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Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment

Published:December 31, 2019DOI:https://doi.org/10.1016/j.ejim.2019.12.022

      Highlights

      • 441 influenza virus infections from a Swiss Hospital were included.
      • During 4 influenza seasons, 238 infections due to influenza A virus; 203 due to b.
      • 30-day mortality was 6.0% and independently associated with A virus.
      • qSOFA≥2 points showed a very good accuracy (0.89).
      • Hospital-acquired infection was a predictor of worst outcome.

      Abstract

      Background

      Influenza infections have been associated with high morbidity. The aims were to determine predictors of mortality among patients with influenza infections and to ascertain the role of quick Sequential Organ Failure Assessment (qSOFA) in predicting poor outcomes.

      Methods

      All adult patients with influenza infection at the Hospital of Jura, Switzerland during four influenza seasons (2014/15 to 2017/18) were included. Cepheid Xpert Xpress Flu/RSV was used during the first three influenza seasons and Cobas Influenza A/B and RSV during the 2017/18 season.

      Results

      Among 1684 influenza virus tests performed, 441 patients with influenza infections were included (238 for influenza A virus and 203 for B). The majority of infections were community onset (369; 83.7%). Thirty-day mortality was 6.0% (25 patients). Multivariate analysis revealed that infection due to A virus (P 0.035; OR 7.1; 95% CI 1.1–43.8), malnutrition (P < 0.001; OR 25.0; 95% CI 4.5–138.8), hospital-acquired infection (P 0.003; OR 12.2; 95% CI 2.3–65.1), respiratory insufficiency (PaO2/FiO2 < 300) (P < 0.001; OR 125.8; 95% CI 9.6–1648.7) and pulmonary infiltrate on X-ray (P 0.020; OR 6.0; 95% CI 1.3–27.0) were identified as predictors of mortality. qSOFA showed a very good accuracy (0.89) equivalent to other more specific and burdensome scores such as CURB-65 and Pneumonia Severity Index (PSI).

      Conclusion

      qSOFA performed similarly to specific severity scores (PSI, CURB-65) in predicting mortality. Infection by influenza A virus, respiratory insufficiency and malnutrition were associated with worse prognosis.

      Keywords

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      References

        • Nielsen J.
        • Vestergaard L.S.
        • Richter L.
        • Schmid D.
        • Bustos N.
        • Asikainen T.
        • et al.
        European all-cause excess and influenza-attributable mortality in the 2017/18 season: should the burden of influenza B be reconsidered?.
        Clin Microbiol Infect. 2019; (pii: S1198-743X(19)30058-8)
        • Iuliano A.D.
        • Roguski K.M.
        • Chang H.H.
        • Muscatello D.J.
        • Palekar R.
        • Tempia S.
        • et al.
        Estimates of global seasonal influenza-associated respiratory mortality: a modelling study.
        Lancet. 2018; 391: 1285-1300
      1. Centers for Disease Control and Prevention. Disease Burden of Influenza. https://www.cdc.gov/flu/about/burden/index.html.

        • Mulrennan S.
        • Tempone S.S.
        • Ling I.T.
        • Williams S.H.
        • Gan G.C.
        • Murray R.J.
        • et al.
        Pandemic influenza (H1N1) 2009 pneumonia: CURB-65 score for predicting severity and nasopharyngeal sampling for diagnosis are unreliable.
        PLoS One. 2010; 5: e12849
        • Estella A.
        Usefulness of CURB-65 and pneumonia severity index for influenza A H1N1v pneumonia.
        Monaldi Arch Chest Dis. 2012; 77: 118-121
        • Brandao-Neto R.A.
        • Goulart A.C.
        • Santana A.N.
        • Martins H.S.
        • Ribeiro S.C.
        • Ho L.Y.
        • et al.
        The role of pneumonia scores in the emergency room in patients infected by 2009 H1N1 infection.
        Eur J Emerg Med. 2012; 19: 200-202
        • Papadimitriou-Olivgeris M.
        • Psychogiou R.
        • Garessus J.
        • Camaret A.
        • Fourre N.
        • Kanagaratnam S.
        • et al.
        Predictors of mortality of bloodstream infections among internal medicine patients in a Swiss Hospital: Role of quick Sequential Organ Failure Assessment.
        Eur J Intern Med. 2019; 65: 86-92
        • Asai N.
        • Watanabe H.
        • Shiota A.
        • Kato H.
        • Sakanashi D.
        • Hagihara M.
        • et al.
        Efficacy and accuracy of qSOFA and SOFA scores as prognostic tools for community-acquired and healthcare-associated pneumonia.
        Int J Infect Dis. 2019; 84: 89-96
        • Singer M.
        • Deutschman C.S.
        • Seymour C.W.
        • Shankar-Hari M.
        • Annane D.
        • Bauer M.
        • et al.
        The third international consensus definitions for sepsis and septic shock (Sepsis-3).
        JAMA. 2016; 315: 801-810
        • Chang S.H.
        • Yeh C.C.
        • Chen Y.A.
        • Hsu C.C.
        • Chen J.H.
        • Chen W.L.
        • et al.
        Quick-SOFA score to predict mortality among geriatric patients with influenza in the emergency department.
        Medicine (Baltimore). 2019; 98: e15966
        • Kondrup J.
        • Rasmussen H.H.
        • Hamberg O.
        • Stanga Z.
        • Ad Hoc ESPEN Working Group
        Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.
        Clin Nutr. 2003; 22: 321-336
        • Karolyi M.
        • Pawelka E.
        • Daller S.
        • Kaczmarek C.
        • Laferl H.
        • Niculescu I.
        • et al.
        Is there a clinical difference between influenza A and B virus infections in hospitalized patients?: Results after routine polymerase chain reaction point-of-care testing in the emergency room from 2017/2018.
        Wien Klin Wochenschr. 2019; 131: 362-368
        • Wang Y.
        • Fan G.
        • Horby P.
        • Hayden F.
        • Li Q.
        • Wu Q.
        • et al.
        Comparative outcomes of adults hospitalized with seasonal influenza A or B Virus infection: application of the 7-Category Ordinal Scale.
        Open Forum Infect Dis. 2019; 6 (ofz053)
        • Lee N.
        • Choi K.W.
        • Chan P.K.
        • Hui D.S.
        • Lui G.C.
        • Wong B.C.
        • et al.
        Outcomes of adults hospitalised with severe influenza.
        Thorax. 2010; 65: 510-515
        • Korem M.
        • Orenbuch-Harroch E.
        • Ben-Chetrit E.
        • Israel S.
        • Cohen M.J.
        • Sviri S.
        • et al.
        Intensive care admissions and associated severity of influenza B versus A during influenza B-vaccine mismatched seasons.
        Clin Infect Dis. 2019; 69: 1049-1052
        • Kim Y.H.
        • Kim H.S.
        • Cho S.H.
        • Seo S.H
        Influenza B virus causes milder pathogenesis and weaker inflammatory responses in ferrets than influenza A virus.
        Viral Immunol. 2009; 22: 423-430
        • Schauwvlieghe A.F.A.D.
        • Rijnders B.J.A.
        • Philips N.
        • Verwijs R.
        • Vanderbeke L.
        • Van Tienen C.
        • et al.
        Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study.
        Lancet Respir Med. 2018; 6: 782-792
        • Wie S.H.
        • So B.H.
        • Song J.Y.
        • Cheong H.J.
        • Seo Y.B.
        • Choi S.H.
        • et al.
        A comparison of the clinical and epidemiological characteristics of adult patients with laboratory-confirmed influenza A or B during the 2011-2012 influenza season in Korea: a multi-center study.
        PLoS One. 2013; 8: e62685
        • Cohen A.L.
        • McMorrow M.
        • Walaza S.
        • Cohen C.
        • Tempia S.
        • Alexander-Scott M.
        • et al.
        Potential impact of co-infections and co-morbidities prevalent in Africa on influenza severity and frequency: a systematic review.
        PLoS One. 2015; 10e0128580
        • Bourke C.D.
        • Berkley J.A.
        • Prendergast A.J
        Immune dysfunction as a cause and consequence of malnutrition.
        Trends Immunol. 2016; 37: 386-398
        • Phung D.T.
        • Wang Z.
        • Rutherford S.
        • Huang C.
        • Chu C
        Body mass index and risk of pneumonia: a systematic review and meta-analysis.
        Obes Rev. 2013; 14: 839-857
        • Ergonul O.
        • Alan S.
        • Ak O.
        • Sargın F.
        • Kantürk A.
        • Gündüz A.
        • et al.
        Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults.
        BMC Infect Dis. 2014; 14: 317