Serpa Neto Ary, Burrell Aidan J C, Bailey Michael, Broadley Tessa, Cooper D Jamie, French Craig J, Pilcher David, Plummer Mark P, Trapani Tony, Webb Steve A, Bellomo Rinaldo, Udy Andrew
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Data Analytics Research and Evaluation Centre, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia.
Ann Am Thorac Soc. 2021 Aug;18(8):1380-1389. doi: 10.1513/AnnalsATS.202010-1311OC.
Both 2009 pandemic influenza A (H1N1) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are transmitted by respiratory secretions and in severe cases result in a viral pneumonitis, requiring intensive care unit (ICU) admission. However, no studies have compared the clinical characteristics and outcomes of such patients. To report and compare the demographic characteristics, treatments, use of critical care resources, and outcomes of patients admitted to an Australian ICU with H1N1 influenza during the winter of 2009, and SARS-CoV-2 during the winter of 2020. This was a multicenter project, using national data from previous and ongoing epidemiological studies concerning severe acute respiratory infections in Australia. All ICUs admitting patients with H1N1 or coronavirus disease (COVID-19) were included and contributed data. We compared clinical characteristics and outcomes of patients with H1N1 admitted to ICU in the winter of 2009 versus patients with COVID-19 admitted to ICU in the winter of 2020. The primary outcome was in-hospital mortality. Potential years of life lost (PYLL) were calculated according to sex-adjusted life expectancy in Australia. Across the two epochs, 861 patients were admitted to ICUs; 236 (27.4%) with COVID-19 and 625 (72.6%) with H1N1 influenza. The number of ICU admissions and bed-days occupied were higher with 2009 H1N1 influenza. Patients with COVID-19 were older, more often male and overweight, and had lower Acute Physiology and Chronic Health Evaluation II scores at ICU admission. The highest age-specific incidence of ICU admission was among infants (0-1 yr of age) for H1N1, and among the elderly (≥65 yr) for COVID-19. Unadjusted in-hospital mortality was similar (11.5% in COVID-19 vs. 16.1% in H1N1; odds ratio, 0.68 [95% confidence interval (95% CI), 0.42-1.06]; = 0.10). The PYLL was greater with H1N1 influenza than with COVID-19 at 154.1 (95% CI, 148.7-159.4) versus 13.6 (95% CI, 12.2-15.1) PYLL per million inhabitants. In comparison with 2009 H1N1 influenza, COVID-19 admissions overwinter in Australia resulted in fewer ICU admissions, and lower bed-day occupancy. Crude in-hospital mortality was similar, but because of demographic differences in affected patients, deaths due to 2009 H1N1 influenza led to an 11-fold increase in the number of PYLL in critically ill patients.
2009年甲型H1N1大流行性流感和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）均通过呼吸道分泌物传播，在严重情况下会导致病毒性肺炎，需要入住重症监护病房（ICU）。然而，尚无研究比较此类患者的临床特征和结局。为报告和比较2009年冬季入住澳大利亚ICU的甲型H1N1流感患者与2020年冬季感染SARS-CoV-2患者的人口统计学特征、治疗方法、重症监护资源使用情况及结局。这是一个多中心项目，使用来自澳大利亚既往和正在进行的有关严重急性呼吸道感染的流行病学研究的全国性数据。所有收治甲型H1N1流感或冠状病毒病（COVID-19）患者的ICU均被纳入并提供数据。我们比较了2009年冬季入住ICU的甲型H1N1流感患者与2020年冬季入住ICU的COVID-19患者的临床特征和结局。主要结局为住院死亡率。根据澳大利亚的性别调整预期寿命计算潜在寿命损失年数（PYLL）。在这两个时期，共有861例患者入住ICU；其中236例（27.4%）为COVID-19患者，625例（72.6%）为甲型H1N1流感患者。2009年甲型H1N1流感患者的ICU入院人数和占用床日数更多。COVID-19患者年龄更大，男性和超重者更常见，且入住ICU时急性生理学与慢性健康状况评价II（APACHE II）评分更低。ICU入院年龄特异性发病率最高的，甲型H1N1流感为婴儿（0至1岁），COVID-19为老年人（≥65岁）。未调整的住院死亡率相似（COVID-19为11.5%，甲型H1N1流感为16.1%；比值比，0.68[95%置信区间（95%CI），0.42 - 1.06]；P = 0.10）。每百万居民的PYLL，甲型H1N1流感（154.1[95%CI，148.7 - 159.4]）高于COVID-19（13.6[95%CI，12.2 - 15.1]）。与2009年甲型H1N1流感相比，澳大利亚冬季COVID-19患者入住ICU的人数更少，占用床日数更低。粗住院死亡率相似，但由于受影响患者的人口统计学差异，2009年甲型H1N1流感导致的死亡使重症患者的PYLL增加了11倍。
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