Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia
Abstract:BACKGROUND: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza.
OBJECTIVE: To evaluate the role of CAP severity scores as predictors of mortality.
METHODS: This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality.
RESULTS: Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0–1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality.
CONCLUSIONS: The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.
Document Type: Regular Paper
Affiliations: 1: Puerto Montt Hospital, Puerto Montt, Chile 2: Hospital Clinico Regional, Valdivia, Chile 3: Hospital Universitario Austral, Pilar, Argentina 4: Centro de Infectologia, Buenos Aires, Argentina 5: Royal Infirmary of Edinburgh, Edinburgh, Scotland 6: Division of Infectious Diseases, University of Louisville, Louisville, Kentucky, USA 7: Clinical San Roque y Centro Medico La Costa, Asuncion, Paraguay 8: Instituto de Investigaciones Medicas A Lanari, Buenos Aires, Argentina 9: Orlando Regional Medical Center, Orlando, Florida, USA 10: Sanatorio 9 de Julio, Tucuman, Argentina 11: Hospital Zenon Santillan, Tucuman, Argentina 12: Sanatorio Otamendi Miroli, Buenos Aires, Argentina 13: Instituto de Neumonologia y Cirugia Toracica, Barcelona, Spain 14: Hospital Maciel, Montevideo, Uruguay 15: Instituto Nacional del Torax, Santiago, Chile 16: Hospital van Buren, Escuela de Medicina, Universidad de Valparaíso, Chile 17: Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain 18: Providence Hospital, Washington, DC, USA 19: Johannesburg Hospital, Johannesburg, South Africa 20: Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico, Milan, Italy 21: Institute of Respiratory Diseases, University of Milan, Milan, Italy 22: Emergency Medicine Department, Ospedale Maggiore,Milan, Italy 23: Hospital Prof. Dr. Bernardo Houssay, Vicente López, Argentina 24: Emprendimientos Médico Hospitalarios S A, Mar del Plata, Argentina 25: Medizinische Hochschule Hannover, Hannover, Germany 26: Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, Kentucky, USA 27: Pulmonary and Critical Care Section, Veterans Affairs Medical Center, Louisville, Kentucky, USA
Publication date: 2011-04-01
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