Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada.
Crit Care. 2011 Jul 28;15(4):R182. doi: 10.1186/cc10331.
There is a paucity of data about the clinical characteristics that help identify patients at high risk of influenza infection upon ICU admission. We aimed to identify predictors of influenza infection in patients admitted to ICUs during the 2007/2008 and 2008/2009 influenza seasons and the second wave of the 2009 H1N1 influenza pandemic as well as to identify populations with increased likelihood of seasonal and pandemic 2009 influenza (pH1N1) infection.
Six Toronto acute care hospitals participated in active surveillance for laboratory-confirmed influenza requiring ICU admission during periods of influenza activity from 2007 to 2009. Nasopharyngeal swabs were obtained from patients who presented to our hospitals with acute respiratory or cardiac illness or febrile illness without a clear nonrespiratory aetiology. Predictors of influenza were assessed by multivariable logistic regression analysis and the likelihood of influenza in different populations was calculated.
In 5,482 patients, 126 (2.3%) were found to have influenza. Admission temperature ≥38°C (odds ratio (OR) 4.7 for pH1N1, 2.3 for seasonal influenza) and admission diagnosis of pneumonia or respiratory infection (OR 7.3 for pH1N1, 4.2 for seasonal influenza) were independent predictors for influenza. During the peak weeks of influenza seasons, 17% of afebrile patients and 27% of febrile patients with pneumonia or respiratory infection had influenza. During the second wave of the 2009 pandemic, 26% of afebrile patients and 70% of febrile patients with pneumonia or respiratory infection had influenza.
The findings of our study may assist clinicians in decision making regarding optimal management of adult patients admitted to ICUs during future influenza seasons. Influenza testing, empiric antiviral therapy and empiric infection control precautions should be considered in those patients who are admitted during influenza season with a diagnosis of pneumonia or respiratory infection and are either febrile or admitted during weeks of peak influenza activity.
关于有助于识别 ICU 入院时流感感染高危患者的临床特征的数据很少。我们旨在确定 2007/2008 年和 2008/2009 年流感季节以及 2009 年 H1N1 流感大流行第二波期间入住 ICU 的患者流感感染的预测因素，并确定季节性和大流行 2009 年流感（pH1N1）感染可能性增加的人群。
六家多伦多急性护理医院参与了从 2007 年到 2009 年流感活跃期间对需要入住 ICU 的实验室确诊流感的主动监测。从因急性呼吸道或心脏疾病或发热而就诊但无明确非呼吸道病因的患者中采集鼻咽拭子。通过多变量逻辑回归分析评估流感的预测因素，并计算不同人群中流感的可能性。
在 5482 名患者中，发现 126 名（2.3%）患有流感。入院时体温≥38°C（pH1N1 的优势比（OR）为 4.7，季节性流感为 2.3）和入院诊断为肺炎或呼吸道感染（pH1N1 的 OR 为 7.3，季节性流感为 4.2）是流感的独立预测因素。在流感季节的高峰期，17%的无热患者和 27%的有肺炎或呼吸道感染的发热患者患有流感。在 2009 年大流行的第二波期间，26%的无热患者和 70%的有肺炎或呼吸道感染的发热患者患有流感。
我们研究的结果可能有助于临床医生在未来流感季节管理入住 ICU 的成年患者时做出最佳决策。在流感季节期间，诊断为肺炎或呼吸道感染且无论发热与否或在流感活动高峰期期间入院的患者，应考虑进行流感检测、经验性抗病毒治疗和经验性感染控制预防措施。
