title: High mortality in critically ill patients infected with 2009 pandemic influenza A (H1N1) with pneumonia and acute kidney injury.
abstract: Patients infected with H1N1 virus may develop pneumonia and acute kidney injury (AKI). To determine the epidemiological characteristics, clinical features, management and out-comes of patients with confirmed H1N1 complicated by pneumonia and AKI and treatment with oseltamivir and to identify the prognostic indicators, we studied all the patients with a confirmed diagnosis of H1N1 infection with pneumonia and AKI, using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay, between October 2009 and March 2010. H1N1 infection was confirmed in 20 patients with pneumonia and AKI; the mean age was 42.8 ± 18.2 years and 12 (60%) of the patients were males. Eleven patients were between 15 and 50 years of age, and 15 had preexisting medical conditions. All patients had fever, cough, dyspnea or respiratory distress, increased serum lactate dehydrogenase levels, pneumonia and AKI. Fifteen (75%) patients required mechanical ventilation and 14 (70%) died. None of the health care workers developed influenza-like illness, when they received oseltamivir prophylaxis. Mortality was associated with higher Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment score (SOFA), Multiple Organ Dysfunction Score (MODS), XRChest score, in addition to requirement of inotrope, ventilator support, renal replacement therapy (RRT), and presence of underlying risk factor for severe disease.
authors.affiliation: Department of Nephrology and Clinical Transplantation, Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases & Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India. drvivekkute@rediffmail.com
authors.forename: V B
authors.initials: VB
authors.lastname: Kute
authors.forename: S M
authors.initials: SM
authors.lastname: Godara
authors.forename: K R
authors.initials: KR
authors.lastname: Goplani
authors.forename: M R
authors.initials: MR
authors.lastname: Gumber
authors.forename: P R
authors.initials: PR
authors.lastname: Shah
authors.forename: A V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: V R
authors.initials: VR
authors.lastname: Shah
authors.forename: H L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000821:virology; D053139:Oseltamivir / Q000627:therapeutic use; D058873:Pandemics; D011024:Pneumonia, Viral / Q000401:mortality* / Q000628:therapy / Q000821:virology; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir