A prediction rule to identify severe cases among adult patients hospitalized with pandemic influenza A (H1N1) 2009

• Published in: Journal of Korean medical science 2011, 26(4), 150, pp.499-506
• Main Authors: Oh, Won Sup, Lee, Seung-Joon, Lee, Chang-Seop, Hur, Ji-An, Hur, Ae-Chung, Park, Yoon Seon, Heo, Sang-Taek, Bae, In-Gyu, Park, Sang Won, Kim, Eu Suk, Kim, Hong Bin, Song, Kyoung-Ho, Lee, Kkot Sil, Lee, Sang-Rok, Yeom, Joon Sup, Lee, Su Jin, Kim, Baek-Nam, Kwak, Yee Gyung, Lee, Jae Hoon, Kim, Yong Keun, Kim, Hyo Youl, Kim, Nam Joong, Oh, Myoung-Don
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antiviral Agents - therapeutic use; APACHE; Female; Hospitalization; Humans; Influenza A Virus, H1N1 Subtype - isolation & purification; Influenza, Human - drug therapy; Influenza, Human - epidemiology; Influenza, Human - mortality; Intensive Care Units; Male; Middle Aged; Original; Pandemics; Predictive Value of Tests; Respiration, Artificial; Risk Factors; ROC Curve; Severity of Illness Index; 의학일반
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2011.26.4.499

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO(2)/FiO(2) ≤ 250), bilateral lung infiltration, and old age (≥ 65 yr) were independent risk factors for severe cases (all P < 0.001). The area under the ROC curve (0.834 [95% CI, 0.778-0.890]) of the number of risk factors were not significantly different with that of APACHE II score (0.840 [95% CI, 0.790-0.891]) (P = 0.496). The presence of ≥ 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of ≥ 13. As a prediction rule, the presence of ≥ 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.