Duan Jiali, Yang Yuejie, Hou Shuya, Xing Xia, Sun Mengfei, Liu Yang, Xing Lihua
Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China.
Department of Intensive Care Medicine, the Sixth People's Hospital of Zhengzhou, Zhengzhou 450015, Henan, China. Corresponding author: Xing Lihua, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Nov;32(11):1304-1309. doi: 10.3760/cma.j.cn121430-20200827-00598.
To investigate the clinical characteristics and prognostic predictors of adult patients with acute respiratory failure due to influenza infection.
A retrospective analysis was performed on adult patients with acute respiratory failure due to confirmed influenza infection admitted to intensive care units (ICU) of the First Affiliated Hospital of Zhengzhou University and the Sixth People's Hospital of Zhengzhou between January 2018 and January 2020. The subjects were divided into survival and death groups according to whether the patients died before discharge. Demographic and clinical data including underlying conditions, laboratory variables, therapy and prognostic factors of hospital mortality between the two groups were analyzed. The risk factors of mortality were evaluated by univariate and multivariate Logistic regression analysis. Then, the correlation between lymphocyte (LYM) count and LYM subsets were analyzed. The survival rates of different acute physiologic and chronic health evaluation II (APACHE II) and LYM level subgroups were compared.
A total of 104 patients were enrolled. Among them, 67 cases (64.4%) had underlying conditions, 91.3% of the patients (95 cases) were infected by influenza A virus, and the hospital mortality rate was 39.4% (41 cases). Compared with survival group, the patients of death group had higher respiratory rate (times/min: 26.0±5.6 vs. 23.7±5.0), APACHE II score (18.20±4.88 vs. 12.35±4.58), procalcitonin [PCT (μg/L): 0.82 (0.23, 4.63) vs. 0.39 (0.11, 0.92)], higher percentage of cardiovascular disease [24.4% (10/41) vs. 7.9% (5/63)] and invasive mechanical ventilation [63.4% (26/41) vs. 17.5% (11/63), all P < 0.01], but had lower oxygenation index [PaO/FiO (mmHg, 1 mmHg = 0.133 kPa): 131.8±34.5 vs. 181.7±31.6] at ICU admission, LYM (×10/L: 0.53±0.40 vs. 0.92±0.44), hemoglobin [Hb (g/L): 105.66±28.17 vs. 118.29±28.29], platelet count [PLT (×10/L): 135.12±85.40 vs. 199.81±110.11], T lymphocyte count [cells/μL: 181 (131, 275) vs. 319 (238, 528)], CD4 count [cells/μL: 110 (71, 161) vs. 190 (120, 311)] and CD8 count [cells/μL: 71 (33, 100) vs. 121 (81, 188), all P < 0.01]. Patients of death group also had a shorter length of hospital stay [days: 7.0 (4.0, 11.0) vs. 12.0 (8.0, 20.0), P < 0.01]. Univariate analysis showed that APACHE II score [odds ratio (OR) = 1.207, 95% confidence interval (95%CI) was 1.094-1.332, P < 0.001], LYM (OR = 0.070, 95%CI was 0.018-0.271, P < 0.001), Hb (OR = 0.984, 95%CI was 0.970-0.999, P = 0.031), PLT (OR = 0.992, 95%CI was 0.987-0.997, P = 0.003), T lymphocyte count (OR = 0.996, 95%CI was 0.993-0.998, P = 0.001) and PaO/FiO (OR = 0.955, 95%CI was 0.938-0.972, P < 0.001) were the risk factors for the prognosis of influenza patients with acute respiratory failure. Further multivariate Logistic analysis also showed that APACHE II score (OR = 1.195, 95%CI was 1.041-1.372, P = 0.011), LYM (OR = 0.063, 95%CI was 0.011-0.369, P = 0.002) and PaO/FiO (OR = 0.953, 95%CI was 0.933-0.973, P < 0.001) were the predictors of mortality. Moreover, patients with peripheral blood LYM < 0.65×10/L or APACHE II score > 14 had a higher risk of poor outcome. There were significantly positive correlation between LYM and LYM subsets (T lymphocyte, CD4 and CD8 lymphocyte, r value was 0.593, 0.563, and 0.500, respectively, all P < 0.001).
Influenza patients with acute respiratory failure were critically ill and had a high mortality rate. APACHE II score, PaO/FiO and LYM at ICU admission were independent risk factors affecting the prognosis of patients.
探讨成人流感感染所致急性呼吸衰竭患者的临床特征及预后预测因素。
对2018年1月至2020年1月在郑州大学第一附属医院和郑州市第六人民医院重症监护病房（ICU）收治的确诊流感感染所致急性呼吸衰竭的成年患者进行回顾性分析。根据患者出院前是否死亡将研究对象分为生存组和死亡组。分析两组患者的人口统计学和临床资料，包括基础疾病、实验室指标、治疗情况及医院死亡的预后因素。采用单因素和多因素Logistic回归分析评估死亡危险因素。然后，分析淋巴细胞（LYM）计数与LYM亚群之间的相关性。比较不同急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）和LYM水平亚组的生存率。
共纳入104例患者。其中，67例（64.4%）有基础疾病，91.3%的患者（95例）感染甲型流感病毒，医院死亡率为39.4%（41例）。与生存组相比，死亡组患者在ICU入院时呼吸频率更高（次/分钟：26.0±5.6比23.7±5.0）、APACHEⅡ评分更高（18.20±4.88比12.35±4.58）、降钙素原[PCT（μg/L）：0.82（0.23，4.63）比0.39（0.11，0.92）]、心血管疾病比例更高[24.4%（10/41）比7.9%（5/63）]以及有创机械通气比例更高[63.4%（26/41）比17./5%（11/63），均P<0.01]，但氧合指数[PaO/FiO（mmHg，1mmHg = 0.133kPa）：131.8±34.5比181.7±31.6]、LYM（×10/L：0.53±0.40比0.92±0.44）、血红蛋白[Hb（g/L）：105.66±28.17比118.29±28.29]、血小板计数[PLT（×10/L）：135.12±85.40比199.81±110.11]、T淋巴细胞计数[细胞/μL：181（131，275）比319（238，528）]、CD4计数[细胞/μL：110（71，161）比190（120，311）]和CD8计数[细胞/μL：71（33，100）比121（81，188），均P<0.01]更低。死亡组患者住院时间也更短[天：7.0（4.0，11.0）比12.0（8.0，20.0），P<0.01]。单因素分析显示，APACHEⅡ评分[比值比（OR） = 1.207，95%置信区间（95%CI）为1.094 - 1.332，P<0.001]、LYM（OR = 0.070，95%CI为0.018 - 0.271，P<0.001）、Hb（OR = 0.984，95%CI为0.970 - 0.999，P = 0.031）、PLT（OR = 0.992，95%CI为0.987 - 0.997，P = 0.003）、T淋巴细胞计数（OR = 0.996，95%CI为0.993 - 0.998，P = 0.001）和PaO/FiO（OR = 0.955，95%CI为0.938 - 0.972，P<0.001）是流感所致急性呼吸衰竭患者预后的危险因素。进一步多因素Logistic分析也显示，APACHEⅡ评分（OR = 1.195，95%CI为1.041 - 1.372，P = 0.011）、LYM（OR = 0.063，95%CI为0.011 - 0.369，P = 0.002）和PaO/FiO（OR = 0.953，95%CI为0.933 - 0.973，P<0.001）是死亡的预测因素。此外，外周血LYM<0.65×10/L或APACHEⅡ评分>14的患者预后不良风险更高。LYM与LYM亚群（T淋巴细胞、CD4和CD8淋巴细胞）之间存在显著正相关（r值分别为0.593、0.563和0.500，均P<0.001）。
流感所致急性呼吸衰竭患者病情危重，死亡率高。ICU入院时的APACHEⅡ评分、PaO/FiO和LYM是影响患者预后的独立危险因素。
