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Clin Infect Dis. 2019 Aug 16. pii: ciz779. doi: 10.1093/cid/ciz779. [Epub ahead of print]
Factors associated with fatality due to avian influenza A(H7N9) infection in China.
Zheng S1,2,3, Zou Q2,3, Wang X2,3, Bao J2,3, Yu F2,3, Guo F4, Liu P5, Shen Y6, Wang Y7, Yang S1, Wu W1, Sheng J1, Vijaykrishna D8,9, Gao H1,4, Chen Y1,2,3.
Author information
1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China. 2 Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, P.R. China. 3 Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China. 4 Department of Infectious Diseases, Shulan (Hangzhou) Hospital, Hangzhou, P.R. China. 5 Department of Infectious Diseases, The second hospital of Ningbo, Ningbo, P.R. China. 6 Department of Infectious and Immune Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China. 7 Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, P.R. China. 8 Department of Microbiology, Biomedicine Discovery Institute, Monash University, Victoria, Australia. 9 World Health Organization Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Abstract
BACKGROUND:
The high case fatality rate of influenza A H7N9 infected patients has been a major clinical concern.
METHODS:
To identify the common causes of death due to H7N9 as well as identify risk factors associated with the high inpatient mortality, we retrospectively collected clinical treatment information from 350 hospitalized human cases of H7N9 virus in mainland China during 2013-2017, of which 109 (31.1%) had died, and systematically analysed the patient's clinical characteristics and risk factors for death.
RESULTS:
The median age of infection was 57 years, whereas the median age of mortality was 61 years, significantly older than those survived. In contrast to previous studies, we found nosocomial infections, comprising Acinetobacter baumannii and Klebsiella most commonly associated with secondary bacterial infections, which was likely due to the high utilization of supportive therapies, including mechanical ventilation (52.6%), ECMO (14%), CRRT (19.1%), and artificial liver therapy (9.7%). Age, time from illness onset to antiviral therapy initiation and secondary bacterial infection were independent risk factors for death. Age >65, secondary bacterial infections, and initiation of neuraminidase inhibitors therapy after 5 days from symptom onset were associated with increased risk of death.
CONCLUSIONS:
Fatality among H7N9 virus infected patients occurred rapidly after hospital admission, especially among older patients, and was followed by severe hypoxemia and multisystem organ failure. Our results show that early neuraminidase-inhibitor therapy and reduction of secondary bacterial infections can help reduce mortality.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
KEYWORDS:
H7N9; Influenza; Risk factors; zoonotic infection
PMID: 31418813 DOI: 10.1093/cid/ciz779
Factors associated with fatality due to avian influenza A(H7N9) infection in China.
Zheng S1,2,3, Zou Q2,3, Wang X2,3, Bao J2,3, Yu F2,3, Guo F4, Liu P5, Shen Y6, Wang Y7, Yang S1, Wu W1, Sheng J1, Vijaykrishna D8,9, Gao H1,4, Chen Y1,2,3.
Author information
1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China. 2 Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, P.R. China. 3 Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China. 4 Department of Infectious Diseases, Shulan (Hangzhou) Hospital, Hangzhou, P.R. China. 5 Department of Infectious Diseases, The second hospital of Ningbo, Ningbo, P.R. China. 6 Department of Infectious and Immune Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China. 7 Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, P.R. China. 8 Department of Microbiology, Biomedicine Discovery Institute, Monash University, Victoria, Australia. 9 World Health Organization Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Abstract
BACKGROUND:
The high case fatality rate of influenza A H7N9 infected patients has been a major clinical concern.
METHODS:
To identify the common causes of death due to H7N9 as well as identify risk factors associated with the high inpatient mortality, we retrospectively collected clinical treatment information from 350 hospitalized human cases of H7N9 virus in mainland China during 2013-2017, of which 109 (31.1%) had died, and systematically analysed the patient's clinical characteristics and risk factors for death.
RESULTS:
The median age of infection was 57 years, whereas the median age of mortality was 61 years, significantly older than those survived. In contrast to previous studies, we found nosocomial infections, comprising Acinetobacter baumannii and Klebsiella most commonly associated with secondary bacterial infections, which was likely due to the high utilization of supportive therapies, including mechanical ventilation (52.6%), ECMO (14%), CRRT (19.1%), and artificial liver therapy (9.7%). Age, time from illness onset to antiviral therapy initiation and secondary bacterial infection were independent risk factors for death. Age >65, secondary bacterial infections, and initiation of neuraminidase inhibitors therapy after 5 days from symptom onset were associated with increased risk of death.
CONCLUSIONS:
Fatality among H7N9 virus infected patients occurred rapidly after hospital admission, especially among older patients, and was followed by severe hypoxemia and multisystem organ failure. Our results show that early neuraminidase-inhibitor therapy and reduction of secondary bacterial infections can help reduce mortality.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
KEYWORDS:
H7N9; Influenza; Risk factors; zoonotic infection
PMID: 31418813 DOI: 10.1093/cid/ciz779