Ji Hong, Gu Qin, Chen Li-Ling, Xu Ke, Ling Xia, Bao Chang-Jun, Tang Fen-Yang, Qi Xian, Wu Ying-Qiu, Ai Jing, Shen Gu-Yu, Dong Dan-Jiang, Yu Hui-Yan, Huang Mao, Cao Quan, Xu Ying, Zhao Wei, Xu Yang-Ting, Xia Yu, Chen Shan-Hui, Yang Gen-Lin, Gu Cai-Ling, Xie Guo-Xiang, Zhu Ye-Fei, Zhu Feng-Cai, Zhou Ming-Hao
Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China.
Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China.
PLoS One. 2014 Mar 4;9(3):e89581. doi: 10.1371/journal.pone.0089581. eCollection 2014.
A novel avian influenza A (H7N9) virus has caused great morbidity as well as mortality since its emergence in Eastern China in February 2013. However, the possible risk factors for death are not yet fully known.
Patients with H7N9 virus infection between March 1 and August 14, 2013 in Jiangsu province were enrolled. Data were collected with a standard form. Mean or percentage was used to describe the features, and Fisher's exact test or t-test test was used to compare the differences between fatal and nonfatal cases with H7N9 virus infection. A total of 28 patients with H7N9 virus infection were identified among whom, nine (32.1%) died. The median age of fatal cases was significant higher than nonfatal cases (P<0.05). Patients with older age were more strongly associated with increased odds of death (OR = 30.0; 95% CI, 2.85-315.62). Co-morbidity with chronic lung disease and hypertension were risk factors for mortality (OR = 14.40; 95% CI, 1.30-159.52, OR = 6.67; 95% CI, 1.09-40.43, respectively). Moreover, the presence of either bilateral lung inflammation or pulmonary consolidation on chest imaging on admission was related with fatal outcome (OR = 7.00; 95%CI, 1.10-44.61). Finally, dynamic monitoring showed that lymphopenia was more significant in fatal group than in nonfatal group from day 11 to week five (P<0.05). The decrease in oxygenation indexes were observed in most cases and more significantly in fatal cases after week three (P<0.05), and the value of nearly all fatal cases were below 200 mmHg during our evaluation period.
Among cases with H7N9 virus infection, increased age accompanied by co-morbidities was the risk of death. The severity of lung infection at admission, the persistence of lymphocytopenia, and the extended duration of lower oxygenation index all contributed to worsened outcomes of patients with H7N9 virus infection.
自2013年2月在中国东部出现以来，一种新型甲型H7N9禽流感病毒已导致大量发病和死亡。然而，死亡的可能风险因素尚未完全明确。
纳入2013年3月1日至8月14日江苏省的H7N9病毒感染患者。用标准表格收集数据。用均值或百分比描述特征，用Fisher精确检验或t检验比较H7N9病毒感染致死病例与非致死病例之间的差异。共识别出28例H7N9病毒感染患者，其中9例（32.1%）死亡。致死病例的年龄中位数显著高于非致死病例（P<0.05）。年龄较大的患者死亡几率增加更明显（OR = 30.0；95%可信区间，2.85 - 315.62）。合并慢性肺病和高血压是死亡的危险因素（分别为OR = 14.40；95%可信区间，1.30 - 159.52，OR = 6.67；95%可信区间，1.09 - 40.43）。此外，入院时胸部影像学显示双侧肺部炎症或肺实变与致死结局相关（OR = 7.00；95%可信区间，1.10 - 44.61）。最后，动态监测显示，从第11天至第5周，致死组淋巴细胞减少比非致死组更显著（P<0.05）。大多数病例观察到氧合指数下降，第3周后致死病例更明显（P<0.05），在我们的评估期内几乎所有致死病例的值均低于200 mmHg。
在H7N9病毒感染病例中，年龄增加伴有合并症是死亡风险。入院时肺部感染的严重程度、淋巴细胞减少的持续存在以及低氧合指数持续时间延长均导致H7N9病毒感染患者预后恶化。
