title: Outcome of influenza A (H1N1) patients admitted to intensive care units in the Paraná state, Brazil.
abstract: OBJECTIVE
  This study aimed to analyze outcome, clinical and epidemiological characteristics and severity factors in adult patients admitted with a diagnosis of infection by virus A (H1N1) to public and private intensive care units, in Paraná, Brazil.
  
  
  METHODS
  Cohort study of medical charts of patients older than 12 years admitted to 11 intensive care units in 6 cities in the state of Parana, Brazil, during a period of 45 days, with diagnosis of swine influenza. The diagnosis of infection with A (H1N1) was made by real time polymerase chain reaction (RT-PCR) of nasopharyngeal secretion, or strong clinical suspicion when other causes had been ruled out (even with negative RT-PCR). Descriptive statistics were performed, analysis by the Chi square test was used to compare percentages and the Student's t test for continuous variables with univariate analysis, assuming a significance level of p <0.05.
  
  
  RESULTS
  There were 63 adult patients admitted with a diagnosis of H1N1, 37 (58.7%) being RT-PCR positive. Most patients were young adults (65% under 40 years of age) with no gender predominance and high incidence of obesity (27.0% with Body Mass Index > 30). Mean of the Acute Physiologic Chronic Health Evaluation II (APACHE II) score was 15.0 + 8.1. Mortality in the intensive care unit was 39.7%. The main factors associated with mortality were: positive RT-PCR, low levels of initial PaO2/FiO2, high initial levels of urea and lactate dehydrogenase, required level of positive end expiratory pressure, need for the prone position and vasopressors.
  
  
  CONCLUSIONS
  Adult patients with A (H1N1) virus infection admitted to intensive care units had a high risk of death, particularly due to respiratory impairment. Positive RT-PCR, urea and lactic dehydrogenase, low initial PaO2/FiO2 and high levels of PEEP were correlated with higher mortality.
authors.affiliation: Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Péricles Almeida Delfino
authors.initials: PA
authors.lastname: Duarte
authors.affiliation: Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Alisson
authors.initials: A
authors.lastname: Venazzi
authors.affiliation: Hospital das Nações, Curitiba, PR, Brasil.
authors.forename: Nazah Cherif Mohamad
authors.initials: NC
authors.lastname: Youssef
authors.affiliation: Hospital do Trabalhador, Curitiba, PR, Brasil.
authors.forename: Mirella Cristine de
authors.initials: MC
authors.lastname: Oliveira
authors.affiliation: Hospital Cajuru, Curitiba, PR, Brasil.
authors.forename: Luana Alves
authors.initials: LA
authors.lastname: Tannous
authors.affiliation: Hospital São Lucas, Curitiba, PR, Brasil.
authors.forename: César Barros
authors.initials: CB
authors.lastname: Duarte
authors.affiliation: Hospital Universitário Regional.
authors.forename: Cíntia Magalhães Carvalho
authors.initials: CM
authors.lastname: Grion
authors.affiliation: Hospital Universitário, Maringá, PR, Brasil.
authors.forename: Almir
authors.initials: A
authors.lastname: Germano
authors.affiliation: Santa Casa, Campo Mourão, PR, Brasil.
authors.forename: Paulo Marcelo
authors.initials: PM
authors.lastname: Schiavetto
authors.affiliation: Hospital Policlínica.
authors.forename: Alexandre Luiz de Gonzaga Pinho
authors.initials: AL
authors.lastname: Lins
authors.affiliation: Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Marcos Menezes Freitas
authors.initials: MM
authors.lastname: Campos
authors.affiliation: Hospital Costa Cavalcanti, Foz do Iguaçu, PR, Brasil.
authors.forename: Cecília Keiko
authors.initials: CK
authors.lastname: Miúra
authors.affiliation: Hospital Universitário do Oeste do Paraná, Cascavel, PR, Brasil.
authors.forename: Carla Sakuma de Oliveira
authors.initials: CS
authors.lastname: Bredt
authors.affiliation: Faculdade Assis Gurgacz, Hospital São Lucas, Cascavel, PR, Brasil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Toso
authors.affiliation: Universidade Federal do Paraná, Curitiba, PR, Brasil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Réa-Neto