title: Influenza infection and risk of acute pulmonary embolism.
abstract: BACKGROUND
  Influenza infections have been associated with procoagulant changes. Whether influenza infections lead to an increased risk of pulmonary embolism remains to be established.
  
  
  METHODS
  We conducted a nested case control study in a large cohort of patients with a clinical suspicion of having pulmonary embolism. Blood samples were collected to investigate the presence of influenza A and B by complement fixation assay (CFA). We compared case patients, in whom pulmonary embolism was proven (n = 102), to controls, in whom pulmonary embolism was excluded (n = 395). Furthermore, we compared symptoms of influenza-like illness in both patient groups 2 weeks prior to inclusion in the study, using the influenza-like illness (ILI) score, which is based on a questionnaire. We calculated the risk of pulmonary embolism associated with influenza infection.
  
  
  RESULTS
  The percentage of patients with influenza A was higher in the control group compared to the case group (4.3% versus 1.0%, respectively, odds ratio 0.22; 95% CI: 0.03-1.72). Influenza B was not detectable in any of the cases and was found in 3 of the 395 controls (0.8%). The ILI score was positive in 24% of the cases and 25% in the control persons (odds ratio 1.16, 95% CI: 0.67-2.01). We did not observe an association between the ILI score and proven influenza infection.
  
  
  CONCLUSIONS
  In this clinical study, influenza infection was not associated with an increased risk of acute pulmonary embolism. The ILI score is non-specific in this clinical setting.
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. Matthijs.vanWissen@slz.nl.
authors.forename: Matthijs
authors.initials: M
authors.lastname: van Wissen
authors.forename: Tymen T
authors.initials: TT
authors.lastname: Keller
authors.forename: Brechje
authors.initials: B
authors.lastname: Ronkes
authors.forename: Victor Ea
authors.initials: VE
authors.lastname: Gerdes
authors.forename: Hans L
authors.initials: HL
authors.lastname: Zaaijer
authors.forename: Eric Cm
authors.initials: EC
authors.lastname: van Gorp
authors.forename: Dees Pm
authors.initials: DP
authors.lastname: Brandjes
authors.forename: Marcel
authors.initials: M
authors.lastname: Levi
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller