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A Risk Classification Model to Predict Mortality Among Laboratory-Confirmed Avian Influenza A H7N9 Patients: A Population-Based Observational Cohort Study

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  • A Risk Classification Model to Predict Mortality Among Laboratory-Confirmed Avian Influenza A H7N9 Patients: A Population-Based Observational Cohort Study


    J Infect Dis. 2019 Oct 17. pii: jiz328. doi: 10.1093/infdis/jiz328. [Epub ahead of print] A Risk Classification Model to Predict Mortality Among Laboratory-Confirmed Avian Influenza A H7N9 Patients: A Population-Based Observational Cohort Study.

    Martinez L1,2, Cheng W3, Wang X3, Ling F3, Mu L4, Li C1, Huo X5, Ebell MH1, Huang H5, Zhu L5, Li C1, Chen E3, Handel A1, Shen Y1.
    Author information

    1 Department of Epidemiology and Biostatistics, College of Public Health, Athens. 2 Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, California. 3 Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. 4 Department of Geography, University of Georgia, Athens. 5 Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.

    Abstract

    BACKGROUND:

    Avian influenza A H7N9 (A/H7N9) is characterized by rapid progressive pneumonia and respiratory failure. Mortality among laboratory-confirmed cases is above 30%; however, the clinical course of disease is variable and patients at high risk for death are not well characterized.
    METHODS:

    We obtained demographic, clinical, and laboratory information on all A/H7N9 patients in Zhejiang province from China Centers for Disease Control and Prevention electronic databases. Risk factors for death were identified using logistic regression and a risk score was created using regression coefficients from multivariable models. We externally validated this score in an independent cohort from Jiangsu province.
    RESULTS:

    Among 305 A/H7N9 patients, 115 (37.7%) died. Four independent predictors of death were identified: older age, diabetes, bilateral lung infection, and neutrophil percentage. We constructed a score with 0-13 points. Mortality rates in low- (0-3), medium- (4-6), and high-risk (7-13) groups were 4.6%, 32.1%, and 62.7% (Ptrend < .0001). In a validation cohort of 111 A/H7N9 patients, 61 (55%) died. Mortality rates in low-, medium-, and high-risk groups were 35.5%, 55.8, and 67.4% (Ptrend = .0063).
    CONCLUSIONS:

    We developed and validated a simple-to-use, predictive risk score for clinical use, identifying patients at high mortality risk.
    ? 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 infection; influenza; mortality; risk score

    PMID: 31622983 DOI: 10.1093/infdis/jiz328

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