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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) |
Appears in Collections: | Artículos |
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