Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Influenza Other Respir Viruses. 2024 Sep;18(9):e13354. doi: 10.1111/irv.13354.
The association between influenza infection and thromboembolism (TE) events, including cardiovascular events, cerebrovascular events, pulmonary embolism, and deep vein thrombosis, is supported by compelling evidence. However, there is a disparity in the risk factors that impact the outcomes of severe influenza-complicated TE in intensive care unit (ICU) patients. The objective of this study was to evaluate the outcomes of severe influenza-complicated TE in ICU patients and identify any associated risk factors.
A retrospective cohort study was conducted, recruiting consecutive patients with TE events admitted to the ICU between December 2015 through December 2018 at our institution in Taiwan. The study included a group of 108 patients with severe influenza and a control group of 192 patients with severe community-acquired pneumonia. Associations between complicated TE, length of ICU stay, and 90-day mortality were evaluated using logistic regression analysis, and risk factors were identified using univariate and multivariate generalized linear regression analyses.
TE event prevalence was significantly higher in ICU patients with severe influenza than in ICU patients with severe CAP (21.3% vs. 5.7%, respectively; p < 0.05). Patients with severe influenza who developed TE experienced a significant increase in the ratio of mechanical ventilation use, length of mechanical ventilation use, ICU stay, and 90-day mortality when compared to patients without TE (all p < 0.05). The comparison of severe CAP patients with and without TE revealed no significant differences (p > 0.05). The development of thromboembolic events in patients with severe influenza or severe noninfluenza CAP is linked to influenza infection and hypertension (p < 0.05). Furthermore, complicated TE and the severity of the APACHE II score are risk factors for 90-day mortality in ICU patients with severe influenza (p < 0.05).
Patients with severe influenza and complicated TE are more likely to have an extended ICU stay and 90-day mortality than patients with severe CAP. The risk is significantly higher for patients with a higher APACHE II score. The results of this study may aid in defining better strategies for early recognition and prevention of severe influenza-complicated TE.
评估 ICU 患者中严重流感合并 TE 患者的结局，并确定任何相关的危险因素。
本研究采用回顾性队列研究，纳入了 2015 年 12 月至 2018 年 12 月期间在我院 ICU 住院的 TE 患者。研究包括 108 例严重流感患者和 192 例严重社区获得性肺炎患者。采用逻辑回归分析评估合并 TE、ICU 住院时间和 90 天死亡率之间的关系，采用单因素和多因素广义线性回归分析确定危险因素。
与 ICU 严重 CAP 患者相比，严重流感患者 TE 发生率显著更高（21.3% vs. 5.7%；p<0.05）。与无 TE 的患者相比，发生 TE 的严重流感患者机械通气使用率、机械通气使用时间、ICU 住院时间和 90 天死亡率均显著增加（均 p<0.05）。严重 CAP 患者中，有和无 TE 者之间比较无显著差异（p>0.05）。严重流感或非流感 CAP 患者发生血栓栓塞事件与流感感染和高血压有关（p<0.05）。此外，严重流感患者中，合并 TE 和 APACHE II 评分严重程度是 90 天死亡率的危险因素（p<0.05）。
与严重 CAP 患者相比，严重流感合并 TE 的患者 ICU 住院时间和 90 天死亡率更高。APACHE II 评分较高的患者风险显著增加。本研究结果可能有助于确定更好的策略来早期识别和预防严重流感合并 TE。
