Predictive factors of severe multilobar pneumonia and shock in patients with influenza
Por:
Gutierrez, SG, Quintana, JM, Baricot, M, Bilbao, A, Capelastegui, A, Eguiluz, CGC, Dominguez, A, Castilla, J, Godoy, P, Delgado-Rodriguez, M, Soldevila, N, Astray, J, Mayoral, JM, Martin, V, Gonzalez-Candelas, F, Galan, JC, Tamames, S, Castro-Acosta, AA, Garin, O, Pumarola, T, Bonfill X., López-Contreras J., Pomar V., Puig T., CIBERESP Cases Controls Pandemic I
Publicada:
1 abr 2014
Resumen:
Purpose To identify risk factors present at admission in adult patients hospitalised due to influenza virus infection during the 2009/10 and 2010/11 seasons-including whether infection was from pandemic or seasonal influenza A infections-that were associated with the likelihood of developing severe pneumonia with multilobar involvement and shock.
Methods Prospective cohort study. Patients hospitalised due to influenza virus infection were recruited. We collected information on sociodemographic characteristics, pre-existing medical conditions, vaccinations, toxic habits, previous medications, exposure to social environments, and EuroQoL-5D (EQ-5D). Severe pneumonia with multilobar involvement and/or shock (SPAS) was the primary outcome of interest. We constructed two multivariate logistic regression models to explain the likelihood of developing SPAS and to create a clinical prediction rule for developing SPAS that includes clinically relevant variables.
Results Laboratory-confirmed A(H1N1) pdm09, EQ-5D utility score 7 days before admission, more than one comorbidity, altered mental status, dyspnoea on arrival, days from onset of symptoms, and influenza season were associated with SPAS. In addition, not being vaccinated against seasonal influenza in the previous year, anaemia, altered mental status, fever and dyspnoea on arrival at hospital, difficulties in performing activities of daily living in the previous 7 days, and days from onset of symptoms to arrival at hospital were related to the likelihood of SPAS (area under the curve value of 0.75; Hosmer-Lemeshow p value of 0.84).
Conclusions These variables should be taken into account by physicians evaluating a patient affected by influenza as additional information to that provided by the usual risk scores.
Filiaciones:
Gutierrez, SG:
Hosp Galdakao Usansolo Osakidetza, Red Invest Serv Salud Enfermedades Cron REDISSEC, Unidad Invest, Galdakao, Bizkaia, Spain
Quintana, JM:
Hosp Galdakao Usansolo Osakidetza, Red Invest Serv Salud Enfermedades Cron REDISSEC, Unidad Invest, Galdakao, Bizkaia, Spain
Baricot, M:
Univ Basque Country, Dept Prevent & Salud Publ, Leioa, Bizkaia, Spain
Bilbao, A:
Hosp Univ Basurto Osakidetza, Red Invest Serv Salud Enfermedades Cron REDISSEC, Unidad Invest, Bilbao, Bizkaia, Spain
Capelastegui, A:
Hosp Galdakao Usansolo, Serv Neumol, Galdakao, Bizkaia, Spain
Eguiluz, CGC:
Hosp Donostia, Serv Microbiol, Donostia San Sebastian, Gipuzkoa, Spain
Dominguez, A:
Univ Barcelona, Dept Salut Publ, Barcelona, Spain
CIBERESP, Madrid, Spain
Castilla, J:
Inst Salud Publ Navarra, Pamplona, Navarra, Spain
Generalitat Catalunya, Dept Salut, Barcelona, Spain
Godoy, P:
CIBERESP, Madrid, Spain
Generalitat Catalunya, Dept Salut, Barcelona, Spain
Delgado-Rodriguez, M:
CIBERESP, Madrid, Spain
Univ Jaen, Jaen, Spain
Soldevila, N:
Univ Barcelona, Dept Salut Publ, Barcelona, Spain
CIBERESP, Madrid, Spain
Astray, J:
Comunidad Madrid, Area Epidemiol, Madrid, Spain
Mayoral, JM:
Serv Vigilancia Andalucia, Andalucia, Andalucia, Spain
Martin, V:
CIBERESP, Madrid, Spain
Univ Leon, Inst Biomed, E-24071 Leon, Spain
Gonzalez-Candelas, F:
CIBERESP, Madrid, Spain
Univ Valencia, Ctr Super Invest Salud Publ, Valencia, Spain
Galan, JC:
CIBERESP, Madrid, Spain
Hosp Univ Ramon y Cajal, Madrid, Spain
Tamames, S:
Junta Castilla & Leon, Direcc Gen Salud Publ & Invest Desarrollo & Innov, Valladolid, Spain
Castro-Acosta, AA:
CIBER, Madrid, Spain
Garin, O:
CIBERESP, Madrid, Spain
Inst Municipal Invest Med, Barcelona, Spain
Pumarola, T:
REIPI, Barcelona, Spain
Bonfill X.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
López-Contreras J.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Pomar V.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Puig T.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
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