tetano
Editor, Senior Moderator
J Infect Dis. 2019 Oct 17. pii: jiz328. doi: 10.1093/infdis/jiz328. [Epub ahead of print] [h=1]A Risk Classification Model to Predict Mortality Among Laboratory-Confirmed Avian Influenza A H7N9 Patients: A Population-Based Observational Cohort Study.[/h]
Martinez L[SUP]1,[/SUP][SUP]2[/SUP], Cheng W[SUP]3[/SUP], Wang X[SUP]3[/SUP], Ling F[SUP]3[/SUP], Mu L[SUP]4[/SUP], Li C[SUP]1[/SUP], Huo X[SUP]5[/SUP], Ebell MH[SUP]1[/SUP], Huang H[SUP]5[/SUP], Zhu L[SUP]5[/SUP], Li C[SUP]1[/SUP], Chen E[SUP]3[/SUP], Handel A[SUP]1[/SUP], Shen Y[SUP]1[/SUP].
[h=3]Author information[/h] 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.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] 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.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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).
[h=4]CONCLUSIONS:[/h] 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.
[h=4]KEYWORDS:[/h] H7N9 infection; influenza; mortality; risk score
PMID: 31622983 DOI: 10.1093/infdis/jiz328
Martinez L[SUP]1,[/SUP][SUP]2[/SUP], Cheng W[SUP]3[/SUP], Wang X[SUP]3[/SUP], Ling F[SUP]3[/SUP], Mu L[SUP]4[/SUP], Li C[SUP]1[/SUP], Huo X[SUP]5[/SUP], Ebell MH[SUP]1[/SUP], Huang H[SUP]5[/SUP], Zhu L[SUP]5[/SUP], Li C[SUP]1[/SUP], Chen E[SUP]3[/SUP], Handel A[SUP]1[/SUP], Shen Y[SUP]1[/SUP].
[h=3]Author information[/h] 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.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] 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.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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).
[h=4]CONCLUSIONS:[/h] 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.
[h=4]KEYWORDS:[/h] H7N9 infection; influenza; mortality; risk score
PMID: 31622983 DOI: 10.1093/infdis/jiz328