title: Predictive factors of severe multilobar pneumonia and shock in patients with influenza.
abstract: OBJECTIVE
  To identify risk factors present at admission in adult patients hospitalised due to influenza virus infection during the 2009/10 and 2010/11 seasons--including whether infection was from pandemic or seasonal influenza A infections--that were associated with the likelihood of developing severe pneumonia with multilobar involvement and shock.
  
  
  METHODS
  Prospective cohort study. Patients hospitalised due to influenza virus infection were recruited. We collected information on sociodemographic characteristics, pre-existing medical conditions, vaccinations, toxic habits, previous medications, exposure to social environments, and EuroQoL-5D (EQ-5D). Severe pneumonia with multilobar involvement and/or shock (SPAS) was the primary outcome of interest. We constructed two multivariate logistic regression models to explain the likelihood of developing SPAS and to create a clinical prediction rule for developing SPAS that includes clinically relevant variables.
  
  
  RESULTS
  Laboratory-confirmed A(H1N1)pdm09, EQ-5D utility score 7 days before admission, more than one comorbidity, altered mental status, dyspnoea on arrival, days from onset of symptoms, and influenza season were associated with SPAS. In addition, not being vaccinated against seasonal influenza in the previous year, anaemia, altered mental status, fever and dyspnoea on arrival at hospital, difficulties in performing activities of daily living in the previous 7 days, and days from onset of symptoms to arrival at hospital were related to the likelihood of SPAS (area under the curve value of 0.75; Hosmer-Lemeshow p value of 0.84).
  
  
  CONCLUSIONS
  These variables should be taken into account by physicians evaluating a patient affected by influenza as additional information to that provided by the usual risk scores.
authors: Unidad de Investigación, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo (Osakidetza), , Galdakao, Bizkaia, Spain.
authors: Susana
authors: S
authors: Garcia Gutierrez
authors: José Maria
authors: JM
authors: Quintana
authors: Maretva
authors: M
authors: Baricot
authors: Amaia
authors: A
authors: Bilbao
authors: Alberto
authors: A
authors: Capelastegui
authors: Carlos Gustavo
authors: CG
authors: Cilla Eguiluz
authors: Angela
authors: A
authors: Domínguez
authors: Jesús
authors: J
authors: Castilla
authors: Pere
authors: P
authors: Godoy
authors: Miguel
authors: M
authors: Delgado-Rodríguez
authors: Núria
authors: N
authors: Soldevila
authors: Jenaro
authors: J
authors: Astray
authors: José María
authors: JM
authors: Mayoral
authors: Vicente
authors: V
authors: Martín
authors: Fernando
authors: F
authors: González-Candelas
authors: Juan Carlos
authors: JC
authors: Galán
authors: Sonia
authors: S
authors: Tamames
authors: Ady Angélica
authors: AA
authors: Castro-Acosta
authors: Olatz
authors: O
authors: Garín
authors: Tomás
authors: T
authors: Pumarola
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000150:complications* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012769:Shock / Q000209:etiology*; D013030:Spain
keywords: Clinical Care; Clinical Management; Infectious Diseases, Viral