Abaziou Timothée, Delmas Clément, Vardon Bounes Fanny, Bignon Fabien, Crognier Laure, Seguin Thierry, Riu-Poulenc Béatrice, Ruiz Stéphanie, Rouget Antoine, Cougot Pierre, Georges Bernard, Conil Jean-Marie, Minville Vincent
Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Toulouse, France.
Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France.
Infect Dis (Auckl). 2020 Feb 6;13:1178633720904081. doi: 10.1177/1178633720904081. eCollection 2020.
Influenza causes significant morbidity and mortality in adults, and numerous patients require intensive care unit (ICU) admission. Acute respiratory distress syndrome (ARDS) is clearly described in this context, but other clinical presentations exist that need to be assessed for incidence and outcome. The primary goal of this study was to describe the characteristics of patients admitted in ICU for influenza, their clinical presentation, and the 3-month mortality rate. The second objective was to search for 3-month mortality risk factors.
This is a retrospective study including all patients admitted to 3 ICUs due to influenza-related disease between October 2013 and June 2016, which assesses the 3-month mortality rate. We compared clinical presentation, biological data, and outcome at 3 months between survivors and non-survivors. We created a predicting 3-month mortality model with Classification and Regression Tree analysis.
Sixty-nine patients were included, 50 patients (72.5%) for ARDS, 5 (7.2%) for myocarditis, and 14 (20.3%) for acute respiratory failure without ARDS criteria. Non-typed influenza A was found in 30 cases (43.5%), influenza A H1N1 in 18 (26.1%), H3N2 in 3 (4.3%), and influenza B in 18 cases (27.5%). The 3-month mortality rate was 29% ( = 20). Extracorporeal membrane oxygenation (ECMO) was implanted in 23 patients, without any significant increase in mortality (39% vs 24% without ECMO, = .19). A creatinine serum superior to 96 μmol/L, an aspartate aminotransferase level superior to 68 UI/L, and a Pao/Fio ration below 110 were associated with 3-month mortality in our predictive mortality model.
Influenza in ICUs may have several clinical presentations. The mortality rate is high, but ECMO may be an effective rescue therapy.
流感在成人中可导致显著的发病率和死亡率，众多患者需要入住重症监护病房（ICU）。在这种情况下，急性呼吸窘迫综合征（ARDS）已有明确描述，但还存在其他临床表现，需要对其发病率和转归进行评估。本研究的主要目的是描述因流感入住ICU患者的特征、临床表现及3个月死亡率。第二个目标是寻找3个月死亡率的危险因素。
这是一项回顾性研究，纳入了2013年10月至2016年6月期间因流感相关疾病入住3个ICU的所有患者，评估其3个月死亡率。我们比较了幸存者和非幸存者的临床表现、生物学数据及3个月时的转归。我们采用分类与回归树分析创建了一个预测3个月死亡率的模型。
共纳入69例患者，其中50例（72.5%）为ARDS，5例（7.2%）为心肌炎，14例（20.3%）为不符合ARDS标准的急性呼吸衰竭。30例（43.5%）检测到甲型非定型流感，18例（26.1%）为甲型H1N1流感，3例（4.3%）为H3N2流感，18例（27.5%）为乙型流感。3个月死亡率为29%（n = 20）。23例患者接受了体外膜肺氧合（ECMO）治疗，死亡率无显著增加（接受ECMO治疗的患者死亡率为39%，未接受ECMO治疗的患者死亡率为24%，P = 0.19）。在我们的预测死亡率模型中，血清肌酐高于96 μmol/L、天冬氨酸转氨酶水平高于68 UI/L以及氧合指数低于110与3个月死亡率相关。
ICU中的流感可能有多种临床表现。死亡率较高，但ECMO可能是一种有效的挽救治疗方法。
