Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study.
<h4>Background</h4>Characteristics of patients with community-acquired pneumonia (CAP) due to pandemic influenza A 2009 (H1N1) have been inadequately compared to CAP caused by other respiratory pathogens. The performance of prediction rules for CAP during an epidemic with a new infectiou...
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oai:doaj.org-article:510b74061b53474594e7cc015ee5d6402021-11-18T08:12:23ZSeverity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study.1932-620310.1371/journal.pone.0046816https://doaj.org/article/510b74061b53474594e7cc015ee5d6402012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23071646/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Characteristics of patients with community-acquired pneumonia (CAP) due to pandemic influenza A 2009 (H1N1) have been inadequately compared to CAP caused by other respiratory pathogens. The performance of prediction rules for CAP during an epidemic with a new infectious agent are unknown.<h4>Methods</h4>Prospective, population-based study from November 2008-November 2009, in centers representing 70% of hospital beds in Iceland. Patients admitted with CAP underwent evaluation and etiologic testing, including polymerase chain reaction (PCR) for influenza. Data on influenza-like illness in the community and overall hospital admissions were collected. Clinical and laboratory data, including pneumonia severity index (PSI) and CURB-65 of patients with CAP due to H1N1 were compared to those caused by other agents.<h4>Results</h4>Of 338 consecutive and eligible patients 313 (93%) were enrolled. During the pandemic peak, influenza A 2009 (H1N1) patients constituted 38% of admissions due to CAP. These patients were younger, more dyspnoeic and more frequently reported hemoptysis. They had significantly lower severity scores than other patients with CAP (1.23 vs. 1.61, P= .02 for CURB-65, 2.05 vs. 2.87 for PSI, P<.001) and were more likely to require intensive care admission (41% vs. 5%, P<.001) and receive mechanical ventilation (14% vs. 2%, P= .01). Bacterial co-infection was detected in 23% of influenza A 2009 (H1N1) patients with CAP.<h4>Conclusions</h4>Clinical characteristics of CAP caused by influenza A 2009 (H1N1) differ markedly from CAP caused by other etiologic agents. Commonly used CAP prediction rules often failed to predict admissions to intensive care or need for assisted ventilation in CAP caused by the influenza A 2009 (H1N1) virus, underscoring the importance of clinical acumen under these circumstances.Agnar BjarnasonGudlaug ThorleifsdottirArthur LöveJanus F GudnasonHilmir AsgeirssonKristinn L HallgrimssonBerglind S KristjansdottirGunnsteinn HaraldssonOlafur BaldurssonKarl G KristinssonMagnus GottfredssonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 10, p e46816 (2012) |
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Medicine R Science Q Agnar Bjarnason Gudlaug Thorleifsdottir Arthur Löve Janus F Gudnason Hilmir Asgeirsson Kristinn L Hallgrimsson Berglind S Kristjansdottir Gunnsteinn Haraldsson Olafur Baldursson Karl G Kristinsson Magnus Gottfredsson Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. |
| description |
<h4>Background</h4>Characteristics of patients with community-acquired pneumonia (CAP) due to pandemic influenza A 2009 (H1N1) have been inadequately compared to CAP caused by other respiratory pathogens. The performance of prediction rules for CAP during an epidemic with a new infectious agent are unknown.<h4>Methods</h4>Prospective, population-based study from November 2008-November 2009, in centers representing 70% of hospital beds in Iceland. Patients admitted with CAP underwent evaluation and etiologic testing, including polymerase chain reaction (PCR) for influenza. Data on influenza-like illness in the community and overall hospital admissions were collected. Clinical and laboratory data, including pneumonia severity index (PSI) and CURB-65 of patients with CAP due to H1N1 were compared to those caused by other agents.<h4>Results</h4>Of 338 consecutive and eligible patients 313 (93%) were enrolled. During the pandemic peak, influenza A 2009 (H1N1) patients constituted 38% of admissions due to CAP. These patients were younger, more dyspnoeic and more frequently reported hemoptysis. They had significantly lower severity scores than other patients with CAP (1.23 vs. 1.61, P= .02 for CURB-65, 2.05 vs. 2.87 for PSI, P<.001) and were more likely to require intensive care admission (41% vs. 5%, P<.001) and receive mechanical ventilation (14% vs. 2%, P= .01). Bacterial co-infection was detected in 23% of influenza A 2009 (H1N1) patients with CAP.<h4>Conclusions</h4>Clinical characteristics of CAP caused by influenza A 2009 (H1N1) differ markedly from CAP caused by other etiologic agents. Commonly used CAP prediction rules often failed to predict admissions to intensive care or need for assisted ventilation in CAP caused by the influenza A 2009 (H1N1) virus, underscoring the importance of clinical acumen under these circumstances. |
| format |
article |
| author |
Agnar Bjarnason Gudlaug Thorleifsdottir Arthur Löve Janus F Gudnason Hilmir Asgeirsson Kristinn L Hallgrimsson Berglind S Kristjansdottir Gunnsteinn Haraldsson Olafur Baldursson Karl G Kristinsson Magnus Gottfredsson |
| author_facet |
Agnar Bjarnason Gudlaug Thorleifsdottir Arthur Löve Janus F Gudnason Hilmir Asgeirsson Kristinn L Hallgrimsson Berglind S Kristjansdottir Gunnsteinn Haraldsson Olafur Baldursson Karl G Kristinsson Magnus Gottfredsson |
| author_sort |
Agnar Bjarnason |
| title |
Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. |
| title_short |
Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. |
| title_full |
Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. |
| title_fullStr |
Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. |
| title_full_unstemmed |
Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. |
| title_sort |
severity of influenza a 2009 (h1n1) pneumonia is underestimated by routine prediction rules. results from a prospective, population-based study. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2012 |
| url |
https://doaj.org/article/510b74061b53474594e7cc015ee5d640 |
| work_keys_str_mv |
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