Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit.

Abstract

PURPOSE:

Information about immunocompromised patients infected with influenza A (H1N1) virus and requiring admission to the ICU is lacking. Our objective was to know the clinical characteristics of these patients and to identify treatment-related variables associated with mortality.

MATERIAL AND METHODS:

A prospective multicenter observational cohort study was based on data from a Spanish registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU with the diagnosis of influenza A (H1N1) virus infection were included. Immunosuppression was clearly defined. Factors associated with mortality in immunocompromised patients were assessed by conventional logistic regression analysis and by a propensity score (PS) adjusted-multivariable analysis.

RESULTS:

Of 1899 patients with influenza A (H1N1) infection, 238 (12.5%) were classified as immunocompromised. Mortality was significantly higher in immunosuppressed patients. Four variables independently associated with mortality were identified: SOFA score, need of vasopressor, use of corticosteroids, and acute renal failure, AKIN 3 stage. In the PS-adjusted model, corticosteroid therapy remained as an independent factor associated with increased mortality (OR 2.25;95%CI, 1.15-4.38;p = 0.017). In the subgroup of hematological patients (n = 141), corticosteroid therapy was also associated with increased mortality (OR 3.12; 95%CI, 1.32-7.41; p = 0.010).

CONCLUSION:

Immunocompromised individuals with influenza A (H1N1) admitted to the ICU have a poor outcome. In this population, the use of corticosteroids is strongly discouraged.

• Authors: José Garnacho-Montero, Cristina León-Moya, Antonio Gutiérrez-Pizarraya, Angel Arenzana-Seisdedos, Loreto Vidaur, José Eugenio Guerrero, Mónica Gordón, Ignacio Martín-Loeches, Alejandro Rodriguez, on Behalf GETGAG Study Group
• Journal: Journal of critical care (J Crit Care) Vol. 48 Pg. 172-177 (12 2018) ISSN: 1557-8615 [Electronic] United States
• PMID: 30216935 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Cohort Studies
• Female
• Hospitalization
• Humans
• Immunocompromised Host
• Influenza A Virus, H1N1 Subtype
• Influenza, Human (mortality)
• Intensive Care Units
• Logistic Models
• Male
• Middle Aged
• Organ Dysfunction Scores
• Prospective Studies
• Registries
• Risk Factors
• Spain