Outcomes of Immunocompromised Adults Hospitalized With Laboratory-confirmed Influenza in the United States, 2011-2015.

Abstract

BACKGROUND:

Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-IC adults.

METHODS:

We identified adults hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had human immunodefiency virus (HIV)/AIDS, cancer, stem cell or organ transplantation, nonsteroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, and/or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics. Multivariable logistic regression and Cox proportional hazards models controlled 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%), nonsteroid immunosuppressive therapy (44%), and HIV (18%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs 46%; P < .001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.20-1.76). Intensive care was more likely among IC patients 65-79 years (aOR, 1.25; 95% CI, 1.06-1.48) and those >80 years (aOR, 1.35; 95% CI, 1.06-1.73) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge, 0.86; 95% CI, .83-.88) and more likely to require mechanical ventilation (aOR, 1.19; 95% CI, 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.

• Authors: Jennifer P Collins, Angela P Campbell, Kyle Openo, Monica M Farley, Charisse Nitura Cummings, Mary Hill, William Schaffner, Mary Lou Lindegren, Ann Thomas, Laurie Billing, Nancy Bennett, Nancy Spina, Marisa Bargsten, Ruth Lynfield, Seth Eckel, Patricia Ryan, Kimberly Yousey-Hindes, Rachel Herlihy, Pam Daily Kirley, Shikha Garg, Evan J Anderson
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 70 Issue 10 Pg. 2121-2130 (05 06 2020) ISSN: 1537-6591 [Electronic] United States
• PMID: 31298691 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Topics

• Adult
• Hospitalization
• Humans
• Immunocompromised Host
• Influenza, Human (epidemiology)
• Laboratories
• United States (epidemiology)
• Vaccination