tetano
Editor, Senior Moderator
J Clin Exp Hepatol. 2019 Mar-Apr;9(2):162-170. doi: 10.1016/j.jceh.2018.04.006. Epub 2018 May 17.
[h=1]A/H1N1/09 Influenza is Associated With High Mortality in Liver Cirrhosis.[/h] Premkumar M[SUP]1[/SUP], Devurgowda D[SUP]1[/SUP], Dudha S[SUP]1[/SUP], Maiwall R[SUP]1[/SUP], Bihari C[SUP]2[/SUP], Grover S[SUP]2[/SUP], Gupta E[SUP]3[/SUP], Kumar S[SUP]4[/SUP], Sarin SK[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]Background/Aims:[/h] A/H1N1/09 influenza is associated with a high risk of complications in patients with chronic diseases. In view of patients with cirrhosis being recognized as another high-risk group for influenza morbidity and mortality, we report a cluster of suspected A/H1N1/09 infection in 110 patients admitted to a hepatology intensive care unit.
[h=4]Methods:[/h] The pattern of spread, clinical outcome, and respiratory parameters of A/H1N1/09 of 22 positive cirrhotic patients were compared with those from a control group of 88 patients with chronic liver disease (CLD) with influenza-like pneumonia who tested negative for A/H1N1/09.
[h=4]Results:[/h] A/H1N1/09 infection was confirmed in 22 (20%) patients. Eighteen of 22 (81.8%) CLD patients with A/H1N1/09 died of pneumonia and acute respiratory distress syndrome despite timely antiviral treatment. In contrast, only 35 (40%)of the control group of cirrhotic patients without A/H1N1/09 died. On univariate analysis, age > 45 years [OR 1.3; 95% CI 1.1-5.7, (P = 0.054)], encephalopathy > grade 2 [OR 5.4; 95% CI 2.8-12.3, (P = 0.042)], serum bilirubin >8 mg/dl [OR 2.1; 95% CI 1.8-12.3, (P = 0.052)], serum creatinine >1.8 mg/dl [OR 2.8; 95% CI 1.9-9.2, (P = 0.042)], PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio <200 [OR 4.5; 95% CI 3.1-18.5, (P = 0.026)] and INR > 2.5 [OR 2.2; 95% CI 1.8-6.7, (P = 0.032)] were risk factors for mortality at presentation. However, on multivariate analysis only PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio <200 and serum creatinine >1.8 mg/dl remained predictors of mortality. Secondary infections, whether fungal or bacterial, were noted to be independent risk factors for disease severity in patients with cirrhosis.
[h=4]Conclusion:[/h] Early detection and referral, and early antiviral treatment with a strict control of nosocomial spread is essential in patients with cirrhosis during epidemic influenza.
[h=4]KEYWORDS:[/h] AKI, Acute Kidney Injury; APACHE II, Acute Physiologic Assessment and Chronic Health Evaluation II; ARDS, Acute Respiratory Distress Syndrome; CLD, Chronic Liver Disease; CTP, Child Turcotte Pugh Score; CXR, Chest Radiograph; H1N1 influenza; ICU, Intensive Care Unit; ILI, Influenza Like Illness; INR, International Normalized Ratio; MELD, Model for End-Stage Liver Disease; NASH, Non Alcoholic Steatohepatitis; PCR, Polymerase Chain Reaction; SOFA, Sequential Organ Failure Score; critical care in liver disease; pneumonia; ventilatory support
PMID: 31024197 PMCID: PMC6477137 [Available on 2020-03-01] DOI: 10.1016/j.jceh.2018.04.006
[h=1]A/H1N1/09 Influenza is Associated With High Mortality in Liver Cirrhosis.[/h] Premkumar M[SUP]1[/SUP], Devurgowda D[SUP]1[/SUP], Dudha S[SUP]1[/SUP], Maiwall R[SUP]1[/SUP], Bihari C[SUP]2[/SUP], Grover S[SUP]2[/SUP], Gupta E[SUP]3[/SUP], Kumar S[SUP]4[/SUP], Sarin SK[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]Background/Aims:[/h] A/H1N1/09 influenza is associated with a high risk of complications in patients with chronic diseases. In view of patients with cirrhosis being recognized as another high-risk group for influenza morbidity and mortality, we report a cluster of suspected A/H1N1/09 infection in 110 patients admitted to a hepatology intensive care unit.
[h=4]Methods:[/h] The pattern of spread, clinical outcome, and respiratory parameters of A/H1N1/09 of 22 positive cirrhotic patients were compared with those from a control group of 88 patients with chronic liver disease (CLD) with influenza-like pneumonia who tested negative for A/H1N1/09.
[h=4]Results:[/h] A/H1N1/09 infection was confirmed in 22 (20%) patients. Eighteen of 22 (81.8%) CLD patients with A/H1N1/09 died of pneumonia and acute respiratory distress syndrome despite timely antiviral treatment. In contrast, only 35 (40%)of the control group of cirrhotic patients without A/H1N1/09 died. On univariate analysis, age > 45 years [OR 1.3; 95% CI 1.1-5.7, (P = 0.054)], encephalopathy > grade 2 [OR 5.4; 95% CI 2.8-12.3, (P = 0.042)], serum bilirubin >8 mg/dl [OR 2.1; 95% CI 1.8-12.3, (P = 0.052)], serum creatinine >1.8 mg/dl [OR 2.8; 95% CI 1.9-9.2, (P = 0.042)], PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio <200 [OR 4.5; 95% CI 3.1-18.5, (P = 0.026)] and INR > 2.5 [OR 2.2; 95% CI 1.8-6.7, (P = 0.032)] were risk factors for mortality at presentation. However, on multivariate analysis only PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio <200 and serum creatinine >1.8 mg/dl remained predictors of mortality. Secondary infections, whether fungal or bacterial, were noted to be independent risk factors for disease severity in patients with cirrhosis.
[h=4]Conclusion:[/h] Early detection and referral, and early antiviral treatment with a strict control of nosocomial spread is essential in patients with cirrhosis during epidemic influenza.
[h=4]KEYWORDS:[/h] AKI, Acute Kidney Injury; APACHE II, Acute Physiologic Assessment and Chronic Health Evaluation II; ARDS, Acute Respiratory Distress Syndrome; CLD, Chronic Liver Disease; CTP, Child Turcotte Pugh Score; CXR, Chest Radiograph; H1N1 influenza; ICU, Intensive Care Unit; ILI, Influenza Like Illness; INR, International Normalized Ratio; MELD, Model for End-Stage Liver Disease; NASH, Non Alcoholic Steatohepatitis; PCR, Polymerase Chain Reaction; SOFA, Sequential Organ Failure Score; critical care in liver disease; pneumonia; ventilatory support
PMID: 31024197 PMCID: PMC6477137 [Available on 2020-03-01] DOI: 10.1016/j.jceh.2018.04.006