Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit

Autores de IIS La Fe

• Mónica Gordón Sahuquillo

  Autor

Participantes ajenos a IIS La Fe

• Garnacho-Montero, J
• Leon-Moya, C
• Gutierrez-Pizarraya, A
• Arenzana-Seisdedos, A
• Vidaur, L
• Guerrero, JE
• Martin-Loeches, I
• Rodriguez, A
• GETGAG Study Grp

Grupos

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

• Medicina Intensiva

  Leader

  Álvaro Castellanos Ortega

Abstract

Purpose: Information about immunocompromised patients infected with influenza A (H1N1) virus and requiring admission to the ICU is lacking. Our objective was to know the clinical characteristics of these patients and to identify treatment-related variables associated with mortality. Material and methods: A prospective multicenter observational cohort study was based on data from a Spanish registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU with the diagnosis of influenza A (H1N1) virus infection were included. Immunosuppression was clearly defined. Factors associated with mortality in immunocompromised patients were assessed by conventional logistic regression analysis and by a propensity score (PS) adjusted-multivariable analysis. Results: Of 1899 patients with influenza A (H1N1 ) infection, 238 (12.5%) were classified as immunocompromised. Mortality was significantly higher in immunosuppressed patients. Four variables independently associated with mortality were identified: SOFA score, need of vasopressor, use of corticosteroids, and acute renal failure, AKIN 3 stage. In the PS-adjusted model, corticosteroid therapy remained as an independent factor associated with increased mortality (OR 2.25;95%CI, 1.15-438;p = 0.017). In the subgroup of hematological patients (n = 141), corticosteroid therapy was also associated with increased mortality (OR 3.12: 95%CI, 1.32-7.41; p = 0.010). Conclusion: Immunocompromised individuals with influenza A ( H1N1) admitted to the ICU have a poor outcome. In this population, the use of corticosteroids is strongly discouraged. (C) 2018 Elsevier Inc. All rights reserved.

Keywords

• CRITICALLY-ILL PATIENTS; INFECTIOUS-DISEASES; CORTICOSTEROIDS; MALIGNANCIES; OUTCOMES; FAILURE; SOCIETY; ADULTS