Eric J Chow1,2, Melissa A Rolfes2, Alissa O'Halloran2, Nisha B Alden3, Evan J Anderson4,5,6, Nancy M Bennett7, Laurie Billing8, Elizabeth Dufort9, Pam D Kirley10, Andrea George11, Lourdes Irizarry12, Sue Kim13, Ruth Lynfield14, Patricia Ryan15, William Schaffner16, H Keipp Talbot16, Ann Thomas17, Kimberly Yousey-Hindes18, Carrie Reed2, Shikha Garg2. 1. Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia. 2. Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. 3. Communicable Disease Branch, Colorado Department of Public Health and Environment, Denver. 4. Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 5. Emerging Infections Program, Atlanta, Georgia. 6. Veterans Affairs Medical Center, Atlanta, Georgia. 7. Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. 8. Bureau of Infectious Diseases, Ohio Department of Health, Columbus. 9. New York State Department of Health, Albany. 10. California Emerging Infections Program, Oakland. 11. Salt Lake County Health Department, Salt Lake City, Utah. 12. New Mexico Department of Health, Albuquerque. 13. Communicable Disease Division, Michigan Department of Health and Human Services, Lansing. 14. Minnesota Department of Health, St Paul. 15. Maryland Department of Health, Baltimore. 16. Division of Infectious Disease, Vanderbilt University School of Medicine, Nashville, Tennessee. 17. Oregon Public Health Division, Portland. 18. Connecticut Emerging Infections Program, Yale School of Public Health, New Haven.
Abstract
Importance: Seasonal influenza virus infection is a major cause of morbidity and mortality and may be associated with respiratory and nonrespiratory diagnoses. Objective: To examine the respiratory and nonrespiratory diagnoses reported for adults hospitalized with laboratory-confirmed influenza between 2010 and 2018 in the United States. Design, Setting, and Participants: This cross-sectional study used data from the US Influenza Hospitalization Surveillance Network (FluSurv-NET) from October 1 through April 30 of the 2010-2011 through 2017-2018 influenza seasons. FluSurv-NET is a population-based, multicenter surveillance network with a catchment area that represents approximately 9% of the US population. Patients are identified by practitioner-ordered influenza testing. Adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza were included in the study. Exposures: FluSurv-NET defines laboratory-confirmed influenza as a positive influenza test result by rapid antigen assay, reverse transcription-polymerase chain reaction, direct or indirect fluorescent staining, or viral culture. Main Outcomes and Measures: Acute respiratory or nonrespiratory diagnoses were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) discharge diagnosis codes. The analysis included calculation of the frequency of acute respiratory and nonrespiratory diagnoses with a descriptive analysis of patient demographic characteristics, underlying medical conditions, and in-hospital outcomes by respiratory and nonrespiratory diagnoses. Results: Of 89 999 adult patients hospitalized with laboratory-confirmed influenza, 76 649 (median age, 69 years; interquartile range, 55-82 years; 55% female) had full medical record abstraction and at least 1 ICD code for an acute diagnosis. In this study, 94.9% of patients had a respiratory diagnosis and 46.5% had a nonrespiratory diagnosis, including 5.1% with only nonrespiratory diagnoses. Pneumonia (36.3%), sepsis (23.3%), and acute kidney injury (20.2%) were the most common acute diagnoses. Fewer patients with only nonrespiratory diagnoses received antiviral therapy for influenza compared with those with respiratory diagnoses (81.4% vs 88.9%; P < .001). Conclusions and Relevance: Nonrespiratory diagnoses occurred frequently among adults hospitalized with influenza, further contributing to the burden of infection in the United States. The findings suggest that during the influenza season, practitioners should consider influenza in their differential diagnosis for patients who present to the hospital with less frequently recognized manifestations and initiate early antiviral treatment for patients with suspected or confirmed infection.
Importance: Seasonal influenza virus infection is a major cause of morbidity and mortality and may be associated with respiratory and nonrespiratory diagnoses. Objective: To examine the respiratory and nonrespiratory diagnoses reported for adults hospitalized with laboratory-confirmed influenza between 2010 and 2018 in the United States. Design, Setting, and Participants: This cross-sectional study used data from the US Influenza Hospitalization Surveillance Network (FluSurv-NET) from October 1 through April 30 of the 2010-2011 through 2017-2018 influenza seasons. FluSurv-NET is a population-based, multicenter surveillance network with a catchment area that represents approximately 9% of the US population. Patients are identified by practitioner-ordered influenza testing. Adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza were included in the study. Exposures: FluSurv-NET defines laboratory-confirmed influenza as a positive influenza test result by rapid antigen assay, reverse transcription-polymerase chain reaction, direct or indirect fluorescent staining, or viral culture. Main Outcomes and Measures: Acute respiratory or nonrespiratory diagnoses were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) discharge diagnosis codes. The analysis included calculation of the frequency of acute respiratory and nonrespiratory diagnoses with a descriptive analysis of patient demographic characteristics, underlying medical conditions, and in-hospital outcomes by respiratory and nonrespiratory diagnoses. Results: Of 89 999 adult patients hospitalized with laboratory-confirmed influenza, 76 649 (median age, 69 years; interquartile range, 55-82 years; 55% female) had full medical record abstraction and at least 1 ICD code for an acute diagnosis. In this study, 94.9% of patients had a respiratory diagnosis and 46.5% had a nonrespiratory diagnosis, including 5.1% with only nonrespiratory diagnoses. Pneumonia (36.3%), sepsis (23.3%), and acute kidney injury (20.2%) were the most common acute diagnoses. Fewer patients with only nonrespiratory diagnoses received antiviral therapy for influenza compared with those with respiratory diagnoses (81.4% vs 88.9%; P < .001). Conclusions and Relevance: Nonrespiratory diagnoses occurred frequently among adults hospitalized with influenza, further contributing to the burden of infection in the United States. The findings suggest that during the influenza season, practitioners should consider influenza in their differential diagnosis for patients who present to the hospital with less frequently recognized manifestations and initiate early antiviral treatment for patients with suspected or confirmed infection.
Authors: Catherine H Bozio; Kristen Butterfield; Stephanie A Irving; Gabriela Vazquez-Benitez; Toan C Ong; Kai Zheng; Sarah W Ball; Allison L Naleway; Michelle Barron; Carrie Reed Journal: Open Forum Infect Dis Date: 2022-10-05 Impact factor: 4.423
Authors: Daniel Owusu; Melissa A Rolfes; Carmen S Arriola; Pam Daily Kirley; Nisha B Alden; James Meek; Evan J Anderson; Maya L Monroe; Sue Kim; Ruth Lynfield; Kathy Angeles; Nancy Spina; Christina B Felsen; Laurie Billing; Ann Thomas; H Keipp Talbot; William Schaffner; Ryan Chatelain; Carrie Reed; Shikha Garg Journal: Open Forum Infect Dis Date: 2022-03-16 Impact factor: 4.423
Authors: Eric J Chow; Melissa A Rolfes; Alissa O'Halloran; Evan J Anderson; Nancy M Bennett; Laurie Billing; Shua Chai; Elizabeth Dufort; Rachel Herlihy; Sue Kim; Ruth Lynfield; Chelsea McMullen; Maya L Monroe; William Schaffner; Melanie Spencer; H Keipp Talbot; Ann Thomas; Kimberly Yousey-Hindes; Carrie Reed; Shikha Garg Journal: Ann Intern Med Date: 2020-08-25 Impact factor: 25.391
Authors: Joann G Elmore; Pin-Chieh Wang; Kathleen F Kerr; David L Schriger; Douglas E Morrison; Ron Brookmeyer; Michael A Pfeffer; Thomas H Payne; Judith S Currier Journal: J Med Internet Res Date: 2020-09-10 Impact factor: 5.428