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Title: Severe pandemic (H1N1)v influenza A infection: Report on the first deaths in Spain
Authors: Martin-Loeches, Ignacio
Rodriguez, Alejandro
Bonastre, Juan
Zaragoza, Rafael
Sierra, Rafael
Marques, Asunción
Juliá-Narvaez, Jose
Diaz, Emili
Rello, Jordi
Cobo, Pedro
Martins, Javier
Carbayo, Cecilia
Robles-Musso, Emilio
Cárdenas, Antonio
Fierro, Javier
Fernández, Ocaña
Huertos, Ma Jesús
Pozo, Juan Carlos
Guerrero, R.
Márquez, Enrique
Rodríguez-Carvajal, Manuel
Jareño, Antonio
Pomares, José
Ballesteros, José Luis
Fernández, Yolanda
Lobato, Francisco
Prieto, José F.
Albofedo-Sánchez, José
Martínez, Pilar
Castellanos, Miguel Angel Díaz
Sevilla, Guillermo
Garnacho-Montero, José
Hinojosa, Rafael
Fernández, Esteban
Loza, Ana
León, Cristóbal
Arenzana, Angel
Ocaña, Dolores
Avellanas, Manuel Luis
Lander, Arantxa
De Arellano, S. Garrido Ramírez
Lacueva, M. I.Marquina
Luque, Pilar
González, Ignacio
Montón, Ma Jose
Díaz, Ma Jose
López-Reina, Pilar
Sáez, Sergio
Iglesias, Lisardo
González, Carmen Pascual
García-Rodríguez, Águeda
Socias, Lorenzo
Ibánez, Pedro
Borges-Sa, Marcío
Socias, A.
Del Castillo, A.
Marcos, Ricard Jordà
Bonell, José M.
Amestarán, Ignacio
Martínez, Sergio
Cáceres, J. J.
Ruiz-Santana, Sergio 
Díaz, Juan José
Hernández, David
Trujillo, Ana
Regalado, Luis
Lorente, Leonardo
Martín, Mar
Suberviola, Borja
Ugarte, P.
García-López, Fernando
Alonso, Angel Álvaro
Pasilla, Antonio
Grande, Ma Luisa Gómez
Albaya, Antonio
Canabal, Alfonso
Marina, Luis
López Messa, Juan B.
Pueyo, Ma Jesús López
Ferreras, Zulema
Macias, Santiago
Berezo, José Ángel
Varela, Jesús Blanco
Andaluz Ojeda, A.
Terrero, Antonio Álvarez
Ezpeleta, Fabiola Tena
Catalán, Ma Rosa
Ferrer, Miquel
Torres, Antoni
Barbadillo, Sandra
Cabré, Lluís
Rovira, Assumpta
UNESCO Clasification: 32 Ciencias médicas
320505 Enfermedades infecciosas
Keywords: Clinical epidemiology
Critical care medicine
H1N1 mortality
Issue Date: 2010
Journal: Respirology 
Abstract: Background and objective:  The impact of pandemic influenza A (H1N1)v infection is still unknown but it is associated with a high case‐fatality rate. Methods:  This was a prospective, observational, multicentre study conducted in 144 Spanish intensive care units. Demographic and clinical data were reviewed for all cases of pandemic influenza A (H1N1)v infection reported from 23 June 2009 through 11 February 2010 and confirmed by reverse transcriptase PCR assay. Results:  Out of 872 cases reported by statewide surveillance, data for the first 131 deceased patients were analysed. Thirty‐seven patients (28.2%) died within the first 14 days. The median age of these patients was 46 years (interquartile range 35–58) and 60.3% were male. Twenty‐eight patients (21.4%) did not present with any comorbidities on admission. Forty‐six per cent of patients were reported to be obese and 22 (16.8%) had COPD. The vast majority of the patients (72.5%) had viral pneumonia; 95.4% of these had bilateral patchy alveolar opacities (predominantly basal), affecting three or four quadrants. One hundred and fifteen patients (87.8%) developed multi‐organ dysfunction syndrome. Ninety‐seven patients (74%) required vasopressor drugs, 37 (27.2%) received renal replacement therapy, and 47 (35.1%) received intravenous corticosteroids on admission to the intensive care unit. Only 68 patients (51.9%) received empirical antiviral treatment. Conclusions:  One‐third of patients with pandemic influenza A (H1N1)v infection died within the first two weeks and these were young patients, with rapidly progressive viral pneumonia as the primary cause of admission. Obese patients were at high risk but one in four patients did not present with any risk factors on admission. Only half the patients received empirical antiviral therapy and this was administered late.
ISSN: 1323-7799
DOI: 10.1111/j.1440-1843.2010.01874.x
Source: Respirology [ISSN 1323-7799],v. 16, p. 78-85
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