Clinical analysis of early predictors of patients with 2009 H1N1 pneumonia

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LIU Xiao-wei(Department of Emergency Medicine, The First Affiliated Hospital, China Medical University, Shenyang 110001, China)
LIU Sheng-ye()
LIU Zhi(Department of Emergency Medicine, The First Affiliated Hospital, China Medical University, Shenyang 110001, China)
Journal Title:
Chinese Journal of Emergency Medicine
Volume 21, Issue 10, 2012
Key Word:
Novel influenza (H1N1) ; Pneumonia; Clinical features; Mortality; Prognosis

Abstract: Objective To explore the early predictors of patients with 2009 H1N1 pneumonia by analyzing the clinical features.Methods The 2009 H1 N1 pneumonia patients,admitted to our emergency intensive care unit (EICU) from October 2009 to January 2010,were retrospectively analyzed. The 86patients were divided into died and survival groups. The chi-square test and T test were used to examine the difference between groups.Results Of the 86 patients we studied,15 ( 17.4% ) cases died and 12 cases received mechanical ventilation. All patients underwent chest radiography on admission and the findings were consistent with pneumonia in all cases.The median duration of symptoms before admission was 3.2 days.The first laboratory test results indicated the average total number of white blood cell (WBC) was (6358 ±483) /mm3.Of the 86 patients,47 (54.7% ) showed a reduction in WBC.Of the 71 patients who survived,35 (49.3%) had leucopenia and12 (80%) in died group (x2 =4.71,P < 0.05).In survival group,39 (54.9%) had lymphopenia and 13 (86.7%) in died group (x2 =5.22,P <0.05).Of 72 patients had T-lymphocyte subsets results,CD4 + T cell counts on average was (424.8 ±231.6 ) /mm3 in57 survival cases and (242.5 ±99.1) /mm3 in 15 died cases (t=2.14,P < 0.05).On admission,serum creatine kinase (CK) in died group was (794.5 ± 85.1 ) U/L,higher than (632.3 ±47.9) U/L in survival group (t =2.25,P < 0.05).Elevated CK was found in 14 (93.3%)of 15 died cases and 50 (70.4%) in survival group (x2 =5.87,P < 0.05). Serum lactate dehydrogenase (LDH) in died group was (1028.6 ± 97.3) U/L,higher than (832.3 ± 56.1 ) U/L in survival group (t =2.31,P < 0.05). According to the criterion of body mass index (BMI) ≥25 kg/m2,33 (38.4%) cases were obesity,in which 13 (86.7% ) in died group and 20 (28.2%) in survival group ( x2 =17.92,P < 0.01 ),The mortality was increasing along with the BMI was increasing ( r =0.37,P =0.048). Conclusions SOFA,MEDS,CURB-65 score used in emergency room as the risk stratification methods can not effectively predict the 2009 H1N1 pneumonia patients. Peripheral blood lymphocyte counts,serum creatine kinase and lactate dehydrogenase,body mass index in the early course may be factors associated with outcomes of 2009 H1N1 pneumonia patients.

  • [1]Perez-Padilla R,de la Rosa-Zamboni D,Ponce de Leon S,et al.Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico.[J].N Engl JMed,2009,361 (7):680-689.
  • [2]Ramsey C,Kumar A.H1N1:viral pneumonia as a cause of acute respiratory distress syndrome[J]. Curr Opin Crit Care,2011,17(1):64-71.
  • [3]Vosylius S,Sipylaite J,Ivaskevicius J. Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis[J]. Croat Med J,2004,45 (6):715-720.
  • [4]Shapiro NI,Wolfe RE,Moore RB,et al. Mortality in Emergency Department Sepsis (MEDS) score:a prospectively derived and validated clinical prediction rule[J]. Crit Care Med,2003,31(3):670-675.
  • [5]Ghanem-Zoubi NO,Vardi M,Laor A,et al.Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments[J]. Crit Care,2011,15 (2):R95.
  • [6]Cui W,Zhao HW,LU X,et al. Factors associated with death in hospitalized pneumonia patients with 2009 H1N1 influenza in Shenyang,China[J].BMC Infect Dis,2010,10:145.
  • [7]Takayama K,Kuramochi J,Oinuma T,et al. Clinical features of the 2009 swine-origin influenza A (H1N1) outbreak in Japan[J].J Infect Chemother,2011,17 (3):401-406.
  • [8]Cao B,Li XW,Mao Y,et al.Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China[J].N Engl J Med,2009,361 (26):2507-2517.
  • [9]Abraham E, Singer M. Mechanisms of sepsis-induced organ dysfunction[J].Crit Care Med,2007,35 (10):2408-2416.
  • [10]Mikkelsen ME,Miltiades AN,Gaieski DF,et al.Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock[J].Crit Care Med,2009,37 (5): 1670-1677.
  • [11]Xing-hai Chen,Yong-jie Yin,Jing-xiao Zhang,et al.Sepsis and immune response[J].World J Emerg Med,2011,2 (2):88-92.
  • [12]Tzong SH,Shih MW,Ching CL.Historical review of pandemic influenza A in Taiwan,2009[J].Pediatr Neonatol,2010,51(2):83-88.
  • [13]Cunha BA,Syed U,Stroll S,et al. Winthrop-University Hospital Infectious Disease Division' s swine influenza (H1N1) pneumonia diagnostic weighted point score system for hospitalized adults with influenza-like illnesses (ILIs) and negative rapid influenza diagnostic tests (RIDTs)[J]. Heart Lung,2009,38 (6):534-538.
  • [14]Cunha BA, Syed U, Strollo S. Non-specific laboratory test indicators of severity in hospitalized adults with swine influenza (H1N1) pneumonia[J]. Eur J Clin Microbiol Infect Dis,2010,29 (12):1583-1588.
  • [15]Louie JK,Acosta M,Winter K,et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California[J].JAMA,2009,302 (17):1872-1879.
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