title: Is influenza A(H1N1) pneumonia more severe than other community-acquired pneumonias? Results of the GiViTI survey of 155 Italian ICUs.
abstract: OBJECTIVE
  Uncertainty about the severity of the A(H1N1) pandemia persists. Information about disease severity can be obtained by investigating intensive care unit (ICU) admissions, especially when historical comparisons can be made with cases of community-acquired pneumonia (CAP).
  
  
  METHODS
  This prospective observational study was conducted in 155 ICUs contributing to the GiViTI national database. To assess the impact on ICU workload, the occupancy rate during the epidemic phase was compared with influenza periods in previous years. A logistic regression model was developed to assess the prognostic importance of A(H1N1) influenza.
  
  
  RESULTS
  The characteristics of the 319 A(H1N1) cases were similar to those reported in other studies, confirming the young age of patients (mean 43 years) and the higher prevalence among pregnant women and obese people. At the epidemic's peak (October-December 2009) the occupancy rate did not significantly differ from the same period of the previous year, and was significantly lower than the 2009 seasonal influenza outbreak (January-March 2009). Compared with CAP of other origin (3,678 patients), A(H1N1) pneumonia was associated with a lower risk of death. However, after adjusting for confounding this was no longer the case (OR 0.88; 95% CI 0.59-1.31; p = 0.52).
  
  
  CONCLUSIONS
  This study confirmed the specific features of critically ill A(H1N1) patients (i.e., young age, pregnancy, obesity). The pandemic did not increase ICU workload compared with other periods. A(H1N1) pneumonia did not have a higher risk of death than CAP of different origin among patients admitted to the ICU.
authors.affiliation: Istituto di Ricerche Farmacologiche Mario Negri, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, 24020, Ranica, Bergamo, Italy. guido.bertolini@marionegri.it
authors.forename: Guido
authors.initials: G
authors.lastname: Bertolini
authors.forename: Carlotta
authors.initials: C
authors.lastname: Rossi
authors.forename: Daniele
authors.initials: D
authors.lastname: Crespi
authors.forename: Stefano
authors.initials: S
authors.lastname: Finazzi
authors.forename: Marco
authors.initials: M
authors.lastname: Morandotti
authors.forename: Sandra
authors.initials: S
authors.lastname: Rossi
authors.forename: Mario
authors.initials: M
authors.lastname: Peta
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
authors.forename: Daniele
authors.initials: D
authors.lastname: Poole
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000401:mortality / Q000503:physiopathology*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016526:Workload; D055815:Young Adult