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Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection
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+ Author Affiliations
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Abstract
Background: Novel 2009 influenza A(H1N1) infection has significantly affected ICUs. We sought to characterize our region?s clinical findings and demographic associations with ICU admission due to novel A(H1N1).
Methods: We conducted an observational study from May 19, 2009, to June 30, 2009, of descriptive clinical course, inpatient mortality, financial data, and demographic characteristics of an ICU cohort. A case-control study was used to compare the ICU cohort to Salt Lake County residents.
Results: The ICU cohort of 47 influenza patients had a median age of 34 years, Acute Physiology and Chronic Health Evaluation II score of 21, and BMI of 35 kg/m<sup>2</sup>. Mortality was 17% (8/47). All eight deaths occurred among the 64% of patients (n = 30) with ARDS, 26 (87%) of whom also developed multiorgan failure. Compared with the Salt Lake County population, patients with novel A(H1N1) were more likely to be obese (22% vs 74%; P < .001), medically uninsured (14% vs 45%; P < .001), and Hispanic (13% vs 23%; P < .01) or Pacific Islander (1% vs 26%; P < .001). Observed ICU admissions were 15-fold greater than expected for those with BMI ≥ 40 kg/m<sup>2</sup> (standardized morbidity ratio 15.8, 95% CI, 8.3-23.4) and 1.5-fold greater than expected among those with BMI of 30 to 39 kg/m<sup>2</sup> for age-adjusted and sex-adjusted rates for Salt Lake County.
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- Russell R. Miller III, MD, MPH,
- Boaz A. Markewitz, MD, FCCP,
- Robert T. Rolfs, MD, MPH,
- Samuel M. Brown, MD,
- Kristin K. Dascomb, MD, PhD,
- Colin K. Grissom, MD, FCCP,
- Michael D. Friedrichs, MS,
- Jeanmarie Mayer, MD,
- Eliotte L. Hirshberg, MD,
- Jamie Conklin, MD,
- Robert Paine III, MD and
- Nathan C. Dean, MD, FCCP
+ Author Affiliations
- <address>From the Division of Pulmonary and Critical Medicine (Drs Miller, Brown, Grissom, Hirshberg, and Dean) and the Department of Clinical Epidemiology and Infectious Diseases (Dr Dascomb), Intermountain Medical Center, Murray; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine (Drs Miller, Markewitz, Brown, Grissom, Hirshberg, Conklin, Paine, and Dean) and the Divisions of Epidemiology and Infectious Diseases (Dr Mayer), University of Utah Health Sciences Center, Salt Lake City; and the Utah Department of Health (Dr Rolfs and Mr Friedrichs), Salt Lake City, UT. </address>
- Correspondence to:
Russell R. Miller III, MD, MPH, Intermountain Medical Center, T4S, Respiratory Intensive Care Unit, 5121 S Cottonwood St, Murray, UT 84107; e-mail: Russ.Miller@imail.org
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Abstract
Background: Novel 2009 influenza A(H1N1) infection has significantly affected ICUs. We sought to characterize our region?s clinical findings and demographic associations with ICU admission due to novel A(H1N1).
Methods: We conducted an observational study from May 19, 2009, to June 30, 2009, of descriptive clinical course, inpatient mortality, financial data, and demographic characteristics of an ICU cohort. A case-control study was used to compare the ICU cohort to Salt Lake County residents.
Results: The ICU cohort of 47 influenza patients had a median age of 34 years, Acute Physiology and Chronic Health Evaluation II score of 21, and BMI of 35 kg/m<sup>2</sup>. Mortality was 17% (8/47). All eight deaths occurred among the 64% of patients (n = 30) with ARDS, 26 (87%) of whom also developed multiorgan failure. Compared with the Salt Lake County population, patients with novel A(H1N1) were more likely to be obese (22% vs 74%; P < .001), medically uninsured (14% vs 45%; P < .001), and Hispanic (13% vs 23%; P < .01) or Pacific Islander (1% vs 26%; P < .001). Observed ICU admissions were 15-fold greater than expected for those with BMI ≥ 40 kg/m<sup>2</sup> (standardized morbidity ratio 15.8, 95% CI, 8.3-23.4) and 1.5-fold greater than expected among those with BMI of 30 to 39 kg/m<sup>2</sup> for age-adjusted and sex-adjusted rates for Salt Lake County.