Outcomes of Immunocompromised Adults Hospitalized With Laboratory-confirmed Influenza in the United States, 2011-2015

• Published in: Clinical infectious diseases Vol. 70; no. 10; pp. 2121 - 2130
• Main Authors: Collins, Jennifer P, Campbell, Angela P, Openo, Kyle, Farley, Monica M, Cummings, Charisse Nitura, Hill, Mary, Schaffner, William, Lindegren, Mary Lou, Thomas, Ann, Billing, Laurie, Bennett, Nancy, Spina, Nancy, Bargsten, Marisa, Lynfield, Ruth, Eckel, Seth, Ryan, Patricia, Yousey-Hindes, Kimberly, Herlihy, Rachel, Kirley, Pam Daily, Garg, Shikha, Anderson, Evan J
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 06.05.2020
• Subjects: Adult; and Commentaries; Hospitalization; Humans; Immunocompromised Host; Influenza, Human - epidemiology; Laboratories; United States - epidemiology; Vaccination; United States; influenza; immunosuppression; immunosuppressive; cancer; HIV
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciz638

Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-IC adults. We identified adults hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had human immunodefiency virus (HIV)/AIDS, cancer, stem cell or organ transplantation, nonsteroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, and/or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics. Multivariable logistic regression and Cox proportional hazards models controlled for confounding by patient demographic characteristics, pre-existing medical conditions, influenza vaccination, and other factors. Among 35 348 adults, 3633 (10%) were IC; cancer (44%), nonsteroid immunosuppressive therapy (44%), and HIV (18%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs 46%; P < .001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.20-1.76). Intensive care was more likely among IC patients 65-79 years (aOR, 1.25; 95% CI, 1.06-1.48) and those >80 years (aOR, 1.35; 95% CI, 1.06-1.73) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge, 0.86; 95% CI, .83-.88) and more likely to require mechanical ventilation (aOR, 1.19; 95% CI, 1.05-1.36). Substantial morbidity and mortality occurred among IC adults hospitalized with influenza. Influenza vaccination and antiviral administration could be increased in both IC and non-IC adults.