Bozio Catherine H, Masalovich Svetlana, O'Halloran Alissa, Kirley Pam Daily, Hoover Cora, Alden Nisha B, Austin Elizabeth, Meek James, Yousey-Hindes Kimberly, Openo Kyle P, Witt Lucy S, Monroe Maya L, Falkowski Anna, Leegwater Lauren, Lynfield Ruth, McMahon Melissa, Sosin Daniel M, Khanlian Sarah A, Anderson Bridget J, Spina Nancy, Felsen Christina B, Gaitan Maria A, Lung Krista, Shiltz Eli, Thomas Ann, Schaffner William, Talbot H Keipp, Mendez Emma, Staten Holly, Reed Carrie, Garg Shikha
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
California Emerging Infections Program, Oakland, CA, USA.
EClinicalMedicine. 2025 Apr 18;83:103207. doi: 10.1016/j.eclinm.2025.103207. eCollection 2025 May.
Patients hospitalised with influenza have heterogeneous clinical presentations and disease severity, which may complicate epidemiologic study design or interpretation. We applied latent class analysis to identify clinically distinct subgroups of adults hospitalised with influenza.
We analysed cross-sectional study data on adults (≥18 years) hospitalised with laboratory-confirmed influenza from the population-based U.S. Influenza Hospitalization Surveillance Network (FluSurv-NET) including 13 states during 2017-2018 and 2018-2019 influenza seasons (October 1 through April 30). Adults were included if they were residents of the FluSurv-NET catchment area, hospitalised with laboratory-confirmed influenza during these two seasons, and had both the main case report form and the supplemental disease severity case report form completed. We constructed a latent class model to identify subgroups from multiple observed variables including baseline characteristics (age and comorbidities) and clinical course (symptoms at admission, respiratory support requirement, and development of new complications and exacerbations of underlying conditions).
Among the 43,811 influenza-associated hospitalizations reported during the 2017-2018 and 2018-2019 influenza seasons, 15,873 (36.2%) were included in our analytic population: among them, 7069 (44.5%) were male and 8804 (55.5%) were female. We identified five subgroups. Subgroup A included persons of all ages with few comorbidities and 87.9% (255/290) of pregnant women. Subgroup B included older adults with comorbidities (cardiovascular disease (79.7% [3650/4581]) and diabetes (50.6% [2320/4581])). Almost all patients in subgroups C and D had asthma or chronic lung disease and high proportions with exacerbations of underlying conditions (59.7% [889/1489] and 65.1% [2274/3496], respectively). Subgroup E had the highest proportion with new complications (90.3% [1383/1531]). Subgroups D and E had the highest proportions with severe disease indicators: 21.0% (733/3496) and 50.4% (771/1531) required ICU admission, 7.2% (253/3496) and 28.0% (428/1531) required invasive mechanical ventilation, and 3.3% (116/3496) and 11.4% (174/1531) died in-hospital, respectively.
The five identified subgroups of adults hospitalised with influenza had varying distributions of age, comorbid conditions, and clinical courses characterized by new complications versus exacerbations of existing conditions. Stratifying by these subgroups may strengthen analyses that assess the impact of influenza vaccination and antiviral treatment on risk of severe disease. Limitations included that results were based on a convenience sample within FluSurv-NET sites and were likely not representative of all adults hospitalised with influenza in the United States. Influenza testing was also clinician-driven, likely leading to under-ascertainment.
Centers for Disease Control and Prevention.
因流感住院的患者临床表现和疾病严重程度各异，这可能使流行病学研究设计或解读变得复杂。我们应用潜在类别分析来识别因流感住院的成年患者中临床上不同的亚组。
我们分析了基于人群的美国流感住院监测网络（FluSurv-NET）中13个州在2017 - 2018年和2018 - 2019年流感季节（10月1日至4月30日）因实验室确诊流感住院的成年人（≥18岁）的横断面研究数据。如果成年人是FluSurv-NET覆盖区域的居民，在这两个季节因实验室确诊流感住院，并且同时完成了主要病例报告表和补充疾病严重程度病例报告表，则纳入研究。我们构建了一个潜在类别模型，以从多个观察变量中识别亚组，这些变量包括基线特征（年龄和合并症）和临床病程（入院时症状、呼吸支持需求以及潜在疾病新并发症的发生和病情加重情况）。
在2017 - 2018年和2018 - 2019年流感季节报告的43,811例与流感相关的住院病例中，15,873例（36.2%）纳入我们的分析人群：其中，男性7069例（44.5%），女性8804例（55.5%）。我们识别出五个亚组。A亚组包括所有年龄段且合并症较少的人以及87.9%（255/290）的孕妇。B亚组包括有合并症（心血管疾病（79.7% [3650/4581]）和糖尿病（50.6% [2320/4581]））的老年人。C亚组和D亚组几乎所有患者都患有哮喘或慢性肺病，且潜在疾病病情加重的比例很高（分别为59.7% [889/1489]和65.1% [2274/3496]）。E亚组新并发症的比例最高（90.3% [1383/1531]）。D亚组和E亚组严重疾病指标的比例最高：分别有21.0%（733/3496）和50.4%（771/1531）需要入住重症监护病房，7.2%（253/3496）和28.0%（428/1531）需要有创机械通气，以及3.3%（116/3496）和11.4%（174/1531）在医院死亡。
识别出的五个因流感住院的成年亚组在年龄、合并症情况以及以新并发症与现有疾病病情加重为特征的临床病程分布上各不相同。按这些亚组进行分层可能会加强评估流感疫苗接种和抗病毒治疗对严重疾病风险影响的分析。局限性包括结果基于FluSurv-NET站点内的便利样本，可能不代表美国所有因流感住院的成年人。流感检测也是由临床医生主导的，可能导致漏诊。
疾病控制与预防中心。
Zotero 插件
