title: Characteristics and outcome of critically ill patients with 2009 H1N1 influenza infection in Syria.
abstract: OBJECTIVE
  To describe the epidemiologic characteristics, clinical features, and outcome of severe cases of 2009 H1N1 influenza A infections who were admitted to the intensive care units (ICUs) in Damascus, Syria.
  
  
  METHODS
  Retrospectively, we collected clinical data on all patients who were admitted to the ICU with confirmed or suspected diagnosis of severe 2009 H1N1 influenza A with respiratory failure at 4 major tertiary care hospitals in Damascus, Syria. Acute Physiology and Chronic Health Evaluation (APACHE) II system was used to assess the severity of illness within the first 24 h after admission. The outcome was overall hospital mortality.
  
  
  RESULTS
  Eighty patients were admitted to the ICU with severe 2009 H1N1 infection. The mean age was 40.7 years; 69.8% of patients had ≥1 of the risk factors: asthmatics 20%, obesity 23.8%, and pregnancy 5%; and 72.5% had acute lung injury or adult respiratory distress syndrome, 12.5% had viral pneumonia, 42.5% had secondary bacterial pneumonia, and 15% had exacerbation of airflow disease. Mechanical ventilation was required in 73.7% of cases. The mean hospital length of stay was 11.7 days (median 8 days, range 0-77 days, IQR: 5-14 days). The overall mortality rate was 51% for a mean APACHE II score of 15.2 with a predicted mortality of 21% (standardized mortality ratio of 2.4, 95% confidence interval: 1.7-3.2, P value < 0.001).
  
  
  CONCLUSIONS
  Critically ill patients with severe 2009 H1N1 infection in this limited resource country had a much higher mortality rate than the predicted APACHE II mortality rate or when compared with the reported mortality rates for severe cases in other countries during 2009 H1N1 pandemic.
authors.affiliation: Emergency Services, Al-Mouassat University Hospital, Damascus, Syria.
authors.forename: Reem
authors.initials: R
authors.lastname: Alsadat
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Dakak
authors.forename: Mouna
authors.initials: M
authors.lastname: Mazlooms
authors.forename: Ghasan
authors.initials: G
authors.lastname: Ghadhban
authors.forename: Shadi
authors.initials: S
authors.lastname: Fattoom
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Betelmal
authors.forename: Nabil
authors.initials: N
authors.lastname: Abouchala
authors.forename: Mazen
authors.initials: M
authors.lastname: Kherallah