Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

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• dc.contributor.author Álvarez Lerma, Franciscoca
• dc.contributor.author Marin Corral, Judithca
• dc.contributor.author Vila, Claraca
• dc.contributor.author Masclans Enviz, Joan Ramonca
• dc.contributor.author González de Molina, Francisco Javierca
• dc.contributor.author Martín Loeches, Ignacioca
• dc.contributor.author Barbadillo, Sandraca
• dc.contributor.author Rodríguez, Alejandroca
• dc.contributor.author H1N1 GETGAG/SEMICYUC Study Groupca
• dc.date.accessioned 2016-11-30T15:07:04Z
• dc.date.available 2016-11-30T15:07:04Z
• dc.date.issued 2016ca
• dc.description.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.
• dc.format.mimetype application/pdfca
• dc.identifier.citation Álvarez Lerma F, Marin Corral J, Vila C, Masclans Enviz JR, González de Molina FJ, Martín Loeches I et al. Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome. Critical Care. 2016;20(1):337. DOI: 10.1186/s13054-016-1512-1ca
• dc.identifier.doi http://dx.doi.org/10.1186/s13054-016-1512-1
• dc.identifier.issn 1364-8535ca
• dc.identifier.uri http://hdl.handle.net/10230/27641
• dc.language.iso engca
• dc.publisher BioMed Centralca
• dc.relation.ispartof Critical Care. 2016;20(1):337
• dc.rights © 2016 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.ca
• dc.rights.accessRights info:eu-repo/semantics/openAccessca
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Influenza A (H1N1)pdm09 virus infection
• dc.subject.keyword Mortality
• dc.subject.keyword Critically ill
• dc.subject.keyword Early diagnosis
• dc.subject.keyword Late diagnosis
• dc.title Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcomeca
• dc.type info:eu-repo/semantics/articleca
• dc.type.version info:eu-repo/semantics/publishedVersionca