title: Clinical experience with severe 2009 H1N1 influenza in the intensive care unit at King Saud Medical City, Saudi Arabia.
abstract: OBJECTIVE
  The objective of this study was to describe the epidemiological characteristics, clinical features, treatment, and outcome of 2009 H1N1-infected patients who were admitted to the intensive care unit (ICU) at King Saud Medical City (KSMC) in Riyadh, Kingdom of Saudi Arabia.
  
  
  METHODS
  Retrospectively, we collected demographic data as well as data on the clinical presentation and risk factors for 86 patients who were admitted to the ICU with H1N1 influenza A. The APACHE IV System was used to assess the severity of the illness. The overall hospital mortality was calculated and correlated with the use of steroids and the time of oseltamivir administration.
  
  
  RESULTS
  The mean age of the patients was 40.8 years. Mortality increased steadily with increasing APACHE IV score. Patients who received steroids had a mortality rate of 47% compared with 23% for patients who were not treated with steroids; this difference was significant, with a P value of <0.01. The late administration of oseltamivir was associated with a mortality rate of 82% compared with 28% in the context of early oseltamivir administration; this difference was significant, with a P value of <0.01.
  
  
  CONCLUSIONS
  Patients who were admitted to the ICU with severe 2009 H1N1 infection were young and had a relatively high severity-of-illness score. The late administration of oseltamivir was associated with a 12-fold increase in mortality. Steroid use was associated with a 3-fold increase in mortality.
authors.affiliation: King Saud Medical Complex, Riyadh, Saudi Arabia. afmady@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Mady
authors.forename: O S
authors.initials: OS
authors.lastname: Ramadan
authors.forename: A
authors.initials: A
authors.lastname: Yousef
authors.forename: Y
authors.initials: Y
authors.lastname: Mandourah
authors.forename: A A
authors.initials: AA
authors.lastname: Amr
authors.forename: M
authors.initials: M
authors.lastname: Kherallah
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir