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PLoS ONE. Demographic and Clinical Predictors of Mortality from Highly Pathogenic Avian Influenza A (H5N1) Virus Infection: CART Analysis of International Cases

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  • PLoS ONE. Demographic and Clinical Predictors of Mortality from Highly Pathogenic Avian Influenza A (H5N1) Virus Infection: CART Analysis of International Cases

    [Source: PLoS ONE, full page: (LINK). Abstract, edited.]


    Open Access / Peer-Reviewed / Research Article

    Demographic and Clinical Predictors of Mortality from Highly Pathogenic Avian Influenza A (H5N1) Virus Infection: CART Analysis of International Cases

    Rita B. Patel, Maya B. Mathur, Michael Gould, Timothy M. Uyeki, Jay Bhattacharya, Yang Xiao, Nayer Khazeni

    Published: March 25, 2014 / DOI: 10.1371/journal.pone.0091630


    Abstract

    Background

    Human infections with highly pathogenic avian influenza (HPAI) A (H5N1) viruses have occurred in 15 countries, with high mortality to date. Determining risk factors for morbidity and mortality from HPAI H5N1 can inform preventive and therapeutic interventions.


    Methods

    We included all cases of human HPAI H5N1 reported in World Health Organization Global Alert and Response updates and those identified through a systematic search of multiple databases (PubMed, Scopus, and Google Scholar), including articles in all languages. We abstracted predefined clinical and demographic predictors and mortality and used bivariate logistic regression analyses to examine the relationship of each candidate predictor with mortality. We developed and pruned a decision tree using nonparametric Classification and Regression Tree methods to create risk strata for mortality.


    Findings

    We identified 617 human cases of HPAI H5N1 occurring between December 1997 and April 2013. The median age of subjects was 18 years (interquartile range 629 years) and 54% were female. HPAI H5N1 case-fatality proportion was 59%. The final decision tree for mortality included age, country, per capita government health expenditure, and delay from symptom onset to hospitalization, with an area under the receiver operator characteristic (ROC) curve of 0.81 (95% CI: 0.760.86).


    Interpretation

    A model defined by four clinical and demographic predictors successfully estimated the probability of mortality from HPAI H5N1 illness. These parameters highlight the importance of early diagnosis and treatment and may enable early, targeted pharmaceutical therapy and supportive care for symptomatic patients with HPAI H5N1 virus infection.
    _____

    Citation: Patel RB, Mathur MB, Gould M, Uyeki TM, Bhattacharya J, et al. (2014) Demographic and Clinical Predictors of Mortality from Highly Pathogenic Avian Influenza A (H5N1) Virus Infection: CART Analysis of International Cases. PLoS ONE 9(3): e91630. doi:10.1371/journal.pone.0091630

    Editor: Gerardo Chowell, Arizona State University, United States of America

    Received: November 9, 2013; Accepted: February 11, 2014; Published: March 25, 2014

    This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

    Funding: This research was supported by the Agency for Healthcare Research and Quality (1 K08 HS019816, Dr. Khazeni). See http://www.ahrq.gov/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    Competing interests: The authors have declared that no competing interests exist.


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