Guerra-de-Blas Paola Del Carmen, Ortega-Villa Ana M, Ortiz-Hernández Ana A, Ramírez-Venegas Alejandra, Moreno-Espinosa Sarbelio, Llamosas-Gallardo Beatriz, Pérez-Patrigeon Santiago, Hunsberger Sally, Magaña Martín, Valdez-Vázquez Rafael, Freimanis Laura, Galán-Herrera Juan Francisco, Guerrero-Almeida M Lourdes, Powers John H, Ruiz-Palacios Guillermo M, Beigel John, Galindo-Fraga Arturo
The Mexican Emerging Infectious Diseases Clinical Research Network (LaRed), Mexico City, Mexico.
National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.
IJID Reg. 2023 Feb 1;6:152-158. doi: 10.1016/j.ijregi.2023.01.012. eCollection 2023 Mar.
The aim of this study was to determine the risk factors associated with severe influenza-like illness (ILI) in Mexican adults that could be useful to clinicians when assessing patients with ILI.
Data from adult patients enrolled from 2010 through 2014 in ILI002 - a prospective hospital-based observational cohort study - were analyzed. Etiology and clinical characteristics were compared between cases of severe ILI (defined as hospitalization and/or death) and cases of non-severe ILI.
Overall, 1428 (39.0%) out of a total 3664 cases of ILI were classified as severe. Adjusted analyses showed a higher risk of severe ILI associated with signs and symptoms related to lower tract infection, i.e. cough with sputum (odds ratio (OR) 2.037, 95% confidence interval (CI) 1.206-3.477; = 0.008), dyspnea (OR 5.044, 95% CI 2.99-8.631; and shortness of breath (OR 5.24, 95% CI 3.0839.124; < 0.001), and with increases in lactate dehydrogenase (OR 4.426, 95% CI 2.321-8.881; < 0.001) and C-reactive protein (OR 3.618, 95% CI 2.5955.196; < 0.001). Further, there was an increased risk of severe ILI with a longer time between symptom onset and inclusion (OR 1.108, 95% CI 1.049-1.172; < 0.001) and with chronic steroid use (OR 14.324, 95% CI 8.059-26.216; < 0.001).
Respiratory viruses can cause severe ILI. The results of this study highlight the importance of evaluating data compatible with lower tract involvement and previous use of immunosuppressants at baseline, because patients meeting these conditions may develop severe illness.
本研究旨在确定墨西哥成年人中与重症流感样疾病（ILI）相关的危险因素，这对临床医生评估ILI患者可能有用。
分析了2010年至2014年纳入ILI002（一项基于医院的前瞻性观察队列研究）的成年患者的数据。比较了重症ILI病例（定义为住院和/或死亡）和非重症ILI病例的病因及临床特征。
总体而言，3664例ILI病例中有1428例（39.0%）被归类为重症。校正分析显示，与下呼吸道感染相关的体征和症状会增加重症ILI的风险，即咳痰咳嗽（比值比（OR）2.037，95%置信区间（CI）1.206 - 3.477；P = 0.008）、呼吸困难（OR 5.044，95% CI 2.99 - 8.631）和呼吸急促（OR 5.24，95% CI 3.083 - 9.124；P < 0.001），以及乳酸脱氢酶升高（OR 4.426，95% CI 2.321 - 8.881；P < 0.001）和C反应蛋白升高（OR 3.618，95% CI 2.595 - 5.196；P < 0.001）。此外，症状出现至纳入研究的时间越长（OR 1.108，95% CI 1.049 - 1.17,2；P < 0.001）和长期使用类固醇（OR 14.324，95% CI 8.059 - 26.216；P < 0.001），重症ILI的风险也会增加。
呼吸道病毒可导致重症ILI。本研究结果强调了在基线时评估与下呼吸道受累及既往使用免疫抑制剂相关数据的重要性，因为符合这些条件的患者可能会发展为重症疾病。
