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Clin Infect Dis. 2019 Jul 11. pii: ciz638. doi: 10.1093/cid/ciz638. [Epub ahead of print]
Outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011-2015.
Collins JP1,2, Campbell AP3, Openo K2, Farley MM2,4, Cummings CN3, Hill M5, Schaffner W6, Lindegren ML6, Thomas A7, Billing L8, Bennett N9, Spina N10, Bargsten M11, Lynfield R12, Eckel S13, Ryan P14, Yousey-Hindes K15, Herlihy R16, Kirley PD17, Garg S3, Anderson EJ1,2,4.
Author information
Abstract
BACKGROUND:
Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-immunocompromised adults.
METHODS:
We identified adults (≥18 years) hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had ≥1: HIV/AIDS, cancer, stem cell or organ transplantation, non-steroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics and used multivariable logistic regression and Cox proportional hazards models to control for confounding by patient demographic characteristics, pre-existing medical conditions, influenza vaccination, and other factors.
RESULTS:
Among 35,348 adults, 3633 (10%) were IC; cancer (44%), non-steroid immunosuppressive therapy (44%), and HIV (17%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs. 46%; p<0.001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 1.46 [1.20-1.76]). Intensive care was more likely among IC patients 65-79 years (aOR [95% CI]: 1.25 [1.06-1.48]) and >80 years (aOR [95% CI]: 1.35 [1.06-1.73]) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge [95% CI]: 0.86 [0.83-0.88]) and were more likely to require mechanical ventilation (aOR [95% CI] 1.19 [1.05-1.36]).
CONCLUSIONS:
Substantial morbidity and mortality occurred among IC adults hospitalized with influenza. Influenza vaccination and antiviral administration could be increased in both IC and non-IC adults.
? 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:
HIV; cancer; immunosuppression; immunosuppressive; influenza
PMID: 31298691 DOI: 10.1093/cid/ciz638
Outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011-2015.
Collins JP1,2, Campbell AP3, Openo K2, Farley MM2,4, Cummings CN3, Hill M5, Schaffner W6, Lindegren ML6, Thomas A7, Billing L8, Bennett N9, Spina N10, Bargsten M11, Lynfield R12, Eckel S13, Ryan P14, Yousey-Hindes K15, Herlihy R16, Kirley PD17, Garg S3, Anderson EJ1,2,4.
Author information
Abstract
BACKGROUND:
Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-immunocompromised adults.
METHODS:
We identified adults (≥18 years) hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had ≥1: HIV/AIDS, cancer, stem cell or organ transplantation, non-steroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics and used multivariable logistic regression and Cox proportional hazards models to control for confounding by patient demographic characteristics, pre-existing medical conditions, influenza vaccination, and other factors.
RESULTS:
Among 35,348 adults, 3633 (10%) were IC; cancer (44%), non-steroid immunosuppressive therapy (44%), and HIV (17%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs. 46%; p<0.001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 1.46 [1.20-1.76]). Intensive care was more likely among IC patients 65-79 years (aOR [95% CI]: 1.25 [1.06-1.48]) and >80 years (aOR [95% CI]: 1.35 [1.06-1.73]) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge [95% CI]: 0.86 [0.83-0.88]) and were more likely to require mechanical ventilation (aOR [95% CI] 1.19 [1.05-1.36]).
CONCLUSIONS:
Substantial morbidity and mortality occurred among IC adults hospitalized with influenza. Influenza vaccination and antiviral administration could be increased in both IC and non-IC adults.
? 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:
HIV; cancer; immunosuppression; immunosuppressive; influenza
PMID: 31298691 DOI: 10.1093/cid/ciz638