Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features

• Published in: PloS one 2022-07, Vol.17 (7), p.e0270814-e0270814
• Main Authors: Jamoussi, Amira, Ayed, Samia, Merhabene, Takoua, Doghri, Hamdi, Ben Khelil, Jalila, Besbes, Mohamed
• Format: Article
• Language: English
• Subjects: Antiviral agents; Biology and life sciences; Care and treatment; Clinical aspects; Complications; Creatinine; Demography; Epidemics; Epidemiology; Fever; Hospitalization; Hospitals; Illnesses; Infections; Influenza; Influenza A; Intensive care; Intubation; Kidney diseases; Laboratories; Lymphocytes; Mechanical ventilation; Medicine and Health Sciences; Mortality; Multivariate analysis; Nosocomial infections; Pandemics; Patient outcomes; Patients; People and Places; Physiology; Pneumonia; Polymerase chain reaction; Respiratory distress syndrome; Sepsis; Thromboembolism; Vaccines; Ventilation; Ventilators; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0270814

Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia. It was a single-center study, including all hospitalized patients in intensive care, between November 1.sup.st, 2009 and October 31.sup.st, 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized. During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H.sub.1 N.sub.1 pdm09 (84.2%) and H.sub.3 N.sub.2 (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25-13] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC.sub.95% [1.474-37.317]; p = 0.015), PaO.sub.2 /FiO.sub.2 [less than or equal to] 95 mmHg (OR = 9.078; IC.sub.95% [1.636-50.363]; p = 0.012) and lymphocytes count [less than or equal to] 1.325 10.sup.9 /L (OR = 10.199; IC.sub.95% [1.550-67.101]; p = 0.016). Influenza A in ICU is n