Prognostic factors for fatal adult influenza pneumonia.
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.
Ho
Ya-Chi
YC
Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan, ROC.
Wang
Jiun-Ling
JL
Wang
Jann-Tay
JT
Wu
Un-In
UI
Chang
Chiu-Wen
CW
Wu
Ho-Sheng
HS
Chen
Chang-Hsun
CH
Chuang
Yu-Min
YM
Chang
Shan-Chwen
SC
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
D012367:RNA, Viral