College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, ICU2, Mail Code 1425, PO Box 22490, Riyadh, 11426, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
BMC Pulm Med. 2024 Sep 19;24(1):464. doi: 10.1186/s12890-024-03281-6.
Influenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia.
This was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality.
During the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p < 0.0001). Mortality was 45.0% in patients with bacterial coinfection, 30.9% in those requiring vasopressors, and 29.2% in those who received mechanical ventilation. Female sex (odds ratio [OR], 2.096; 95% confidence interval [CI] 1.070, 4.104), ischemic heart disease (OR, 3.053; 95% CI 1.457, 6.394), immunosuppressed state (OR, 7.102; 95% CI 1.803, 27.975), Pneumonia Severity Index (OR, 1.029; 95% CI, 1.017, 1.041), leukocyte count and serum lactate level (OR, 1.394; 95% CI, 1.163, 1.671) were independently associated with hospital mortality.
Influenza followed a seasonal pattern in Saudi Arabia, with H3N2 and H1N1 being the predominant circulating strains during the study period. ICU admission was required for > 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.
流感是一种常见的全球致病原因，其在流行病学和临床特征上存在地域差异。我们评估了在沙特阿拉伯利雅得的一家三级保健中心因聚合酶链反应确诊的流感而住院的患者的特征和结局。
这是一项对 2018 年 1 月 1 日至 2022 年 5 月 31 日期间因聚合酶链反应确诊的流感而入住 King Abdulaziz Medical City-Riyadh 的成年患者的回顾性队列研究。我们比较了需要入住重症监护病房（ICU）和不需要入住 ICU 的患者，并进行多变量逻辑回归分析以评估 ICU 入住和医院死亡率的预测因素。
在研究期间，675 名成年患者因流感住院（中位年龄 68.0 岁，女性占 53.8%，高血压占 59.9%，糖尿病占 55.1%，慢性呼吸道疾病占 31.1%）。大多数住院病例（83.0%）发生在利雅得较冷的月份（10 月至 3 月），即使在夏季（6 月至 8 月）也有季节性病例。甲型流感占病例的 79.0%，研究期间 H3N2 和 H1N1 亚型普遍流行。12 名患者（1.8%）发生呼吸道病毒合并感染，42 名患者（17.4%）发生细菌合并感染。151 名患者（22.4%）需要入住 ICU，其中 62.3%使用了血管加压药，48.0%使用了机械通气。入住 ICU 的危险因素包括年龄较小、高血压、胸部 X 线双肺浸润和肺炎严重指数。总的医院死亡率为 7.4%（ICU 患者为 22.5%，p<0.0001）。细菌合并感染患者的死亡率为 45.0%，需要血管加压药的患者死亡率为 30.9%，使用机械通气的患者死亡率为 29.2%。女性（比值比 [OR]，2.096；95%置信区间 [CI]，1.070-4.104）、缺血性心脏病（OR，3.053；95%CI，1.457-6.394）、免疫抑制状态（OR，7.102；95%CI，1.803-27.975）、肺炎严重指数（OR，1.029；95%CI，1.017-1.041）、白细胞计数和血清乳酸水平（OR，1.394；95%CI，1.163-1.671）与医院死亡率独立相关。
流感在沙特阿拉伯呈季节性流行，H3N2 和 H1N1 是研究期间主要流行的毒株。>20%的患者需要入住 ICU。女性、高肺炎严重指数、缺血性心脏病和免疫抑制状态与死亡率增加有关。
