https://doi.org/10.4081/monaldi.2021.1876
Predictors of severity and in-hospital mortality in patients with influenza
Submitted: April 3, 2021
Accepted: July 20, 2021
Published: August 10, 2021
Accepted: July 20, 2021
Abstract Views: 1347
PDF: 519
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Influenza virus is a common agent of acute respiratoty infections during epidemic periods. It is a major cause of morbidity and mortality and represent a significant burden on the healthcare system. We aimed to evaluate predictors of severity and of in-hospital mortality in patients hospitalized with influenza infection. We performed a retrospective cohort study of hospitalized, laboratory confirmed cases of influenza disease in Centro Hospitalar de São João between October 2016-May 2017 and October 2017-May 2018. The endpoints being analysed were severity and in-hospital mortality. A multivariate logistic regression analysis was used to determine independent predictors of severity and of in-hospital mortality. We studied 221 hospitalized influenza infection cases. Mean age 66±16 years, 57.9% were male, thirty-seven patients (16.7%) died in-hospital and 101 patients (45.7%) met severity criteria. C-reactive protein (CRP) was the only independent predictor of severity as well as the only independent predictor of higher in-hospital mortality in patients admitted due to influenza infection. Multivariate-adjusted CRP OR for severity was 1.10, 95% CI 1.06-1.15 per each 10 mg/L increase in CPR and for in-hospital mortality risk the OR was of 1.05, 95% CI 1.01-1.09, p=0.01, per each 10 mg/L increase. Concluding, in patients’ hospital-admitted due to influenza infection CRP was the only predictor of severity with a 10% increased risk of inotropic support/ventilatory support/prolonged hospitalization needs and a 5% increase risk of in-hospital death per each 10 mg/l increase.
Center for Disease Control and Prevention. Seasonal influenza (flu). Accessed: 01/06/2019. Available from: https://www.cdc.gov/flu/about/index.html
Uyeki TM. Influenza. Ann Intern Med 2017;167:ITC33-48.
Bresee J, Hayden FG. Epidemic influenza-responding to the expected but unpredictable. N Engl J Med 2013;368:589.
DOI: https://doi.org/10.1056/NEJMp1300375
European Centre for Disease Prevention and Control. Influenza virus characterisation, summary Europe, September 2018. Stockholm: ECDC; 2018.
Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. [Boletim de Vigilância Epidemiológica da Gripe, Época 2016/2017 - Semana 20].[in Portuguese]. Instituto Nacional de Saúde Doutor Ricardo Jorge I.P., 2017.
Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. [Boletim de Vigilância Epidemiológica da Gripe, Época 2017-2018 - Semana 20].[in Portuguese]. Instituto Nacional de Saúde Doutor Ricardo Jorge I.P., 2018.
Chaves SS, Aragon D, Bennett N, et al. Patients hospitalized with laboratory-confirmed influenza during the 2010-2011 influenza season: exploring disease severity by virus type and subtype. J Infect Dis 2013;208:1305-14.
DOI: https://doi.org/10.1093/infdis/jit316
Ribeiro AF, Pellini AC, Kitagawa BY, et al. Risk factors for death from Influenza A(H1N1)pdm09, State of Sao Paulo, Brazil, 2009. PLoS One 2015;10:e0118772.
Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clin Infect Dis 2017;65:1289-97.
DOI: https://doi.org/10.1093/cid/cix468
Center for Disease Control and Prevention. Prevent flu. Accessed: 01/06/2019. Available from: https://www.cdc.gov/flu/prevent/vaccinations.htm
Ghebrehewet S, MacPherson P, Ho A. Influenza. BMJ 2016;355:i6258.
Moscona A. Neuraminidase inhibitors for influenza. N Engl J Med 2005;353:1363-73.
DOI: https://doi.org/10.1056/NEJMra050740
Cooper NJ, Sutton AJ, Abrams KR, et al. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ 2003;326:1235.
DOI: https://doi.org/10.1136/bmj.326.7401.1235
Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet 2015;385:1729.
DOI: https://doi.org/10.1016/S0140-6736(14)62449-1
Jefferson T, Demicheli V, Rivetti D, et al. Antivirals for influenza in healthy adults: systematic review. Lancet 2006;367:303.
DOI: https://doi.org/10.1016/S0140-6736(06)67970-1
Hong KW, Cheong HJ, Choi WS, et al. Clinical courses and outcomes of hospitalized adult patients with seasonal influenza in Korea, 2011–2012: hospital-based influenza morbidity & mortality (HIMM) surveillance. J Infect Chemother 2014;29:9–14.
DOI: https://doi.org/10.1016/j.jiac.2013.07.001
Canak G, Kovacevic N, Turkulov V, et al. Clinical features, treatments and the outcomes of influenza A (H1N1) 2009 among the hospitalized patients in the clinic for infectious diseases in Novi Sad. Vojnosanit Pregl 2013;70:155–62.
DOI: https://doi.org/10.2298/VSP1302155C
Baden LR, Swaminathan S, Angarone M, et al. Prevention and treatment of cancer-related infections, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2016;14:882-913.
DOI: https://doi.org/10.6004/jnccn.2016.0093
Vasileva D, Badawi A. C-reactive protein as a biomarker of severe H1N1 influenza. Inflamm Res 2019;68:39–46.
DOI: https://doi.org/10.1007/s00011-018-1188-x
Zimmerman O, Rogowski O, Aviram G, et al. C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection. BMC Infect Dis 2010;10:288.
DOI: https://doi.org/10.1186/1471-2334-10-288
Gao RB, Wang L, Bai T, et al. C-reactive mediating immunopathological lesions: a potential treatment option for severe influenza A diseases. EBioMedicine 2017;22:133–42.
DOI: https://doi.org/10.1016/j.ebiom.2017.07.010
Liu Q, Zhou YH, Yang ZQ. The cytokine storm of severe influenza and development of immunomodulatory therapy. Cell Mol Immunol 2016;13:3–10.
DOI: https://doi.org/10.1038/cmi.2015.74
Shah SH, Newby LK. C-reactive protein: a novel marker of cardiovascular risk. Cardiol Rev 2003;11:169-79.
DOI: https://doi.org/10.1097/01.CRD.0000077906.74217.6E
Supporting Agencies
not applicableHow to Cite
Serino, Mariana, Nuno Melo, João Paulo Caldas, Ana Ferreira, David Garcia, and Patrícia Lourenço. 2021. “Predictors of Severity and in-Hospital Mortality in Patients With Influenza”. Monaldi Archives for Chest Disease 92 (1). https://doi.org/10.4081/monaldi.2021.1876.
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Carlos A. Jiménez-Ruiz, Marcos Garcia Rueda, Manuel A. Martinez Muñiz, Jacobo Sellarés, Maria A. Jiménez-Fuentes, Lourdes Lázaro Asegurado, Esther RodrÃguez Gonzalez, Concepción Rodriguez Garcia, Oriol Armengol, Emilia Abad, Teresa Peña, Adolfo Domenech del Rio, Juan A. Riesco Miranda, Varenicline in smokers with severe or very severe COPD after 24 weeks of treatment. A descriptive analysis: VALUE study , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Claudio F. Donner, Sandro Amaducci, Elena Bacci, Sandra Baldacci, Maria L. Bartoli, Gianfranco M. Beghi, Alida Benfante, Sara Brighindi, Lucio Casali, Daniela Castiglia, Mario Cazzola, Alessandro Celi, Silvana Cianchetti, Giorgio Colombo, Claudia Crimi, Federico L. Dente, Giuseppe Di Maria, Annalisa Di Maria, Manuela Latorre, Federico Lavorini, Sara Maio, Claudia Mannini, Riccardo Messina, Pier Luigi Paggiaro, Patrizia Pignatti, David Price, Nicola Scichilone, Marzia Simoni, Antonio Spanevello, Martina Stagno d’Alcontres, Shawna Tan, Roberto Torchio, Giovanni Viegi, Dina Visca, Emiel F.M. Wouters, Shaylynn Yu Hui Xin, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Gabriele Valli, Francesca De Marco, Maria Teresa Spina, Valentina Valeriano, Antonello Rosa, Valentina Minerva, Enrico Mirante, Maria Pia Ruggieri, Francesco Rocco Pugliese, A pilot study on the application of the current European guidelines for the management of acute coronary syndrome without elevation of ST segment (NSTEMI) in the Emergency Department setting in the Italian region Lazio , Monaldi Archives for Chest Disease: Vol. 82 No. 4 (2014): Cardiac series
- Muhammad Ijaz, Muhammad Jaffar Khan, Jawad Khan, . Usama, Association of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- C. Ortolani, F. Agostinis, S. Amoroso, R. Ariano, A. Barbato, M. Bassi, G. Cadario, P. Campi, F. Cardinale, G. Ciprandi, R. D’Anneo, M. Di Gioacchino, V. Di Rienzo, A. Fiocchi, M. Galimberti, E. Galli, M. Giovannini, C. Incorvaia, S. La Grutta, C. Lombardi, F. Marcucci, G. Marseglia, M. Minelli, A. Musarra, E. Nettis, E. Novembre, G. Pajno, G. Patriarca, F. Pezzuto, P. Piras, S. Pucci, A. Romano, C. Romano, O. Quercia, G. Scala, D. Schiavino, G. Sforza, M. Tosca, S. Tripodi, F. Frati, Practice parameters for sublingual immunotherapy , Monaldi Archives for Chest Disease: Vol. 65 No. 1 (2006): Pulmonary series
- Francesca Gatta, Yama Haqzad, George Gradinariu, Pietro Giorgio Malvindi, Zubair Khalid, Rona L. Suelo-Calanao, Nader Moawad, Aladdin Bashir, Luke J. Rogers, Clinton Lloyd, Bao Nguyen, Karen Booth, Lu Wang, Nawwar Al-Attar, Neil McDowall, Stuart Watkins, Rana Sayeed, Saleh Baghdadi, Andrea D’Alessio, Maria Monteagudo-vela, Jasmina Djordjevic, Matej Goricar, Solveig Hoppe, Charlotte Bocking, Azar Hussain, Betsy Evans, Salman Arif, Christopher Malkin, Mark Field, Kully Sandhu, Amer Harky, Ahmed Torky, Mauin Uddin, Muhammad Abdulhakeem, Ayman Kenawy, John Massey, Neil Cartwright, Nathan Tyson, Niki Nicou, Kamran Baig, Mark Jones, Firas Aljanadi, Colum G. Owens, Tunde Oyebanji, Joseph Doyle, Mark S. Spence, Paul F. Brennan, Ganesh Manoharan, Taha Ramadan, Sunil Ohri, Mahmoud Loubani, Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis , Monaldi Archives for Chest Disease: Vol. 94 No. 1 (2024)
- Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava, Revolving door respiratory patients: A rehabilitative perspective , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Gianfranco Beghi, Antonio De Tanti, Paolo Serafini, Chiara Bertolino, Antonietta Celentano, Graziella Taormina, Monitoring of hospital acquired pneumonia in patients with severe brain injury on first access to intensive neurological rehabilitation: First year of observation , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- D. Scala, S. Cozzolino, G. D’Amato, G. Cocco, A. Sena, P. Martucci, E. Ferraro, A.A. Mancini, Sharing knowledge is the key to success in a patient-physician relationship: how to produce a patient information leaflet on COPD , Monaldi Archives for Chest Disease: Vol. 69 No. 2 (2008): Pulmonary series
- Giovanni Pulignano, Maria Denitza Tinti, Donatella Del Sindaco, Stefano Tolone, Giovanni Minardi, Antonio Lax, Massimo Uguccioni, Barriers to cardiac rehabilitation access of older heart failure patients and strategies for better implementation , Monaldi Archives for Chest Disease: Vol. 84 No. 1-2 (2015): Cardiac series
You may also start an advanced similarity search for this article.
