title: Hospitalized adult patients with 2009 influenza A(H1N1) in Beijing, China: risk factors for hospital mortality.
abstract: BACKGROUND
  In April 2009, the pandemic influenza A(H1N1) virus emerged and spread globally. The objective of this study was to describe the independent risk factors for hospital mortality and the treatment effect of corticosteroids among patients with 2009 influenza A(H1N1) infection.
  
  
  METHODS
  We retrospectively obtained clinical data of 155 adult patients with confirmed infection of 2009 influenza A(H1N1) in 23 hospitals in Beijing, China from October 1 to December 23, 2009. Risk factors for hospital mortality were identified with multivariate logistic regression analysis.
  
  
  RESULTS
  Among the 155 patients, 90 (58.1%) were male, and mean age was 43.0 ± 18.6 years, and comorbidities were present in 81 (52.3%) patients. The most common organ dysfunctions included acute respiratory failure, altered mental status, septic shock, and acute renal failure. Oseltamivir was initiated in 125 patients (80.6%), only 16 patients received antiviral therapy within 48 hours after symptom onset. Fifty-two patients (33.5%) were treated with systemic corticosteroids, with a median daily dose of 80 mg. Twenty-seven patients (17.4%) died during hospital stay. Diabetes [odds ratio (OR) 8.830, 95% confidence interval [CI] 2.041 to 38.201, p = 0.004) and lactate dehydrogenase (LDH) level (OR 1.240, 95% CI 1.025 to 1.500, p = 0.027) were independent risk factors of hospital death, as were septic shock and altered mental status. Corticosteroids use was associated with a trend toward higher hospital mortality (OR 3.668, 95% CI 0.987 to 13.640, p = 0.052).
  
  
  CONCLUSIONS
  Hospitalized patients with 2009 H1N1 influenza had relative poor outcome. The risk factors at hospitalization may help clinicians to identify the high-risk patients. In addition, corticosteroids use should not be regarded as routine pharmacologic therapy.
authors.affiliation: Department of Critical Care Medicine, Beijing Fuxing Hospital, Capital University of Medical Sciences, 20A Fu Xing Men Wai Da Jie, Beijing 100038, China.
authors.forename: Xiuming
authors.initials: X
authors.lastname: Xi
authors.forename: Yuan
authors.initials: Y
authors.lastname: Xu
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
authors.forename: Ang
authors.initials: A
authors.lastname: Li
authors.forename: Jie
authors.initials: J
authors.lastname: Duan
authors.forename: Bin
authors.initials: B
authors.lastname: Du
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents
references.citation: MMWR Morb Mortal Wkly Rep. 2009 May 8;58(17):467-70
references.pmid: 19444150
references.citation: JAMA. 2003 Jan 1;289(1):76-9
references.pmid: 12503980
references.citation: Ann Acad Med Singap. 2006 May;35(5):326-31
references.pmid: 16829999
references.citation: Crit Care Med. 2009 Feb;37(2):463-70
references.pmid: 19114915
references.citation: JAMA. 2009 Nov 4;302(17):1896-902
references.pmid: 19887665
references.citation: Clin Infect Dis. 2004 Nov 1;39(9):1300-6
references.pmid: 15494906
references.citation: JAMA. 2009 Nov 4;302(17):1872-9
references.pmid: 19822627
references.citation: Med J Aust. 2010 Jan 18;192(2):84-6
references.pmid: 20078408
references.citation: N Engl J Med. 2009 Nov 12;361(20):1935-44
references.pmid: 19815859
references.citation: CMAJ. 2010 Mar 9;182(4):349-55
references.pmid: 20159893
references.citation: Crit Care. 2004 Apr;8(2):105-7
references.pmid: 15515216
references.citation: Intensive Care Med. 1996 Jul;22(7):707-10
references.pmid: 8844239
references.citation: Clin Infect Dis. 2009 Jun 15;48(12):1639-46
references.pmid: 19435433
references.citation: J Infect. 2010 Feb;60(2):168-74
references.pmid: 20036689
references.citation: J Infect. 2005 Aug;51(2):98-102
references.pmid: 16038758
references.citation: MMWR Morb Mortal Wkly Rep. 2009 May 1;58(16):431-3
references.pmid: 19407737
references.citation: Microbes Infect. 2009 Jul-Aug;11(8-9):725-8
references.pmid: 19442755
references.citation: Lancet. 2009 Dec 19;374(9707):2072-2079
references.pmid: 19913290
references.citation: J Chin Med Assoc. 2005 Jan;68(1):4-10
references.pmid: 15742856
references.citation: N Engl J Med. 2009 Nov 12;361(20):1925-34
references.pmid: 19815860
references.citation: PLoS Curr. 2010 Mar 09;2:RRN1150
references.pmid: 20228857
references.citation: J Infect Dis. 2009 Aug 15;200(4):492-500
references.pmid: 19591575
references.citation: Chest. 1992 Jun;101(6):1644-55
references.pmid: 1303622
references.citation: Wkly Epidemiol Rec. 2009 Nov 13;84(46):481-4
references.pmid: 19928298
references.citation: Respirology. 2007 Jul;12(4):531-42
references.pmid: 17587420
references.citation: N Engl J Med. 2009 Dec 24;361(26):2507-17
references.pmid: 20007555
references.citation: JAMA. 2009 Nov 4;302(17):1880-7
references.pmid: 19822626
references.citation: N Engl J Med. 2010 May 6;362(18):1708-19
references.pmid: 20445182
references.citation: Thorax. 2010 Jul;65(7):645-51
references.pmid: 20627925
references.citation: PLoS One. 2010 Mar 15;5(3):e9694
references.pmid: 20300571