title: Prognostic factors for fatal adult influenza pneumonia.
abstract: OBJECTIVE
  To elucidate the prognostic factors for fatal adult influenza pneumonia.
  
  
  METHODS
  Complicated influenza pneumonia is a notifiable disease in Taiwan. In this retrospective nationwide cohort, medical records were reviewed in 38 qualifying cases from 2001 to 2007. In-hospital mortality was the primary endpoint of this study.
  
  
  RESULTS
  The median patient age was 52 years, with the in-hospital mortality rate of 44.7%. Influenza A virus was found in 25 patients and influenza B was in 13 patients. Fifty percent of patients had no comorbidities. More than half of the patients developed sepsis, septic shock, respiratory failure or acute respiratory distress syndrome. The median duration from symptom onset to hospital visit was 3 days, and from hospital visit to death was 4 days. A univariate analysis demonstrated poor prognosis in patients with shock, respiratory rate > or =25/min, arterial pH<7.35, creatinine> or =2mg/dL and Pneumonia Severity Index IV or V. A multivariate analysis showed an association with mortality in patients with APACHE II score > or =20 (hazard ratio 5.941, p=0.024) or PaO(2)/FiO(2) ratio <150 (hazard ratio 4.194, p=0.017).
  
  
  CONCLUSIONS
  Clinical knowledge of identified prognostic factors for mortality may aid management of adult influenza pneumonia.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan, ROC.
authors.forename: Ya-Chi
authors.initials: YC
authors.lastname: Ho
authors.forename: Jiun-Ling
authors.initials: JL
authors.lastname: Wang
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Un-In
authors.initials: UI
authors.lastname: Wu
authors.forename: Chiu-Wen
authors.initials: CW
authors.lastname: Chang
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Wu
authors.forename: Chang-Hsun
authors.initials: CH
authors.lastname: Chen
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Chuang
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018563:Disease Notification; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D009980:Influenza A virus / Q000302:isolation & purification* / Q000472:pathogenicity; D009981:Influenza B virus / Q000302:isolation & purification* / Q000472:pathogenicity; D007251:Influenza, Human / Q000150:complications / Q000401:mortality* / Q000473:pathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011024:Pneumonia, Viral / Q000150:complications / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012367:RNA, Viral / Q000737:chemistry / Q000235:genetics; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality / Q000473:pathology; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000401:mortality / Q000473:pathology; D012772:Shock, Septic / Q000150:complications / Q000401:mortality / Q000473:pathology; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D012367:RNA, Viral