2009 - 2010年加拿大原住民和非原住民中与甲型流感（H1N1）相关的危重病情况。

2009-2010 Influenza A(H1N1)-related critical illness among Aboriginal and non-Aboriginal Canadians.

作者信息

Jung James J, Pinto Ruxandra, Zarychanski Ryan, Cook Deborah J, Jouvet Philippe, Marshall John C, Kumar Anand, Long Jennifer, Rodin Rachel, Fowler Robert A

机构信息

University of Toronto, Faculty of Medicine. Department of Critical Care Medicine; Sunnybrook Hospital; Toronto, Ontario, Canada.

Department of Critical Care Medicine; Sunnybrook Hospital; Toronto, Ontario, Canada.

出版信息

PLoS One. 2017 Oct 19;12(10):e0184013. doi: 10.1371/journal.pone.0184013. eCollection 2017.

DOI:10.1371/journal.pone.0184013

PMID:29049285

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5648104/

Abstract

BACKGROUND

Preliminary studies suggested that Aboriginal Canadians had disproportionately higher rates of infection, hospitalization, and critical illness due to pandemic Influenza A(H1N1)pdm09.

METHODS

We used a prospective cohort study of critically ill patients with laboratory confirmed or probable H1N1 infection in Canada between April 16 2009 and April 12 2010. Baseline characteristics, medical interventions, clinical course and outcomes were compared between Aboriginal and non-Aboriginal patients. The primary outcome was hospital mortality.

RESULTS

Of 647 critically ill adult patients with known ethnicity, 81 (12.5%) were Aboriginal, 566 (87.5%) were non-Aboriginal. Aboriginal patients were younger (mean [SD] age 40.7[13.7] v. 49.0[14.9] years, p < 0.001) and more frequently female (64.2% v. 51.1%, p = 0.027). Rates of any co-morbid illnesses (Aboriginal v. non-Aboriginal, 92.6% v. 91.0%, p = 0.63), time from symptom onset to hospital admission (median [interquartile range] 4 [2-7] v. 4 [2-7] days, p = 0.84), time to ICU admission (5 [3-8] v.5 [3-8] days, p = 0.91), and severity of illness (mean APACHE II score (19.9 [9.6] v. 21.1 [9.9], p = 0.33) were similar. A similar proportion of Aboriginal patients received antiviral medication before ICU admission than non-Aboriginal patients (91.4% v. 93.8%, p = 0.40). Among Aboriginal versus non-Aboriginal patients, the need for mechanical ventilation (93.8% v. 88.6%, p = 0.15), ventilator-free days (14 [3-23] v. 17 [0-24], p = 0.62), durations of stay in ICU (13[7-19.5] v. 11 [5-8] days, p = 0.05), hospital (19 [12.5-33.5] v. 18 [11-35] days, p = 0.63), and hospital mortality were similar (19.8% v. 22.6%, p = 0.56). In multiple logistic regression analyses, higher APACHE II score (1.06; 1.04-1.09, p<0.001) was independently associated with an increased risk of death; antiviral treatment with a lower risk of death (0.34; 0.15 - 0.78, p = 0.01). Ethnicity was not associated with mortality.

INTERPRETATION

During the 2009-2010 Influenza A (H1N1) pandemic, Aboriginal and non-Aboriginal Canadians with H1N1-related critical illness had a similar risk of death, after adjusting for potential confounding factors.

摘要

背景

初步研究表明，加拿大原住民因甲型H1N1流感大流行导致感染、住院和危重病的比例过高。

方法

我们对2009年4月16日至2010年4月12日期间加拿大实验室确诊或疑似H1N1感染的危重病患者进行了一项前瞻性队列研究。比较了原住民和非原住民患者的基线特征、医疗干预措施、临床病程和结局。主要结局是医院死亡率。

结果

在647名已知种族的成年危重病患者中，81名（12.5%）为原住民，566名（87.5%）为非原住民。原住民患者更年轻（平均[标准差]年龄40.7[13.7]岁对49.0[14.9]岁，p<0.001），女性比例更高（64.2%对51.1%，p = 0.027）。任何合并症的发生率（原住民对非原住民，92.6%对91.0%，p = 0.63）、从症状出现到入院的时间（中位数[四分位间距]4[2 - 7]天对4[2 - 7]天，p = 0.84）、入住重症监护病房的时间（5[3 - 8]天对5[3 - 8]天，p = 0.91）以及疾病严重程度（平均急性生理学与慢性健康状况评分II（APACHE II）19.9[9.6]对21.1[9.9]，p = 0.33）相似。与非原住民患者相比，原住民患者在入住重症监护病房前接受抗病毒药物治疗的比例相似（91.4%对93.8%，p = 0.40）。在原住民与非原住民患者中，机械通气需求（93.8%对88.6%，p = 0.15）、无呼吸机天数（14[3 - 23]天对17[0 - 24]天，p = 0.62）、重症监护病房住院时间（13[7 - ......]天对11[5 - 8]天，p = 0.05）、住院时间（19[12.5 - 33.5]天对18[11 - 35]天，p = 0.63）以及医院死亡率相似（19.8%对22.6%，p = 0.56）。在多因素逻辑回归分析中，较高的APACHE II评分（1.06；1.04 - 1.09，p<0.001）与死亡风险增加独立相关；抗病毒治疗与较低的死亡风险相关（0.34；0.15 - 0.78，p = 0.01）。种族与死亡率无关。