Aziza Eitan, Slemko Jocelyn, Zapernick Lori, Smith Stephanie W, Lee Nelson, Sligl Wendy I
Division of Internal Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
J Assoc Med Microbiol Infect Dis Can. 2021 Dec 3;6(4):269-277. doi: 10.3138/jammi-2021-0011. eCollection 2021 Dec.
Influenza infection is a major cause of mortality in critical care units.
ata on critically ill adult patients with influenza infection from 2014 to 2019 were retrospectively collected, including mortality and critical care resource utilization. Independent predictors of mortality were identified using Cox regression.
ne hundred thirty patients with confirmed influenza infection had a mean age of 56 (SD 16) years; 72 (55%) were male. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) score was 22 (SD 9). One hundred eight (83%) patients had influenza A (46% H1N1pdm09, 33% H3N2); 21 (16%) had influenza B. Fifty-five (42%) patients had bacterial co-infection. Only 5 (4%) had fungal co-infection. One hundred eight (83%) patients required mechanical ventilation; 94 (72%), vasopressor support; 26 (20%), continuous renal replacement therapy (CRRT); and 11 (9%), extracorporeal membrane oxygenation. One hundred twenty one (93%) patients received antiviral therapy (median 5 d). Thirty-day mortality was 23%. Patients who received antiviral treatment were more likely to survive with an adjusted hazard ratio (aHR) of 0.15 (95% CI 0.04 to 0.51, = 0.003). Other independent predictors of mortality were the need for CRRT (aHR 2.48, 95% CI 1.14 to 5.43, = 0.023), higher APACHE II score (aHR 1.08, 95% CI 1.02 to 1.14, = 0.011), and influenza A (aHR 7.10, 95% CI 1.37 to 36.8, = 0.020) compared with influenza B infection.
mong critically ill influenza patients, antiviral therapy was independently associated with survival. CRRT, higher severity of illness, and influenza A infection were associated with mortality.
流感感染是重症监护病房死亡的主要原因。
回顾性收集2014年至2019年成年重症流感感染患者的数据，包括死亡率和重症监护资源利用情况。使用Cox回归确定死亡率的独立预测因素。
130例确诊流感感染患者的平均年龄为56岁（标准差16）；72例（55%）为男性。急性生理与慢性健康状况评分系统（APACHE II）的平均评分为22分（标准差9）。108例（83%）患者感染甲型流感（46%为H1N1pdm09，33%为H3N2）；21例（16%）感染乙型流感。55例（42%）患者合并细菌感染。只有5例（4%）合并真菌感染。108例（83%）患者需要机械通气；94例（72%）需要血管活性药物支持；26例（20%）需要持续肾脏替代治疗（CRRT）；11例（9%）需要体外膜肺氧合。121例（93%）患者接受了抗病毒治疗（中位数为5天）。30天死亡率为23%。接受抗病毒治疗的患者存活可能性更大，校正风险比（aHR）为0.15（95%置信区间0.04至0.51，P = 0.003）。死亡率的其他独立预测因素包括需要CRRT（aHR 2.48，95%置信区间1.14至5.43，P = 0.023）、较高的APACHE II评分（aHR 1.08，95%置信区间1.02至1.14，P = 0.011），以及与乙型流感感染相比的甲型流感感染（aHR 7.10，95%置信区间1.37至36.8，P = 0.020）。
在重症流感患者中，抗病毒治疗与生存独立相关。CRRT、更高的疾病严重程度和甲型流感感染与死亡率相关。
