title: Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults.
abstract: BACKGROUND
  The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients.
  
  
  METHODS
  This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality.
  
  
  RESULTS
  In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p=0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p=0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p=0.133) significantly increased the likelihood of fatality.
  
  
  CONCLUSIONS
  Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Koç University, School of Medicine, Istanbul, Turkey. oergonul@ku.edu.tr.
authors.forename: Önder
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authors.lastname: Ergönül
authors.forename: Servet
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authors.forename: Derya
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authors.forename: Ilker Inanc
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authors.forename: Bahadir
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authors.lastname: Ceylan
authors.forename: Nur
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authors.forename: Saadet
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authors.lastname: Yazıcı
authors.forename: Funda
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authors.lastname: Şimşek
authors.forename: Nuray
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authors.forename: Asuman
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authors.forename: Meral
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authors.forename: Kenan
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authors.forename: Mustafa
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authors.lastname: Ozyurt
authors.forename: Selim
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authors.lastname: Badur
authors.forename: Serap
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authors.lastname: Gencer
authors.forename: Ozcan
authors.initials: O
authors.lastname: Nazlıcan
authors.forename: Serdar
authors.initials: S
authors.lastname: Özer
authors.forename: Nail
authors.initials: N
authors.lastname: Özgüneş
authors.forename: Taner
authors.initials: T
authors.lastname: Yıldırmak
authors.forename: Turan
authors.initials: T
authors.lastname: Aslan
authors.forename: Pasa
authors.initials: P
authors.lastname: Göktaş
authors.forename: Nese
authors.initials: N
authors.lastname: Saltoğlu
authors.forename: Muzaffer
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authors.lastname: Fincancı
authors.forename: Ali Ihsan
authors.initials: AI
authors.lastname: Dokucu
authors.forename: Haluk
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authors.lastname: Eraksoy
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009439:Neuraminidase / Q000037:antagonists & inhibitors; D016017:Odds Ratio; D053139:Oseltamivir / Q000627:therapeutic use; D011247:Pregnancy; D014421:Turkey / Q000453:epidemiology; D053243:Zanamivir / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir; D009439:Neuraminidase; D053243:Zanamivir