Guo Maoqing, Tong Zhaohui
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
Int J Gen Med. 2021 Oct 29;14:7381-7390. doi: 10.2147/IJGM.S329323. eCollection 2021.
Influenza co-infection with fungal infection increases the risk of death. Our study was to estimate risk factors associated with invasive pulmonary mycosis (IPM) among severe influenza patients at a single center in Beijing, China.
A retrospective chart review was carried out of all patients with severe influenza admitted to respiratory the department including the respiratory intensive care unit (RICU) during the 2014 to 2019 influenza seasons in Beijing Chao-yang hospital, China. We compared the differences of characteristics and examination outcomes between IPM patients and non-IPM patients, and explored the predictors of IPM by a multivariate logistic regression.
Influenza associated IPM was found in 65 of 131 (49.62%) patients. The average age of IPM patients was 57.28±14.56 years and 70.77% were male. The mortality rate was much higher in the IPM group than the non-IPM group (34.85% versus 18.46%, =0.026). Older age, hypoimmunity, liver disease, hypertension, positive serum GM test, steroids using, gasping, gastrointestinal symptoms, high APECHEII, low oxygenation index, other viruses co-infection, bacterial co-infection, low lymphocyte counts, low CD4+ T-cell counts, low CD8+ T-cell counts, low RBC, low hemoglobin, low platelets, high N%, low total protein, high CRP, low albumin, low fibrinogen, high BUN, positive serum GM test, more mechanical ventilation requirement, and more renal replacement requirement were risk factors of influenza IPM co-infection.
IPM is a severe complication of influenza hospitalizations. It is associated with increasing mortality, longer hospital stays, and higher hospital charges compared with non-IPM patients. Clinicians caring for patients with severe influenza should consider IPM.
流感合并真菌感染会增加死亡风险。我们的研究旨在评估中国北京某单中心重症流感患者侵袭性肺真菌病（IPM）的相关危险因素。
对2014年至2019年流感季节期间在中国北京朝阳医院呼吸内科（包括呼吸重症监护病房[RICU]）收治的所有重症流感患者进行回顾性病历审查。我们比较了IPM患者和非IPM患者的特征及检查结果差异，并通过多因素逻辑回归分析探索IPM的预测因素。
131例患者中有65例（49.62%）发现流感相关IPM。IPM患者的平均年龄为57.28±14.56岁，男性占70.77%。IPM组的死亡率远高于非IPM组（34.85%对18.46%，P = 0.026）。年龄较大、免疫低下、肝病、高血压、血清GM试验阳性、使用类固醇、喘息、胃肠道症状、高急性生理与慢性健康状况评分系统II（APACHEII）、低氧合指数、其他病毒合并感染、细菌合并感染、淋巴细胞计数低、CD4+T细胞计数低、CD8+T细胞计数低、红细胞计数低、血红蛋白低、血小板低、中性粒细胞百分比高、总蛋白低、C反应蛋白高、白蛋白低、纤维蛋白原低、血尿素氮高、血清GM试验阳性、更多机械通气需求以及更多肾脏替代需求是流感合并IPM感染的危险因素。
IPM是流感住院患者的严重并发症。与非IPM患者相比，它与死亡率增加、住院时间延长和住院费用更高相关。诊治重症流感患者的临床医生应考虑到IPM。
