title: A prediction rule to identify severe cases among adult patients hospitalized with pandemic influenza A (H1N1) 2009.
abstract: The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO(2)/FiO(2) ≤ 250), bilateral lung infiltration, and old age (≥ 65 yr) were independent risk factors for severe cases (all P < 0.001). The area under the ROC curve (0.834 [95% CI, 0.778-0.890]) of the number of risk factors were not significantly different with that of APACHE II score (0.840 [95% CI, 0.790-0.891]) (P = 0.496). The presence of ≥ 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of ≥ 13. As a prediction rule, the presence of ≥ 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.
authors.affiliation: Department of Internal Medicine, Kangwon National University School of Medicine, Chucheon, Korea.
authors.forename: Won Sup
authors.initials: WS
authors.lastname: Oh
authors.forename: Seung-Joon
authors.initials: SJ
authors.lastname: Lee
authors.forename: Chang-Seop
authors.initials: CS
authors.lastname: Lee
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Hur
authors.forename: Ae-Chung
authors.initials: AC
authors.lastname: Hur
authors.forename: Yoon Seon
authors.initials: YS
authors.lastname: Park
authors.forename: Sang-Taek
authors.initials: ST
authors.lastname: Heo
authors.forename: In-Gyu
authors.initials: IG
authors.lastname: Bae
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Park
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Kkot Sil
authors.initials: KS
authors.lastname: Lee
authors.forename: Sang-Rok
authors.initials: SR
authors.lastname: Lee
authors.forename: Joon Sup
authors.initials: JS
authors.lastname: Yeom
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Baek-Nam
authors.initials: BN
authors.lastname: Kim
authors.forename: Yee Gyung
authors.initials: YG
authors.lastname: Kwak
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Yong Keun
authors.initials: YK
authors.lastname: Kim
authors.forename: Hyo Youl
authors.initials: HY
authors.lastname: Kim
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
authors.forename: Myoung-Don
authors.initials: MD
authors.lastname: Oh
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D011237:Predictive Value of Tests; D012372:ROC Curve; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents