Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

• Published in: BMC infectious diseases Vol. 14; no. 1; p. 317
• Main Authors: Ergönül, Önder, Alan, Servet, Ak, Öznur, Sargın, Fatman, Kantürk, Arzu, Gündüz, Alper, Engin, Derya, Öncül, Oral, Balkan, Ilker Inanc, Ceylan, Bahadir, Benzonana, Nur, Yazıcı, Saadet, Şimşek, Funda, Uzun, Nuray, Inan, Asuman, Gulhan, Eren, Ciblak, Meral, Midilli, Kenan, Ozyurt, Mustafa, Badur, Selim, Gencer, Serap, Nazlıcan, Ozcan, Özer, Serdar, Özgüneş, Nail, Yıldırmak, Taner, Aslan, Turan, Göktaş, Pasa, Saltoğlu, Nese, Fincancı, Muzaffer, Dokucu, Ali Ihsan, Eraksoy, Haluk
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.06.2014; BioMed Central
• Subjects: Adult; Analysis; Antiviral Agents - therapeutic use; Care and treatment; Cross Infection - epidemiology; Cross Infection - mortality; Disease Outbreaks; Female; Hospital patients; Hospitalization; Hospitals; Humans; Immunization; Influenza; Influenza A Virus, H1N1 Subtype - pathogenicity; Influenza, Human - drug therapy; Influenza, Human - epidemiology; Influenza, Human - mortality; Influenza, Human - virology; Male; Middle Aged; Multivariate Analysis; Neuraminidase - antagonists & inhibitors; Odds Ratio; Oseltamivir - therapeutic use; Pandemics; Patient outcomes; Pregnancy; Turkey - epidemiology; Womens health; Zanamivir - therapeutic use; Turkey; Istanbul Turkey
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-14-317

The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p=0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p=0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p=0.133) significantly increased the likelihood of fatality. Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.