2012 年至 2016 年住院患者流感病毒感染严重程度相关的病毒性肺炎分析及危险因素。
Analysis of viral pneumonia and risk factors associated with severity of influenza virus infection in hospitalized patients from 2012 to 2016.
机构信息
Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain.
IdISBa estadistic and methodological support, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
出版信息
BMC Infect Dis. 2024 Mar 12;24(1):302. doi: 10.1186/s12879-024-09173-8.
BACKGROUND
Influenza viruses cause pneumonia in approximately one-third of cases, and pneumonia is an important cause of death. The aim was to identify risk factors associated with severity and those that could predict the development of pneumonia.
METHODS
This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during four influenza seasons in Spain (October to May) from to 2012-2016.
RESULTS
Overall, 666 patients with laboratory-confirmed influenza were included, 93 (14%) of which were severe; 73 (10.9%) were admitted to Intensive Care Unit (ICU), 39 (5.8%) died, and 185 (27.7%) developed pneumonia. Compared to less severe cases, patients with severe disease: were less vaccinated (40% vs. 28%, p = 0.021); presented with more confusion (26.9% vs. 6.8%), were more hypoxemic (Horowitz index (PaO/FiO) 261 vs. 280), had higher C-reactive protein (CRP) (12.3 vs. 4.0), had more coinfections (26.8% vs. 6.3%) and had more pleural effusion (14% vs. 2.6%) (last six all p < 0.001). Risk factors significantly associated with severity were pneumonia [OR (95% CI) = 4.14 (2.4-7.16)], history of heart disease (1.84, 1.03-3.28), and confusion at admission (4.99, 2.55-9.74). Influenza vaccination was protective (0.53, 0.28-0.98). Compared to those without pneumonia, the pneumonia group had higher CRP (11.3 vs. 4.0, p < 0.001), lower oxygen saturation (92% vs. 94%, p < 0.001), were more hypoxic (PaO/FiO 266 vs. 281, p < 0.001), and incurred more mechanical ventilation, septic shock, admission to the ICU, and deaths (all four p < 0.001). Higher CRP and lower oxygen saturation were independent variables for predicting the development of pneumonia.
CONCLUSIONS
Pneumonia, history of heart disease, confusion and no influenza vaccination were independent variables to present complications in patients admitted with influenza infection.
背景
流感病毒可导致约三分之一的病例发生肺炎，肺炎是重要的死亡原因。本研究旨在确定与严重程度相关的危险因素，并预测肺炎的发生。
方法
这是一项回顾性、观察性研究，纳入了 2012 年至 2016 年西班牙四个流感季节期间（10 月至 5 月）在 Son Espases 大学医院因确诊流感病毒感染而住院的所有成年患者。
结果
共纳入了 666 例实验室确诊的流感患者，其中 93 例（14%）为重症患者；73 例（10.9%）入住重症监护病房（ICU），39 例（5.8%）死亡，185 例（27.7%）发生肺炎。与轻症患者相比，重症患者：疫苗接种率较低（40%比 28%，p=0.021）；更易出现意识混乱（26.9%比 6.8%），低氧血症更严重（Horowitz 指数（PaO/FiO）261 比 280），C 反应蛋白（CRP）更高（12.3 比 4.0），合并感染更多（26.8%比 6.3%），胸腔积液更多（14%比 2.6%）（后六项均 p<0.001）。与严重程度显著相关的危险因素包括肺炎[比值比（OR）（95%可信区间）=4.14（2.4-7.16）]、心脏病史（1.84，1.03-3.28）和入院时意识混乱（4.99，2.55-9.74）。流感疫苗接种具有保护作用（0.53，0.28-0.98）。与无肺炎患者相比，肺炎组的 CRP 更高（11.3 比 4.0，p<0.001），血氧饱和度更低（92%比 94%，p<0.001），低氧血症更严重（PaO/FiO 266 比 281，p<0.001），需要更多的机械通气、感染性休克、入住 ICU 和死亡（四项均 p<0.001）。较高的 CRP 和较低的血氧饱和度是预测肺炎发生的独立变量。
结论
肺炎、心脏病史、意识混乱和未接种流感疫苗是导致流感感染患者发生并发症的独立危险因素。
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