[Relationship between clinical features and prognosis of highly pathogenic avian influenza A/H5N1 infection in humans in mainland China].
OBJECTIVE
To investigate the relationship between clinical features of patients with A/H5N1 infection and their prognosis in mainland China.


METHODS
This study included 28 human cases with A/H5N1 infection in mainland China from October 2005 to May 2008. Data were collected and reviewed from hospital medical records and publishied papers. A database was built by EPIDATA 3.02 and statistical analyses were performed with SPSS 13.0.


RESULTS
The median age of the 28 cases was 29 years (range 6-62), and 15 were females. Ten patients survived, and 18 died. The typically clinical manifestations of human influenza A/H5N1 infection included fever and lower respiratory infection. The numbers of peripheral white blood cells, lymphocytes and platelets in the survival and non-survival groups were (4.01 +/- 1.86) x 10(9)/L vs (5.1 +/- 2.9) x 10(9)/L, (1.09 +/- 0.49) x 10(9)/L vs (0.98 +/- 0.44) x 10(9)/L, and (116 +/- 39) x 10(9)/L vs (101 +/- 40) x 10(9)/L, respectively; the differences were not statistically significant between the 2 groups (P>0.05). There was also no statistically significant difference in the increased serum enzymes, such as aspartate aminotransferase [(173 +/- 246) U/L vs (272 +/- 263) U/L], lactate dehydrogenase [(1016 +/- 568) U/L vs (1512 +/- 1052) U/L], creatine kinase [(1099 +/- 1590) U/L vs (2534 +/- 4281) U/L] and MB isoenzyme of creatine kinase [(28 +/- 30) U/L vs (125 +/- 197) U/L] (P>0.05) between the survival and the non-survival groups. However, there was a statistically significant difference in the number of patients with an initial LDH level more than 8 fold of the normal value between the survival and the non-survival groups (none vs 6, P<0.05). All of the 28 cases developed bilateral multiple infiltrates and consolidation in chest radiographs. Acute respiratory distress syndrome occurred in 22 cases, 17 of them died. All the 9 patients with acute kidney injury died. Ten patients received antiviral treatment with oseltamivir, and 6 of them survived. There was a statistical difference in the time of initiating oseltamivir treatment between the survival and the non-survival cases [(6.5 +/- 3.0) d vs (11.8 +/- 3.3) d, Z = 3.70, P<0.05]. Broad spectrum antibiotics and corticosteroids were administered in all of the 28 cases. There was no statistical difference between the survival and the non-survival groups regarding to the corticosteroid treatment (P>0.05).


CONCLUSIONS
Initial LDH level reaching more than 8 fold of the normal value suggests a poor prognosis for human H5N1 infection. Patients complicated with either ARDS or acute kidney injury had a higher risk of death. Early administration of effective antiviral agents might improve the prognosis and decrease case fatality.
Department of Respiratory Medicine, Peking University People's Hospital, Beijing 100044, China.
Jia
J
Li
Yu
Y
Xu
Yu-qing
YQ
Chen
Yang
Y
Ge
Long-hui
LH
Zhang
Xiao-ling
XL
Xu
Tong-sheng
TS
Wu
Yu-sheng
YS
Chen
Jing
J
Wang
Jian-nan
JN
Liu
Li-ping
LP
Wei
Chen
C
Qiu
Xiao-ning
XN
Zhong
Mei-xing
MX
Huang
Jian-bao
JB
Xin
Ru-ping
RP
Luo
Ming-shun
MS
Zhao
Zai-qing
ZQ
Li
Cheng-ping
CP
Hu
Wei
W
Zhao
Hong
H
Wang
Wei
W
Zhang
Lu-sheng
LS
Guo
Qiu-yue
QY
Wang
Long-nü
LN
Zhou
Zong-an
ZA
Liang
Jun-qing
JQ
Ma
Yue-jian
YJ
Liu
Yuan-ming
YM
Jiang
Wan-sheng
WS
Xie
Ji-fang
JF
Sheng
Zhan-cheng
ZC
Gao
D058186:Acute Kidney Injury / Q000150:complications; D000293:Adolescent; D000328:Adult; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis / Q000201:enzymology / Q000453:epidemiology* / Q000628:therapy*; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications; D016896:Treatment Outcome; D055815:Young Adult
D007770:L-Lactate Dehydrogenase