Clinical characteristics of critical patients with pandemic influenza A (H1N1) virus infection in Chengdu, China.
OBJECTIVE
The critical illness of pandemic influenza A (H1N1) virus infection may be associated with relatively poor outcomes. The objective of this study is to describe clinical features and factors associated with the deaths of critical patients.


METHODS
Medical records of 26 critical patients with H1N1 infection admitted from Sept. 1 to Dec. 31, 2009, were retrospectively reviewed. Diagnosis was established by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay.


RESULTS
The mean age of the patients was (40.4 ± 18.4) years and 73.1% of them were male. Clinical manifestations included fever, cough, and sputum production. The laboratory findings included leukocytosis, lymphopenia, C-reaction protein, and lactic dehydrogenase elevation. In this series, 17 subjects survived and 9 died. The parameters between the deaths and survivors were compared, which included acute physiology and chronic health evaluation II (APACHE II) scores (23.8 ± 10.1 vs. 14.3 ± 6.6, P<0.05), sequential organ failure assessment (SOFA) scores (13.3 ± 3.0 vs. 6.6 ± 3.3, P<0.05), and multiple organ dysfunction syndrome (MODS) scores (7.4 ± 2.5 vs. 3.3 ± 1.7, P<0.05). The cases of deaths had higher incidences of cardiovascular failure (100% vs. 41.2%, P<0.05), renal failure (55.6% vs. 11.7%, P<0.05), encephalopathy (44.4% vs. 5.9%, P<0.05), hepatic failure (33.3% vs. 5.9%, P<0.05), and septic shock (33.3% vs. 17.6%, P<0.05).


CONCLUSIONS
The critical patients with H1N1 infection have high APACHE II, SOFA, and MODS scores, which may be associated with an increased risk of death and complex clinical courses.
Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China.
Li-hui
LH
Deng
Yi-lan
YL
Zeng
Ping
P
Feng
Ya-ling
YL
Liu
Li-chun
LC
Wang
Yun
Y
Bai
Hong
H
Tang
D018806:APACHE; D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology / Q000473:pathology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D058873:Pandemics; D012367:RNA, Viral / Q000737:chemistry / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies
D012367:RNA, Viral