title: Outcome of pandemic H1N1 pneumonia: clinical and radiological findings for severity assessment.
abstract: OBJECTIVE
  Pandemic influenza A (H1N1) virus infection presents with variable severity. However, little is known about clinical predictors of disease severity. We studied the clinical predictors of severe pandemic H1N1 pneumonia and their correlation with radiological findings.
  
  
  METHODS
  We reviewed medical and radiological records of adults with pandemic H1N1 pneumonia. After classification of patients into severe and non-severe groups, the following data were evaluated: demographic data, pneumonia severity index (PSI), CURB65, risk factors, time to first dose of antiviral medication, routine laboratory data, clinical outcome, and radiological characteristics.
  
  
  RESULTS
  Of 37 patients with pandemic H1N1 pneumonia, 12 and 25 were assigned to the severe and non-severe groups, respectively. PSI score, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dyhydrogenase (LDH) levels were higher in the severe group than in the non-severe group (p = 0.035, 0.0003, 0.0023, and 0.0002, respectively). AST, ALT, and LDH levels were positively correlated with the radiological findings (p < 0.0001, 0.0003, and < 0.0001, respectively) and with the number of involved lobes (p = 0.663, 0.0134, and 0.0019, respectively). The most common finding on high resolution computed tomography (HRCT) scans was ground-glass attenuation with consolidation (n = 22, 60%), which had a predominantly patchy distribution (n = 31).
  
  
  CONCLUSIONS
  We demonstrated a positive correlation between clinical findings, such as serum AST, ALT, and LDH levels, and radiological findings. A combination of clinical and HRCT indicators would be useful in predicting the clinical outcome of pandemic H1N1 pneumonia.
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Cho
authors.forename: Yun Seong
authors.initials: YS
authors.lastname: Kim
authors.forename: Doo Soo
authors.initials: DS
authors.lastname: Jeon
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Kun Il
authors.initials: KI
authors.lastname: Kim
authors.forename: Hee Yun
authors.initials: HY
authors.lastname: Seol
authors.forename: Ki Uk
authors.initials: KU
authors.lastname: Kim
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Park
authors.forename: Min Ki
authors.initials: MK
authors.lastname: Lee
authors.forename: Soon Kew
authors.initials: SK
authors.lastname: Park
authors.forename: Yeon Joo
authors.initials: YJ
authors.lastname: Jeong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004796:Clinical Enzyme Tests; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy / Q000821:virology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008168:Lung / Q000000981:diagnostic imaging* / Q000821:virology; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy / Q000821:virology; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase