Shufa Zheng1,2,3, Qianda Zou2,3, Xiaochen Wang2,3, Jiaqi Bao2,3, Fei Yu2,3, Feifei Guo4, Peng Liu5, Yinzhong Shen6, Yimin Wang7, Shigui Yang1, Wei Wu1, Jifang Sheng1, Dhanasekaran Vijaykrishna8,9, Hainv Gao1,4, Yu Chen1,2,3. 1. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. 2. Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Zhejiang University, Hangzhou, People's Republic of China. 3. Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. 4. Department of Infectious Diseases, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, People's Republic of China. 5. Department of Infectious Diseases, Second Hospital of Ningbo, Ningbo, People's Republic of China. 6. Department of Infectious and Immune Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China. 7. Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, People's Republic of China. 8. Department of Microbiology, Biomedicine Discovery Institute, Monash University, Victoria, Australia. 9. World Health Organization Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: The high case fatality rate of influenza A(H7N9)-infected patients has been a major clinical concern. METHODS: To identify the common causes of death due to H7N9 as well as identify risk factors associated with the high inpatient mortality, we retrospectively collected clinical treatment information from 350 hospitalized human cases of H7N9 virus in mainland China during 2013-2017, of which 109 (31.1%) had died, and systematically analyzed the patients' clinical characteristics and risk factors for death. RESULTS: The median age at time of infection was 57 years, whereas the median age at time of death was 61 years, significantly older than those who survived. In contrast to previous studies, we found nosocomial infections comprising Acinetobacter baumannii and Klebsiella most commonly associated with secondary bacterial infections, which was likely due to the high utilization of supportive therapies, including mechanical ventilation (52.6%), extracorporeal membrane oxygenation (14%), continuous renal replacement therapy (19.1%), and artificial liver therapy (9.7%). Age, time from illness onset to antiviral therapy initiation, and secondary bacterial infection were independent risk factors for death. Age >65 years, secondary bacterial infections, and initiation of neuraminidase-inhibitor therapy after 5 days from symptom onset were associated with increased risk of death. CONCLUSIONS: Death among H7N9 virus-infected patients occurred rapidly after hospital admission, especially among older patients, followed by severe hypoxemia and multisystem organ failure. Our results show that early neuraminidase-inhibitor therapy and reduction of secondary bacterial infections can help reduce mortality.Characterization of 350 hospitalized avian influenza A(H7N9)-infected patients in China shows that age >65 years, secondary bacterial infections, and initiation of neuraminidase-inhibitor therapy after 5 days from symptom onset were associated with increased risk of death.
BACKGROUND: The high case fatality rate of influenza A(H7N9)-infected patients has been a major clinical concern. METHODS: To identify the common causes of death due to H7N9 as well as identify risk factors associated with the high inpatient mortality, we retrospectively collected clinical treatment information from 350 hospitalized human cases of H7N9 virus in mainland China during 2013-2017, of which 109 (31.1%) had died, and systematically analyzed the patients' clinical characteristics and risk factors for death. RESULTS: The median age at time of infection was 57 years, whereas the median age at time of death was 61 years, significantly older than those who survived. In contrast to previous studies, we found nosocomial infections comprising Acinetobacter baumannii and Klebsiella most commonly associated with secondary bacterial infections, which was likely due to the high utilization of supportive therapies, including mechanical ventilation (52.6%), extracorporeal membrane oxygenation (14%), continuous renal replacement therapy (19.1%), and artificial liver therapy (9.7%). Age, time from illness onset to antiviral therapy initiation, and secondary bacterial infection were independent risk factors for death. Age >65 years, secondary bacterial infections, and initiation of neuraminidase-inhibitor therapy after 5 days from symptom onset were associated with increased risk of death. CONCLUSIONS:Death among H7N9 virus-infected patients occurred rapidly after hospital admission, especially among older patients, followed by severe hypoxemia and multisystem organ failure. Our results show that early neuraminidase-inhibitor therapy and reduction of secondary bacterial infections can help reduce mortality.Characterization of 350 hospitalized avian influenza A(H7N9)-infected patients in China shows that age >65 years, secondary bacterial infections, and initiation of neuraminidase-inhibitor therapy after 5 days from symptom onset were associated with increased risk of death.
Authors: Ignacio Martin-Loeches; Marcus J Schultz; Jean-Louis Vincent; Francisco Alvarez-Lerma; Lieuwe D Bos; Jordi Solé-Violán; Antoni Torres; Alejandro Rodriguez Journal: Intensive Care Med Date: 2016-10-05 Impact factor: 17.440
Authors: Chen Wang; Hongjie Yu; Peter W Horby; Bin Cao; Peng Wu; Shigui Yang; Hainv Gao; Hui Li; Tim K Tsang; Qiaohong Liao; Zhancheng Gao; Dennis K M Ip; Hongyu Jia; Hui Jiang; Bo Liu; Michael Y Ni; Xiahong Dai; Fengfeng Liu; Nguyen Van Kinh; Nguyen Thanh Liem; Tran Tinh Hien; Yu Li; Juan Yang; Joseph T Wu; Yaming Zheng; Gabriel M Leung; Jeremy J Farrar; Benjamin J Cowling; Timothy M Uyeki; Lanjuan Li Journal: Clin Infect Dis Date: 2014-01-31 Impact factor: 9.079
Authors: I Martin-Loeches; T Lisboa; A Rhodes; R P Moreno; E Silva; C Sprung; J D Chiche; D Barahona; M Villabon; C Balasini; R M Pearse; R Matos; J Rello Journal: Intensive Care Med Date: 2010-11-24 Impact factor: 17.440
Authors: Shengjie Lai; Ying Qin; Benjamin J Cowling; Xiang Ren; Nicola A Wardrop; Marius Gilbert; Tim K Tsang; Peng Wu; Luzhao Feng; Hui Jiang; Zhibin Peng; Jiandong Zheng; Qiaohong Liao; Sa Li; Peter W Horby; Jeremy J Farrar; George F Gao; Andrew J Tatem; Hongjie Yu Journal: Lancet Infect Dis Date: 2016-05-17 Impact factor: 25.071