title: Novel avian-origin influenza A (H7N9) in critically ill patients in China*.
abstract: OBJECTIVE
  In March 2013, human infection with a novel avian-origin reassortment influenza A (H7N9) virus was identified in China. A total of 26 cases were confirmed and treated in Jiangsu. All the patients had findings consistent with pneumonia and were admitted to an ICU, which pose a threat to human health. We aimed to provide the clinical features, treatment, and prognosis of the critically ill patients with H7N9 viral infection.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Eight closed ICUs in general hospitals distributed throughout the Jiangsu Provincial, China.
  
  
  METHODS
  Patients infected with influenza A (H7N9) virus from March 20, 2013, through May 1, 2013, in Jiangsu Province were included.
  
  
  METHODS
  None.
  
  
  RESULTS
  Twenty-seven patients infected with H7N9 virus were identified in Jiangsu. Of these, 26 were hospitalized. The median age was 54.5 years, and 18 patients (69.2%) were men. The most common symptoms at the onset of illness were high fever and cough. White cell counts were normal or decreased. All the patients had findings consistent with pneumonia. Twenty-four patients (92.3%) developed acute respiratory distress syndrome, and 10 (38.5%) developed septic shock quickly after the onset of illness. Treatment with antiviral drugs was initiated in all the patients at a median of 8 days after the onset of illness. Mortality was 19.2% at 28 days and 30.8% at 90 days. Based on multiple logistic regression analysis, septic shock associated with severe hypoxemia was the only independent risk factor for mortality.
  
  
  CONCLUSIONS
  Infection with novel avian-origin reassortment influenza A (H7N9) virus is characterized by high fever, cough, and severe respiratory failure and is associated with a high mortality. These data provide some general understandings for the early identification, ICU treatment, and short-term prognosis of hospitalized critical patients with H7N9.
authors.affiliation: 1Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China. 2Department of Critical Care Medicine, the Second Affiliated Hospital of Southeast University, Nanjing, People's Republic of China. 3Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, People's Republic of China. 4Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China. 5Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China. 6Department of Respiratory Medicine, Nanjing General Hospital of Nanjing Military Command, People's Liberation Army, Nanjing, People's Republic of China. 7Department of Infectious Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China. 8Department of Critical Care Medicine, the First Affiliated Hospital of Suzhou University, Suzhou, People's Republic of China. 9Department of Critical Care Medicine, Wuxi People's Hospital, Wuxi, People's Republic of China. 10Department of Critical Care Medicine, Zhenjiang First People's Hospital, Zhenjiang, People's Republic of China. 11Department of Critical Care Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, People's Republic of China. 12Department of Critical Care Medicine, Yancheng City No. 1 People's Hospital, Yancheng, People's Republic of China. 13Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University (Nanjing First Hospital), Nanjing, People's Republic of China. 14Department of Respiratory Medicine, Nanjing Drum Tower Hospital, Nanjing, People's Republic of China. 15Department of Respiratory Medicine, the First Affiliated Hospital of Suzhou University, Suzhou, People's Republic of China. 16Department of Critical Care Medicine, Nanjing General Hospital of Nanjing Military C
authors.forename: Yi
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authors.forename: Fengmei
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authors.lastname: Jin
authors.forename: Xing
authors.initials: X
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authors.forename: Yijun
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authors.lastname: Deng
authors.forename: Lihua
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authors.forename: Jianan
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authors.forename: Weiqin
authors.initials: W
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authors.forename: Airan
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authors.forename: Bingwei
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authors.initials: AS
authors.lastname: Slutsky
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype; D007251:Influenza, Human / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D060888:Real-Time Polymerase Chain Reaction; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012737:Sex Factors; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D000998:Antiviral Agents