V, Rivetti D, et al. Antivirals for influenza in healthy adults: systematic review. Lancet 2006;367:303. DOI: https://doi.org/10.1016/S0140-6736(06)67970-1
Hong KW, Cheong HJ, Choi WS, et al. Clinical courses and outcomes of hospitalized adult patients with seasonal influenza in Korea, 2011–2012: hospital-based influenza morbidity & mortality (HIMM) surveillance. J Infect Chemother 2014;29:9–14. DOI: https://doi.org/10.1016/j.jiac.2013.07.001
Canak G, Kovacevic N, Turkulov V, et al. Clinical features, treatments and the outcomes of influenza A (H1N1) 2009 among the hospitalized patients in the clinic for infectious diseases in Novi Sad. Vojnosanit Pregl 2013;70:155–62. DOI: https://doi.org/10.2298/VSP1302155C
Baden LR, Swaminathan S, Angarone M, et al. Prevention and treatment of cancer-related infections, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2016;14:882-913. DOI: https://doi.org/10.6004/jnccn.2016.0093
Vasileva D, Badawi A. C-reactive protein as a biomarker of severe H1N1 influenza. Inflamm Res 2019;68:39–46. DOI: https://doi.org/10.1007/s00011-018-1188-x
Zimmerman O, Rogowski O, Aviram G, et al. C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection. BMC Infect Dis 2010;10:288. DOI: https://doi.org/10.1186/1471-2334-10-288
Gao RB, Wang L, Bai T, et al. C-reactive mediating immunopathological lesions: a potential treatment option for severe influenza A diseases. EBioMedicine 2017;22:133–42. DOI: https://doi.org/10.1016/j.ebiom.2017.07.010
Liu Q, Zhou YH, Yang ZQ. The cytokine storm of severe influenza and development of immunomodulatory therapy. Cell Mol Immunol 2016;13:3–10. DOI: https://doi.org/10.1038/cmi.2015.74
Shah SH, Newby LK. C-reactive protein: a novel marker of cardiovascular risk. Cardiol Rev 2003;11:169-79. DOI: https://doi.org/10.1097/01.CRD.0000077906.74217.6E

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How to Cite

Serino, Mariana, Nuno Melo, João Paulo Caldas, Ana Ferreira, David Garcia, and Patrícia Lourenço. 2021. “Predictors of Severity and in-Hospital Mortality in Patients With Influenza”. Monaldi Archives for Chest Disease 92 (1). https://doi.org/10.4081/monaldi.2021.1876.