Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/45938
Title: Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome
Authors: Álvarez-Lerma, Francisco
Marín-Corral, Judith
Vila, Clara
Masclans, Joan Ramón
González de Molina, Francisco Javier
Martín Loeches, Ignacio
Barbadillo, Sandra
Rodríguez, Alejandro
Cobo, Pedro
Martins, Javier
Carbayo, Cecilia
Robles-Musso, Emilio
Cárdenas, Antonio
Fierro, Javier
Fernández, Dolores Ocaña
Sierra, Rafael
Huertos, Ma Jesús
Pérez, Ma Luz Carmona
Laderas, Juan Carlos Pozo
Guerrero, R.
Robles, Juan Carlos
León, Melissa Echevarría
Gómez, Alberto Bermejo
Márquez, Enrique
Rodríguez-Carvajal, Manuel
Estella, Ángel
Pomares, José
Ballesteros, José Luis
Romero, Olga Moreno
Fernández, Yolanda
Lobato, Francisco
Prieto, José F.
Albofedo-Sánchez, José
Martínez, Pilar
de la Torre, María Victoria
Nieto, María
Sola, Estefanía Cámara
Castellanos, Miguel ángel Díaz
Soler, Guillermo Sevilla
Leyba, Carlos Ortiz
Garnacho-Montero, José
Hinojosa, Rafael
Fernández, Esteban
Loza, Ana
León, Cristóbal
López, Samuel González
Arenzana, Ángel
Ocaña, Dolores
Navarrete, Inés
Beryanaki, Medhi Zaheri
Sánchez, Ignacio
Alé, Manuel Pérez
Brea, Ana Ma Poullet
Casas, Juan Francisco Machado
Serón, Carlos
Avellanas, Manuel Luis
Lander, Arantxa
de Arellano, S. Garrido Ramírez
Marquina Lacueva, M. I.
Luque, Pilar
Serrano, Elena Plumed
Lázaro, Juan Francisco Martín
Polo, Carlos Sánchez
Cía, Isabel Gutiérrez
Bartolomé, Belén Jiménez
Núñez, Carlos López
González, Ignacio
Marsilla, José Ignacio Tomás
Andrés, Clara Jaques
Ibañes, Pablo Gutiérrez
Aguilar, Pilar Araujo
Montón, Jose Ma
Regil, Paloma Dorado
Iglesias, Lisardo
González, Carmen Pascual
Fernández, Brígida Quindós
Iglesias, Lorena Martín
Soria, Lucía Viña
Escudero, Raquel Yano
Revuelta, Ma del Rosario Martínez
Ruiz, José Ma Quiroga
García-Rodríguez, Águeda
Cuadrado, Marta Martín
Mariño, Ana Luz Balán
Socias, Lorenzo
Ibáñez, Pedro
Borges-Sa, Marcío
Socias, A.
Del Castillo, A.
Marcos, Ricard Jordà
Muñoz, Cristina
Goytisolo, José M.Bonell
UNESCO Clasification: 32 Ciencias médicas
320505 Enfermedades infecciosas
Keywords: Influenza A
H1N1
Virus infection
Critically ill patients
Issue Date: 2016
Journal: Critical Care 
Abstract: Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.
URI: http://hdl.handle.net/10553/45938
ISSN: 1364-8535
DOI: 10.1186/s13054-016-1512-1
Source: Critical Care [ISSN 1364-8535],v. 20 (337)
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