title: The potential influence of common viral infections diagnosed during hospitalization among critically ill patients in the United States.
abstract: Viruses are the most common source of infection among immunocompetent individuals, yet they are not considered a clinically meaningful risk factor among the critically ill. This work examines the association of viral infections diagnosed during the hospital stay or not documented as present on admission to the outcomes of ICU patients with no evidence of immunosuppression on admission. This is a population-based retrospective cohort study of University HealthSystem Consortium (UHC) academic centers in the U.S. from the years 2006 to 2009. The UHC is an alliance of over 90% of the non-profit academic medical centers in the U.S. A total of 209,695 critically ill patients were used in this analysis. Eight hospital complications were examined. Patients were grouped into four cohorts: absence of infection, bacterial infection only, viral infection only, and bacterial and viral infection during same hospital admission. Viral infections diagnosed during hospitalization significantly increased the risk of all complications. There was also a seasonal pattern for viral infections. Specific viruses associated with poor outcomes included influenza, RSV, CMV, and HSV. Patients who had both viral and bacterial infections during the same hospitalization had the greatest risk of mortality RR 6.58, 95% CI (5.47, 7.91); multi-organ failure RR 8.25, 95% CI (7.50, 9.07); and septic shock RR 271.2, 95% CI (188.0, 391.3). Viral infections may play a significant yet unrecognized role in the outcomes of ICU patients. They may serve as biological markers or play an active role in the development of certain adverse complications by interacting with coincident bacterial infection.
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Makesha
authors.initials: M
authors.lastname: Miggins
authors.forename: Anjum
authors.initials: A
authors.lastname: Hasan
authors.forename: Samuel
authors.initials: S
authors.lastname: Hohmann
authors.forename: Frederick
authors.initials: F
authors.lastname: Southwick
authors.forename: George
authors.initials: G
authors.lastname: Casella
authors.forename: Denise
authors.initials: D
authors.lastname: Schain
authors.forename: Huazhi
authors.initials: H
authors.lastname: Liu
authors.forename: Azra
authors.initials: A
authors.lastname: Bihorac
authors.forename: Lyle
authors.initials: L
authors.lastname: Moldawer
authors.forename: Philip
authors.initials: P
authors.lastname: Efron
authors.forename: Darwin
authors.initials: D
authors.lastname: Ang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology*; D003967:Diarrhea / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014777:Virus Diseases / Q000453:epidemiology*; D055815:Young Adult