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Chest. Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection
Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection (CHEST, abstract, edited)
[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/137/4/752.short?rss=1">Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection ? CHEST</cite>. Abstract, edited.]
Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection
1. Russell R. Miller III, MD, MPH, 2. Boaz A. Markewitz, MD, FCCP, 3. Robert T. Rolfs, MD, MPH, 4. Samuel M. Brown, MD, 5. Kristin K. Dascomb, MD, PhD, 6. Colin K. Grissom, MD, FCCP, 7. Michael D. Friedrichs, MS, 8. Jeanmarie Mayer, MD, 9. Eliotte L. Hirshberg, MD, 10. Jamie Conklin, MD, 11. Robert Paine III, MD and 12. Nathan C. Dean, MD, FCCP
Author Affiliations
1. 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.
1. 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
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/m2. 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/m2 (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/m2 for age-adjusted and sex-adjusted rates for Salt Lake County.
Conclusions:
Severe ARDS with multiorgan dysfunction in the absence of bacterial infection was a common clinical presentation. In this cohort, young nonwhites without medical insurance were disproportionately likely to require ICU care. Obese patients were particularly susceptible to critical illness due to novel A(H1N1) infection.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).
* For editorial comment see page 745
* Abbreviations: ALI acute lung injury, APACHE II Acute Physiology and Chronic Health Evaluation II, CDC Centers for Disease Control and Prevention, IQR interquartile range, novel A(H1N1) novel 2009 influenza A(H1N1), OR odds ratio, SMR standardized morbidity ratio, SOFA Sequential Organ Failure Assessment
* Received October 26, 2009. Accepted November 13, 2009.
* ? 2010 American College of Chest Physicians
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[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/137/4/752.short?rss=1">Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection ? CHEST</cite>. Abstract, edited.]
Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) Infection
1. Russell R. Miller III, MD, MPH, 2. Boaz A. Markewitz, MD, FCCP, 3. Robert T. Rolfs, MD, MPH, 4. Samuel M. Brown, MD, 5. Kristin K. Dascomb, MD, PhD, 6. Colin K. Grissom, MD, FCCP, 7. Michael D. Friedrichs, MS, 8. Jeanmarie Mayer, MD, 9. Eliotte L. Hirshberg, MD, 10. Jamie Conklin, MD, 11. Robert Paine III, MD and 12. Nathan C. Dean, MD, FCCP
Author Affiliations
1. 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.
1. 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
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/m2. 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/m2 (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/m2 for age-adjusted and sex-adjusted rates for Salt Lake County.
Conclusions:
Severe ARDS with multiorgan dysfunction in the absence of bacterial infection was a common clinical presentation. In this cohort, young nonwhites without medical insurance were disproportionately likely to require ICU care. Obese patients were particularly susceptible to critical illness due to novel A(H1N1) infection.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).
* For editorial comment see page 745
* Abbreviations: ALI acute lung injury, APACHE II Acute Physiology and Chronic Health Evaluation II, CDC Centers for Disease Control and Prevention, IQR interquartile range, novel A(H1N1) novel 2009 influenza A(H1N1), OR odds ratio, SMR standardized morbidity ratio, SOFA Sequential Organ Failure Assessment
* Received October 26, 2009. Accepted November 13, 2009.
* ? 2010 American College of Chest Physicians
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