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Severe Influenza in 33 US Hospitals, 2013–2014: Complications and Risk Factors for Death in 507 Patients

Published online by Cambridge University Press:  30 July 2015

Nirav S. Shah ,
Jared A. Greenberg ,
Moira C. McNulty ,
Kevin S. Gregg ,
James Riddell IV ,
Julie E. Mangino ,
Devin M. Weber ,
Courtney L. Hebert ,
Natalie S. Marzec  and
Michelle A. Barron
...Show all authors
Nirav S. Shah*
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Jared A. Greenberg
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Moira C. McNulty
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Kevin S. Gregg
Affiliation:
Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan
James Riddell IV
Affiliation:
Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Julie E. Mangino
Affiliation:
Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
Devin M. Weber
Affiliation:
Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
Courtney L. Hebert
Affiliation:
Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, Ohio
Natalie S. Marzec
Affiliation:
Department of Medicine, University of Colorado Denver, Denver, Colorado
Michelle A. Barron
Affiliation:
Department of Medicine, University of Colorado Denver, Denver, Colorado
Fredy Chaparro-Rojas
Affiliation:
Department of Medicine, Vidant Medical Center, Greenville, North Carolina
Alejandro Restrepo
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas
Vagish Hemmige
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas
Kunatum Prasidthrathsint
Affiliation:
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Sandra Cobb
Affiliation:
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Loreen Herwaldt
Affiliation:
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Vanessa Raabe
Affiliation:
Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
Christopher R. Cannavino
Affiliation:
Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
Andrea Green Hines
Affiliation:
Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Sara H. Bares
Affiliation:
Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Philip B. Antiporta
Affiliation:
Department of Medicine, Loyola University Medical Center, Maywood, Illinois Department of Medicine, Edward Hines Veterans Affairs (VA) Hospital, Maywood, Illinois
Tonya Scardina
Affiliation:
Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois
Ursula Patel
Affiliation:
Department of Pharmacy, Edward Hines VA Hospital, Maywood, Illinois
Gail Reid
Affiliation:
Department of Medicine, Loyola University Medical Center, Maywood, Illinois Department of Medicine, Edward Hines Veterans Affairs (VA) Hospital, Maywood, Illinois
Parvin Mohazabnia
Affiliation:
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Suresh Kachhdiya
Affiliation:
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Binh-Minh Le
Affiliation:
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Connie J. Park
Affiliation:
Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Belinda Ostrowsky
Affiliation:
Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
Ari Robicsek
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois Department of Medicine, Northshore University HealthSystem, Evanston, Illinois
Becky A. Smith
Affiliation:
Department of Medicine, Northshore University HealthSystem, Evanston, Illinois
Jeanmarie Schied
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
Micah M. Bhatti
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
Stockton Mayer
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
Monica Sikka
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
Ivette Murphy-Aguilu
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois
Priti Patwari
Affiliation:
Department of Medicine, Community Care Networks, Munster, Indiana
Shira R. Abeles
Affiliation:
Department of Medicine, University of California San Diego, San Diego, California
Francesca J. Torriani
Affiliation:
Department of Medicine, University of California San Diego, San Diego, California
Zainab Abbas
Affiliation:
Department of Medicine, Methodist Hospitals, Merrillville, Indiana
Sophie Toya
Affiliation:
Department of Medicine, Methodist Hospitals, Merrillville, Indiana
Katherine Doktor
Affiliation:
Department of Medicine, University of Miami/Jackson Health System, Miami, Florida
Anindita Chakrabarti
Affiliation:
Department of Medicine, University of Miami/Jackson Health System, Miami, Florida
Susanne Doblecki-Lewis
Affiliation:
Department of Medicine, University of Miami/Jackson Health System, Miami, Florida
David J. Looney
Affiliation:
Department of Medicine, VA San Diego/University of California San Diego, San Diego, California
Michael Z. David
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois Department of Pediatrics, University of Chicago, Chicago, Illinois
*
Address correspondence to Nirav S. Shah, MD, MPH, Department of Medicine, University of Chicago, Chicago, IL 60637 (nss197@gmail.com).
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Abstract

BACKGROUND

Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.

METHODS

A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.

RESULTS

A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).

CONCLUSION

Risk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.

Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1251 - 1260
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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