José Garnacho-Montero1, Cristina León-Moya2, Antonio Gutiérrez-Pizarraya3, Angel Arenzana-Seisdedos3, Loreto Vidaur4, José Eugenio Guerrero5, Mónica Gordón6, Ignacio Martín-Loeches7, Alejandro Rodriguez8. 1. Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Instituto de Biomedicina. Sevilla (IBIS), Seville, Spain. Electronic address: jgarnachom@gmail.com. 2. Critical Care and Emergency Unit. H. San Juan de Dios del Aljarafe, Bormujos, Seville, Spain. 3. Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain. 4. Intensive Care Unit, Hospital Donostia, San Sebastian, Spain. 5. Intensive Care Unit, Hospital Gregorio Marañón, Madrid, Spain. 6. Intensive Care Unit, Hospital La Fe. Valencia, Spain. 7. Department of Anesthesia and Critical Care, St James ́s University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland. 8. Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
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, 1.15-4.38;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.
PURPOSE: Information about immunocompromised patientsinfected 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, 1.15-4.38;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.
Authors: Talita Rantin Belucci; Alexandre R Marra; Michael B Edmond; João Renato Rebello Pinho; Paula Kiyomi Onaga Yokota; Ana Carolina Cintra Nunes Mafra; Oscar Fernando Pavão Dos Santos Journal: BMC Infect Dis Date: 2018-11-16 Impact factor: 3.090
Authors: Elie Azoulay; Lene Russell; Andry Van de Louw; Victoria Metaxa; Philippe Bauer; Pedro Povoa; José Garnacho Montero; Ignacio Martin Loeches; Sangeeta Mehta; Kathryn Puxty; Peter Schellongowski; Jordi Rello; Djamel Mokart; Virginie Lemiale; Adrien Mirouse Journal: Intensive Care Med Date: 2020-02-07 Impact factor: 17.440
Authors: Kailey Hughes; Donald B Middleton; Mary Patricia Nowalk; Goundappa K Balasubramani; Emily T Martin; Manjusha Gaglani; H Keipp Talbot; Manish M Patel; Jill M Ferdinands; Richard K Zimmerman; Fernanda P Silveira Journal: Clin Infect Dis Date: 2021-12-06 Impact factor: 9.079