Hostname: page-component-669899f699-b58lm Total loading time: 0 Render date: 2025-04-25T05:35:19.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Severe Influenza in 33 US Hospitals, 2013–2014: Complications and Risk Factors for Death in 507 Patients

Published online by Cambridge University Press:  30 July 2015

Nirav S. Shah ,
Jared A. Greenberg ,
Moira C. McNulty ,
Kevin S. Gregg ,
James Riddell IV ,
Julie E. Mangino ,
Devin M. Weber ,
Courtney L. Hebert ,
Natalie S. Marzec  and
Michelle A. Barron
...Show all authors
Nirav S. Shah*
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Jared A. Greenberg
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Moira C. McNulty
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Kevin S. Gregg
Affiliation:
Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan
James Riddell IV
Affiliation:
Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Julie E. Mangino
Affiliation:
Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
Devin M. Weber
Affiliation:
Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
Courtney L. Hebert
Affiliation:
Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, Ohio
Natalie S. Marzec
Affiliation:
Department of Medicine, University of Colorado Denver, Denver, Colorado
Michelle A. Barron
Affiliation:
Department of Medicine, University of Colorado Denver, Denver, Colorado
Fredy Chaparro-Rojas
Affiliation:
Department of Medicine, Vidant Medical Center, Greenville, North Carolina
Alejandro Restrepo
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas
Vagish Hemmige
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas
Kunatum Prasidthrathsint
Affiliation:
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Sandra Cobb
Affiliation:
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Loreen Herwaldt
Affiliation:
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Vanessa Raabe
Affiliation:
Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
Christopher R. Cannavino
Affiliation:
Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
Andrea Green Hines
Affiliation:
Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Sara H. Bares
Affiliation:
Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Philip B. Antiporta
Affiliation:
Department of Medicine, Loyola University Medical Center, Maywood, Illinois Department of Medicine, Edward Hines Veterans Affairs (VA) Hospital, Maywood, Illinois
Tonya Scardina
Affiliation:
Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois
Ursula Patel
Affiliation:
Department of Pharmacy, Edward Hines VA Hospital, Maywood, Illinois
Gail Reid
Affiliation:
Department of Medicine, Loyola University Medical Center, Maywood, Illinois Department of Medicine, Edward Hines Veterans Affairs (VA) Hospital, Maywood, Illinois
Parvin Mohazabnia
Affiliation:
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Suresh Kachhdiya
Affiliation:
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Binh-Minh Le
Affiliation:
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Connie J. Park
Affiliation:
Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Belinda Ostrowsky
Affiliation:
Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Ari Robicsek
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois Department of Medicine, Northshore University HealthSystem, Evanston, Illinois
Becky A. Smith
Affiliation:
Department of Medicine, Northshore University HealthSystem, Evanston, Illinois
Jeanmarie Schied
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
Micah M. Bhatti
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
Stockton Mayer
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
Monica Sikka
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
Ivette Murphy-Aguilu
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
Priti Patwari
Affiliation:
Department of Medicine, Community Care Networks, Munster, Indiana
Shira R. Abeles
Affiliation:
Department of Medicine, University of California San Diego, San Diego, California
Francesca J. Torriani
Affiliation:
Department of Medicine, University of California San Diego, San Diego, California
Zainab Abbas
Affiliation:
Department of Medicine, Methodist Hospitals, Merrillville, Indiana
Sophie Toya
Affiliation:
Department of Medicine, Methodist Hospitals, Merrillville, Indiana
Katherine Doktor
Affiliation:
Department of Medicine, University of Miami/Jackson Health System, Miami, Florida
Anindita Chakrabarti
Affiliation:
Department of Medicine, University of Miami/Jackson Health System, Miami, Florida
Susanne Doblecki-Lewis
Affiliation:
Department of Medicine, University of Miami/Jackson Health System, Miami, Florida
David J. Looney
Affiliation:
Department of Medicine, VA San Diego/University of California San Diego, San Diego, California
Michael Z. David
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois Department of Pediatrics, University of Chicago, Chicago, Illinois
*
Address correspondence to Nirav S. Shah, MD, MPH, Department of Medicine, University of Chicago, Chicago, IL 60637 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.

METHODS

A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.

RESULTS

A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).

CONCLUSION

Risk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.

Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1251 - 1260
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1. Centers for Disease Control and Prevention (CDC). Estimates of deaths associated with seasonal influenza–United States, 1976-2007. MMWR Morb Mortal Wkly Rep 2010;59:1057–1062.Google Scholar
2. Taubenberger, JK, Morens, DM. 1918 Influenza: the mother of all pandemics. Emerging Infect Dis 2006;12:15–22.Google Scholar
3. Jordan, EO. Epidemic Influenza. Chicago: American Medical Association; 1927.Google Scholar
4. Centers for Disease Control and Prevention (CDC). Outbreak of swine-origin influenza A (H1N1) virus infection–Mexico, March-April 2009. MMWR Morb Mortal Wkly Rep 2009;8(58):467–470.Google Scholar
5. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood, FS, Jain, S, Finelli, L, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360:2605–2615.Google Scholar
6. Jain, S, Kamimoto, L, Bramley, AM, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009;361:1935–1944.Google Scholar
7. Nguyen, AM, Noymer, A. Influenza mortality in the United States, 2009 pandemic: burden, timing and age distribution. PLOS ONE 2013;8:e64198.CrossRefGoogle ScholarPubMed
8. Centers for Disease Control and Prevention (CDC). Update: influenza activity–United States, 2010-11 season, and composition of the 2011-12 influenza vaccine. MMWR Morb Mortal Wkly Rep 2011;60:705–712.Google Scholar
9. Centers for Disease Control and Prevention (CDC). Update: influenza activity–United States, 2011-12 season and composition of the 2012-13 influenza vaccine. MMWR Morb Mortal Wkly Rep 2012;61:414–420.Google Scholar
10. Centers for Disease Control and Prevention (CDC). Update: influenza activity–United States, September 30, 2012-February 9, 2013. MMWR Morb Mortal Wkly Rep 2013;62:124–130.Google Scholar
11. Arriola, CS, Brammer, L, Epperson, S, et al. Update: influenza activity–United States, September 29, 2013-February 8, 2014. MMWR Morb Mortal Wkly Rep 2014;63:148–154.Google Scholar
12. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.Google Scholar
13. Centers for Disease Control and Prevention (CDC). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices–United States, 2013-2014. MMWR Recomm Rep 2013;62:1–43.Google Scholar
14. Ferreira, FL, Bota, DP, Bross, A, Mélot, C, Vincent, JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754–1758.Google Scholar
15. Louie, JK, Acosta, M, Samuel, MC, et al. A novel risk factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1). Clin Infect Dis 2011;52:301–312.Google Scholar
16. Louie, JK, Acosta, M, Jamieson, DJ, Honein, MA, California Pandemic (H1N1) Working Group. Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med 2010;362:27–35.Google Scholar
17. Siston, AM, Rasmussen, SA, Honein, MA, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA 2010;303:1517–1525.Google Scholar
18. Santa-Olalla Peralta, P, Cortes García, M, Limia Sánchez, A, et al. Critically ill patients with 2009 pandemic influenza A (H1N1) infection in Spain: factors associated with death, April 2009-January 2010 [in Spanish]. Rev Esp Salud Publica 2010;84:547–567.Google Scholar
19. Borja-Aburto, VH, Chowell, G, Viboud, C, et al. Epidemiological characterization of a fourth wave of pandemic A/H1N1 influenza in Mexico, winter 2011-2012: age shift and severity. Arch Med Res 2012;43:563–570.Google Scholar
20. Dávila, J, Chowell, G, Borja-Aburto, VH, Viboud, C, Grajales Muñiz, C, Miller, M. Substantial morbidity and mortality associated with pandemic A/H1N1 influenza in Mexico, winter 2013-2014: gradual age shift and severity. PLOS Curr 2014:6.Google Scholar
21. Lehners, N, Geis, S, Eisenbach, C, Neben, K, Schnitzler, P. Changes in severity of influenza A(H1N1) pdm09 infection from pandemic to first postpandemic season, Germany. Emerging Infect Dis 2013;19:748–755.Google Scholar
22. Martin-Loeches, I, Díaz, E, Vidaur, L, et al. Pandemic and post-pandemic influenza A (H1N1) infection in critically ill patients. Crit Care 2011;15:R286.Google Scholar
23. Lynfield, R, Davey, R, Dwyer, DE, et al. Outcomes of influenza A(H1N1) pdm09 virus infection: results from two international cohort studies. PLOS ONE 2014;9:e101785.Google Scholar
24. Kumar, A, Zarychanski, R, Pinto, R, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 2009; 302:1872–1879.Google Scholar
25. Epperson, S, Blanton, L, Kniss, K, et al. Influenza activity–United States, 2013-14 season and composition of the 2014-15 influenza vaccines. MMWR Morb Mortal Wkly Rep 2014;63:483–490.Google ScholarPubMed
26. Ayscue, P, Murray, E, Uyeki, T, et al. Influenza-associated intensive-care unit admissions and deaths–California, September 29, 2013-January 18, 2014. MMWR Morb Mortal Wkly Rep 2014;63:143–147.Google Scholar
27. Louie, JK, Yang, S, Acosta, M, et al. Treatment with neuraminidase inhibitors for critically ill patients with influenza A (H1N1) pdm09. Clin Infect Dis 2012;55:1198–1204.Google Scholar
28. Miller, RR, Markewitz, BA, Rolfs, RT, et al. Clinical findings and demographic factors associated with ICU admission in Utah due to novel 2009 influenza A(H1N1) infection. Chest 2010;137:752–758.Google Scholar
29. Quandelacy, TM, Viboud, C, Charu, V, Lipsitch, M, Goldstein, E. Age- and sex-related risk factors for influenza-associated mortality in the United States between 1997-2007. Am J Epidemiol 2014;179:156–167.CrossRefGoogle ScholarPubMed
30. Klein, SL, Passaretti, C, Anker, M, Olukoya, P, Pekosz, A. The impact of sex, gender and pregnancy on 2009 H1N1 disease. Biol Sex Differ 2010;1:5.CrossRefGoogle ScholarPubMed
31. Ogden, CL, Carroll, MD, Kit, BK, Flegal, KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806–814.Google Scholar
32. Lu, P, Santibanez, TA, Williams, WW, et al. Surveillance of influenza vaccination coverage–United States, 2007-08 through 2011-12 influenza seasons. MMWR Surveill Summ 2013;62:1–28.Google ScholarPubMed
33. Ding, H, Black, CL, Ball, S, et al. Influenza vaccination coverage among pregnant women–United States, 2013-14 influenza season. MMWR Morb Mortal Wkly Rep 2014;63:816–821.Google Scholar
34. Chien, Y-W, Klugman, KP, Morens, DM. Bacterial pathogens and death during the 1918 influenza pandemic. N Engl J Med 2009;361:2582–2583.Google Scholar
35. Morens, DM, Taubenberger, JK, Fauci, AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis 2008;198:962–970.CrossRefGoogle ScholarPubMed
36. Blyth, CC, Webb, SAR, Kok, J, et al. The impact of bacterial and viral co-infection in severe influenza. Influenza Other Respir Viruses 2013;7:168–176.Google Scholar
37. Bramley, AM, Dasgupta, S, Skarbinski, J, et al. Intensive care unit patients with 2009 pandemic influenza A (H1N1 pdm09) virus infection–United States, 2009. Influenza Other Respir Viruses 2012;6:e134–e142.CrossRefGoogle ScholarPubMed