Nardocci Paula, Gullo Caio Eduardo, Lobo Suzana Margareth
Faculdade de Medicina de São José do Rio Preto - FAMERP - São José do Rio Preto SP, Brazil.
Rev Bras Ter Intensiva. 2013 Apr-Jun;25(2):123-9. doi: 10.5935/0103-507X.20130023.
To analyze the clinical, laboratory and evolution data of patients with severe influenza A H1N1 pneumonia and compare the data with that of patients with severe community-acquired bacterial pneumonia.
Cohort and retrospective study. All patients admitted to the intensive care unit between May 2009 and December 2010 with a diagnosis of severe pneumonia caused by the influenza A H1N1 virus were included in the study. Thirty patients with severe community-acquired pneumonia admitted within the same period were used as a control group. Severe community-acquired pneumonia was defined as the presence of at least one major severity criteria (ventilator or vasopressor use) or two minor criteria.
The data of 45 patients were evaluated. Of these patients, 15 were infected with H1N1. When compared to the group with community-acquired pneumonia, patients from the H1N1 group had significantly lower leukocyte counts on admission (6,728±4,070 versus 16,038±7,863; p<0.05) and lower C-reactive protein levels (Day 2: 15.1±8.1 versus 22.1±10.9 mg/dL; p<0.05). The PaO2/FiO2 ratio values were lower in the first week in patients with H1N1. Patients who did not survive the H1N1 severe pneumonia had significantly higher levels of C-reactive protein and higher serum creatinine levels compared with patients who survived. The mortality rate was significantly higher in the H1N1 group than in the control group (53% versus 20%; p=0.056, respectivelly).
Differences in the leukocyte count, C-reactive protein concentrations and oxygenation profiles may contribute to the diagnosis and prognosis of patients with severe influenza A H1N1 virus-related pneumonia and community-acquired pneumonia.
分析甲型H1N1流感重症肺炎患者的临床、实验室及病情演变数据，并与重症社区获得性细菌性肺炎患者的数据进行比较。
队列研究和回顾性研究。纳入2009年5月至2010年12月期间入住重症监护病房、诊断为甲型H1N1病毒所致重症肺炎的所有患者。同期收治的30例重症社区获得性肺炎患者作为对照组。重症社区获得性肺炎定义为存在至少一项主要严重标准（使用呼吸机或血管活性药物）或两项次要标准。
对45例患者的数据进行了评估。其中15例感染H1N1。与社区获得性肺炎组相比，H1N1组患者入院时白细胞计数显著更低（6,728±4,070对16,038±7,863；p<0.05），C反应蛋白水平更低（第2天：15.1±8.1对22.1±10.9mg/dL；p<0.05）。H1N1患者第一周的PaO2/FiO2比值更低。甲型H1N1流感重症肺炎死亡患者的C反应蛋白水平和血清肌酐水平显著高于存活患者。H1N1组的死亡率显著高于对照组（分别为53%对20%；p=0.056）。
白细胞计数、C反应蛋白浓度和氧合情况的差异可能有助于甲型H1N1流感病毒相关重症肺炎和社区获得性肺炎患者的诊断和预后判断。
