University of Tunis EI Manar, Faculty of Medicine, Medical Intensive Care Unit, Abderrahmen Mami Hospital, Ariana, Tunisia.
Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia.
PLoS One. 2022 Jul 6;17(7):e0270814. doi: 10.1371/journal.pone.0270814. eCollection 2022.
Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia.
It was a single-center study, including all hospitalized patients in intensive care, between November 1st, 2009 and October 31st, 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized.
During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H1N1 pdm09 (84.2%) and H3N2 (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25-13] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC95% [1.474-37.317]; p = 0.015), PaO2/FiO2 ≤ 95 mmHg (OR = 9.078; IC95% [1.636-50.363]; p = 0.012) and lymphocytes count ≤ 1.325 109/L (OR = 10.199; IC95% [1.550-67.101]; p = 0.016).
Influenza A in ICU is not uncommon, even in A(H1N1) dominant seasons; its management is highly demanding. It is responsible for considerable morbi-mortality especially in elderly patients.
甲型流感病毒感染是一种传染性急性呼吸道感染，主要以流行形式演变，偶尔以大流行形式爆发。它可能会出现严重的临床症状，需要在重症监护病房（ICU）进行治疗。本研究旨在描述甲型流感的流行病学和临床特征，然后确定突尼斯阿里亚纳的阿卜杜勒拉赫曼·马米医院 ICU 死亡率的独立预测因素。
这是一项单中心研究，纳入了 2009 年 11 月 1 日至 2019 年 10 月 31 日期间所有因甲型流感病毒感染而住院的 ICU 患者。我们记录了人口统计学、临床和生物学数据以及病情变化特征；然后对 ICU 死亡率的预测因素进行了多变量分析。
在研究期间（10 个连续季节），共有 120 名严重甲型流感患者（比例为 2.5%）入住 ICU，中位年龄为 48 岁，性别比为 1.14。其中 14 名女性为孕妇。在入住 ICU 前的一年中，只有 7 名患者（5.8%）接种了季节性流感疫苗。简化急性生理学评分 II、急性生理和慢性健康评估 II 和脓毒症相关器官衰竭评估的中位数分别为 26、10 和 3。通过聚合酶链反应鉴定的病毒株为 H1N1 pdm09（84.2%）和 H3N2（15.8%）。88 名（73.3%）患者接受了抗病毒治疗。19 例患者合并感染：细菌（n=17）和曲霉菌（n=2）。82 例患者诊断为急性呼吸窘迫综合征（ARDS）。72 名患者接受了无创通气（NIV）治疗，其中 34 例成功。59 名患者进行了气管插管，有创机械通气的中位时间为 8[3.25-13]天。最常见的并发症包括急性肾损伤（n=50，41.7%）、休克（n=48，40%）、医院获得性感染（n=46，38.8%）和血栓栓塞事件（n=19，15.8%）。总体 ICU 死亡率为 31.7%（死亡 38 例）。确定的 ICU 死亡率的独立预测因素包括：年龄大于 56 岁（OR=7.417；95%CI[1.474-37.317]；p=0.015）、PaO2/FiO2≤95mmHg（OR=9.078；95%CI[1.636-50.363]；p=0.012）和淋巴细胞计数≤1.325×109/L（OR=10.199；95%CI[1.550-67.101]；p=0.016）。
甲型流感在 ICU 并不罕见，即使在 A(H1N1)占主导地位的季节也是如此；其治疗要求很高。它会导致相当高的发病率和死亡率，尤其是在老年患者中。
