Ho Ya-Chi, Wang Jiun-Ling, Wang Jann-Tay, Wu Un-In, Chang Chiu-Wen, Wu Ho-Sheng, Chen Chang-Hsun, Chuang Yu-Min, Chang Shan-Chwen
Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan, ROC.
J Infect. 2009 Jun;58(6):439-45. doi: 10.1016/j.jinf.2009.03.007. Epub 2009 Mar 25.
To elucidate the prognostic factors for fatal adult influenza pneumonia.
Complicated influenza pneumonia is a notifiable disease in Taiwan. In this retrospective nationwide cohort, medical records were reviewed in 38 qualifying cases from 2001 to 2007. In-hospital mortality was the primary endpoint of this study.
The median patient age was 52 years, with the in-hospital mortality rate of 44.7%. Influenza A virus was found in 25 patients and influenza B was in 13 patients. Fifty percent of patients had no comorbidities. More than half of the patients developed sepsis, septic shock, respiratory failure or acute respiratory distress syndrome. The median duration from symptom onset to hospital visit was 3 days, and from hospital visit to death was 4 days. A univariate analysis demonstrated poor prognosis in patients with shock, respiratory rate > or =25/min, arterial pH<7.35, creatinine> or =2mg/dL and Pneumonia Severity Index IV or V. A multivariate analysis showed an association with mortality in patients with APACHE II score > or =20 (hazard ratio 5.941, p=0.024) or PaO(2)/FiO(2) ratio <150 (hazard ratio 4.194, p=0.017).
Clinical knowledge of identified prognostic factors for mortality may aid management of adult influenza pneumonia.
阐明成人致命性流感肺炎的预后因素。
在台湾，复杂性流感肺炎属于法定报告疾病。在这项全国性回顾性队列研究中，对2001年至2007年期间38例符合条件的病例的医疗记录进行了审查。住院死亡率是本研究的主要终点。
患者中位年龄为52岁，住院死亡率为44.7%。25例患者检测出甲型流感病毒，13例患者检测出乙型流感病毒。50%的患者无合并症。超过半数的患者发生了败血症、感染性休克、呼吸衰竭或急性呼吸窘迫综合征。从症状出现到就诊的中位时间为3天，从就诊到死亡的中位时间为4天。单因素分析显示，休克、呼吸频率≥25次/分钟、动脉血pH<7.35、肌酐≥2mg/dL以及肺炎严重程度指数为IV或V级的患者预后较差。多因素分析显示，急性生理与慢性健康状况评分系统II（APACHE II）评分≥20（风险比5.941，p=0.024）或动脉血氧分压/吸入氧分数（PaO₂/FiO₂）比值<150（风险比4.194，p=0.017）的患者与死亡率相关。
了解已确定的死亡率预后因素的临床知识可能有助于成人流感肺炎的管理。
