Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
Department of Medical Education, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Influenza Other Respir Viruses. 2023 Jan;17(1):e13081. doi: 10.1111/irv.13081. Epub 2022 Dec 8.
Public health organizations have recommended various definitions of influenza-like illnesses under the assumption that the symptoms do not change during influenza virus infection. To explore the relationship between symptoms and influenza over time, we analyzed a dataset from an international multicenter prospective emergency department (ED)-based influenza-like illness cohort study.
We recruited patients in the US and Taiwan between 2015 and 2020 with: (1) flu-like symptoms (fever and cough, headache, or sore throat), (2) absence of any of the respiratory infection symptoms, or (3) positive laboratory test results for influenza from the current ED visit. We evaluated the association between the symptoms and influenza virus infection on different days of illness. The association was evaluated among different subgroups, including different study countries, influenza subtypes, and only patients with influenza.
Among the 2471 recruited patients, 45.7% tested positive for influenza virus. Cough was the most predictive symptom throughout the week (odds ratios [OR]: 7.08-11.15). In general, all symptoms were more predictive during the first 2 days (OR: 1.55-10.28). Upper respiratory symptoms, such as sore throat and productive cough, and general symptoms, such as body ache and fatigue, were more predictive in the first half of the week (OR: 1.51-3.25). Lower respiratory symptoms, such as shortness of breath and wheezing, were more predictive in the second half of the week (OR: 1.52-2.52). Similar trends were observed for most symptoms in the different subgroups.
The time course is an important factor to be considered when evaluating the symptoms of influenza virus infection.
公共卫生组织根据假设在流感病毒感染期间症状不会改变，推荐了各种流感样疾病的定义。为了探究症状与流感之间随时间的关系，我们分析了一项来自国际多中心前瞻性急诊（ED）基于流感样疾病队列研究的数据。
我们招募了 2015 年至 2020 年间美国和中国台湾的患者，他们具有以下特征：（1）流感样症状（发热和咳嗽、头痛或喉咙痛）；（2）无任何呼吸道感染症状；或（3）目前 ED 就诊时流感的实验室检测结果为阳性。我们评估了不同疾病日患者症状与流感病毒感染之间的关联。还在不同亚组中评估了这种关联，包括不同的研究国家、流感亚型和仅患有流感的患者。
在 2471 名入组患者中，45.7%的患者流感病毒检测呈阳性。咳嗽是整个星期最具预测性的症状（比值比[OR]：7.08-11.15）。一般来说，所有症状在前 2 天更具预测性（OR：1.55-10.28）。上呼吸道症状，如喉咙痛和有痰咳嗽，以及全身症状，如身体疼痛和疲劳，在本周前半周更具预测性（OR：1.51-3.25）。下呼吸道症状，如呼吸急促和喘息，在本周后半周更具预测性（OR：1.52-2.52）。在不同亚组中，大多数症状也观察到了类似的趋势。
在评估流感病毒感染的症状时，时间进程是一个重要的考虑因素。
