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J Crit Care. 2018 Aug 24;48:172-177. doi: 10.1016/j.jcrc.2018.08.017. [Epub ahead of print]
Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit.
Garnacho-Montero J1, Le?n-Moya C2, Guti?rrez-Pizarraya A3, Arenzana-Seisdedos A3, Vidaur L4, Guerrero JE5, Gord?n M6, Mart?n-Loeches I7, Rodriguez A8; on Behalf GETGAG Study Group.
Author information
Abstract
PURPOSE:
Information about immunocompromised patients infected with influenza A (H1N1) virus and requiring admission to the ICU is lacking. Our objective was to know the clinical characteristics of these patients and to identify treatment-related variables associated with mortality.
MATERIAL AND METHODS:
A prospective multicenter observational cohort study was based on data from a Spanish registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU with the diagnosis of influenza A (H1N1) virus infection were included. Immunosuppression was clearly defined. Factors associated with mortality in immunocompromised patients were assessed by conventional logistic regression analysis and by a propensity score (PS) adjusted-multivariable analysis.
RESULTS:
Of 1899 patients with influenza A (H1N1) infection, 238 (12.5%) were classified as immunocompromised. Mortality was significantly higher in immunosuppressed patients. Four variables independently associated with mortality were identified: SOFA score, need of vasopressor, use of corticosteroids, and acute renal failure, AKIN 3 stage. In the PS-adjusted model, corticosteroid therapy remained as an independent factor associated with increased mortality (OR 2.25;95%CI, 1.15-4.38;p = 0.017). In the subgroup of hematological patients (n = 141), corticosteroid therapy was also associated with increased mortality (OR 3.12; 95%CI, 1.32-7.41; p = 0.010).
CONCLUSION:
Immunocompromised individuals with influenza A (H1N1) admitted to the ICU have a poor outcome. In this population, the use of corticosteroids is strongly discouraged.
Copyright ? 2018 Elsevier Inc. All rights reserved.
PMID: 30216935 DOI: 10.1016/j.jcrc.2018.08.017
Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit.
Garnacho-Montero J1, Le?n-Moya C2, Guti?rrez-Pizarraya A3, Arenzana-Seisdedos A3, Vidaur L4, Guerrero JE5, Gord?n M6, Mart?n-Loeches I7, Rodriguez A8; on Behalf GETGAG Study Group.
Author information
Abstract
PURPOSE:
Information about immunocompromised patients infected with influenza A (H1N1) virus and requiring admission to the ICU is lacking. Our objective was to know the clinical characteristics of these patients and to identify treatment-related variables associated with mortality.
MATERIAL AND METHODS:
A prospective multicenter observational cohort study was based on data from a Spanish registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU with the diagnosis of influenza A (H1N1) virus infection were included. Immunosuppression was clearly defined. Factors associated with mortality in immunocompromised patients were assessed by conventional logistic regression analysis and by a propensity score (PS) adjusted-multivariable analysis.
RESULTS:
Of 1899 patients with influenza A (H1N1) infection, 238 (12.5%) were classified as immunocompromised. Mortality was significantly higher in immunosuppressed patients. Four variables independently associated with mortality were identified: SOFA score, need of vasopressor, use of corticosteroids, and acute renal failure, AKIN 3 stage. In the PS-adjusted model, corticosteroid therapy remained as an independent factor associated with increased mortality (OR 2.25;95%CI, 1.15-4.38;p = 0.017). In the subgroup of hematological patients (n = 141), corticosteroid therapy was also associated with increased mortality (OR 3.12; 95%CI, 1.32-7.41; p = 0.010).
CONCLUSION:
Immunocompromised individuals with influenza A (H1N1) admitted to the ICU have a poor outcome. In this population, the use of corticosteroids is strongly discouraged.
Copyright ? 2018 Elsevier Inc. All rights reserved.
PMID: 30216935 DOI: 10.1016/j.jcrc.2018.08.017