A predictive tool for mortality of influenza A community-acquired pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 CHEN Liang ¹ , HAN Xiudi ² , XING Xiqian ³ , ZHU Xiaoli ⁴

1. Department of Infectious Diseases, Beijing Jishuitan Hospital, Beijing 100096, P. R. China;
2. Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P. R. China;
3. Department of Respiratory Medicine, Yan’an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan 650051, P. R. China;
4. Occupational Medicine and Toxicology Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, P. R. China;

Corresponding author：

CHEN Liang, Email: chenliang1995@sina.com

Keywords：

Influenza A; Community-acquired pneumonia; Mortality; Predictive tool

DOI：

10.7507/1671-6205.201803062

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ObjectivesTo explore a reliable and simple predictive tool for 30-day mortality of influenza A community-acquired pneumonia (CAP).MethodsA multicenter retrospective study was conducted on 178 patients hospitalized with influenza A CAP, including 144 alive patients and 34 dead patients. Receiver operating characteristic (ROC) curves were performed to verify the accuracy of severity scores as 30-day mortality predictors in the study patients.ResultsThe 30-day mortality of influenza A CAP was 19.1%. The actual mortality of PSI risk class Ⅰ-Ⅱ and CURB-65 score 0-1 were 14.5% and 15.7%, respectively, which were much higher than the predicted mortality. Logistic regression confirmed blood urea nitrogen >7 mmol/L (U), albumin <35 g/L (A) and peripheral blood lymphocyte count <0.7×10 ⁹/L (L) were independent risk factors for 30-day mortality of influenza A CAP. The area under the ROC curve (AUC) of UAL (blood urea nitrogen >7 mmol/L+ albumin <35 g/L+ peripheral blood lymphocyte count <0.7×10 ⁹/L) was 0.891, which was higher than CURB-65 score (AUC=0.777, P=0.008 3), CRB-65 score (AUC=0.590, P<0.000 1), and PSI risk class (AUC=0.568,P=0.000 1).ConclusionUAL is a reliable and simple predictive tool for 30-day mortality of influenza A CAP.

Citation： CHEN Liang, HAN Xiudi, XING Xiqian, ZHU Xiaoli. A predictive tool for mortality of influenza A community-acquired pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(5): 445-449. doi: 10.7507/1671-6205.201803062 Copy

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2.	Rothberg MB, Haessler SD, Brown RB. Complications of viral influenza. Am J Med, 2008, 121(4): 258-264.
3.	Louria DB, Blumenfeld HL, Ellis JT, et al. Studies on influenza in the pandemic of 1957-1958. II. Pulmonary complications of influenza. J Clin Invest, 1959, 38(1 Part 2): 213-265.
4.	Foy HM, Cooney MK, Allan I, et al. Rates of pneumonia during influenza epidemics in Seattle, 1964 to 1975. JAMA, 1979, 241(3): 253-258.
5.	Commons RJ, Denholm J. Triaging pandemic flu: pneumonia severity scores are not the answer. Int J Tuberc Lung Dis, 2012, 16(5): 670-673.
6.	Shi SJ, Li H, Liu M, et al. Mortality prediction to hospitalized patients with influenza pneumonia: PO₂/FiO₂ combined lymphocyte count is the answer. Clin Respir J, 2017, 11(3): 352-360.
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9.	Oliveira EC, Marik PE, Colice G. Influenza pneumonia: a descriptive study. Chest, 2001, 119(6): 1717-1723.
10.	Wi YM, Kim JM, Peck KR. Serum albumin level as a predictor of intensive respiratory or vasopressor support in influenza A (H1N1) virus infection. Int J Clin Pract, 2014, 68(2): 222-229.
11.	Maruyama T, Fujisawa T, Suga S, et al. Outcomes and prognostic features of patients with influenza requiring hospitalization and receiving early antiviral therapy: a prospective multicenter cohort study. Chest, 2016, 149(2): 526-534.
12.	Foley EF, Borlase BC, Dzik WH, et al. Albumin supplementation in the critically ill: a prospective, randomized trial. Arch Surg, 1990, 125(6): 739-742.
13.	Nafisi S, Vishkaee TS. Study on the interaction of tamiflu and oseltamivir carboxylate with human serum albumin. J Photochem Photobiol B, 2011, 105(1): 34-39.
14.	Duarte PA, Venazzi A, Youssef NC, et al. Outcome of influenza A (H1N1) patients admitted to intensive care units in the Paraná state, Brazil. Rev Bras Ter Intensiva, 2009, 21(3): 231-236.
15.	Djordjević Z, Lazić Z, Gajović O, et al. Risk factors for acute respiratory distress syndrome development in patients with type A influenza (H1N1). Srp Arh Celok Lek, 2012, 140(7): 441-447.
16.	Kaya S, Yilmaz G, Arslan M, et al. Predictive factors for fatality in pandemic influenza A (H1N1) virus infected patients. Saudi Med J, 2012, 33(2): 146-151.
17.	Tutuncu EE, Ozturk B, Gurbuz Y, et al. Clinical characteristics of 74 pandemic H1N1 influenza patients from Turkey. Risk factors for fatality. Saudi Med J, 2010, 31(9): 993-998.
18.	Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003, 58(5): 377-382.
19.	Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med, 1997, 336(4): 243-250.
20.	Cunha BA, Pherez FM, Schoch P. Diagnostic importance of relative lymphopenia as a marker of swine influenza (H1N1) in adults. Clin Infect Dis, 2009, 49(9): 1454-1456.
21.	Tumpey TM, Lu X, Morken T, et al. Depletion of lymphocytes and diminished cytokine production in mice infected with a highly virulent influenza A (H5N1) virus isolated from humans. J Virol, 2000, 74(13): 6105-6116.
22.	Lee ACY, To KKW, Zhu HS, et al. Avian influenza virus A H7N9 infects multiple mononuclear cell types in peripheral blood and induces dysregulated cytokine responses and apoptosis in infected monocytes. J Gen Virol, 2017, 98(5): 922-934.
23.	Templeton KE, Scheltinga SA, van den Eeden WCJFM, et al. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis, 2005, 41(3): 345-351.
24.	Diederen BMW, Van Der Eerden MM, Vlaspolder F, et al. Detection of respiratory viruses and Legionella spp. by real-time polymerase chain reaction in patients with community acquired pneumonia. Scand J Infect Dis, 2009, 41(1): 45-50.
25.	Jennings LC, Anderson TP, Beynon KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax, 2008, 63(1): 42-48.
26.	Wang C, Yu H, Horby PW, et al. Comparison of patients hospitalized with influenza A subtypes H7N9, H5N1, and 2009 pandemic H1N1. Clin Infect Dis, 2014, 58(8): 1095-1103.

1. Webster RG, Bean WJ, Gorman OT, et al. Evolution and ecology of influenza A viruses. Microbiol Rev, 1992, 56(1): 152-179.
2. Rothberg MB, Haessler SD, Brown RB. Complications of viral influenza. Am J Med, 2008, 121(4): 258-264.
3. Louria DB, Blumenfeld HL, Ellis JT, et al. Studies on influenza in the pandemic of 1957-1958. II. Pulmonary complications of influenza. J Clin Invest, 1959, 38(1 Part 2): 213-265.
4. Foy HM, Cooney MK, Allan I, et al. Rates of pneumonia during influenza epidemics in Seattle, 1964 to 1975. JAMA, 1979, 241(3): 253-258.
5. Commons RJ, Denholm J. Triaging pandemic flu: pneumonia severity scores are not the answer. Int J Tuberc Lung Dis, 2012, 16(5): 670-673.
6. Shi SJ, Li H, Liu M, et al. Mortality prediction to hospitalized patients with influenza pneumonia: PO₂/FiO₂ combined lymphocyte count is the answer. Clin Respir J, 2017, 11(3): 352-360.
7. 瞿介明, 曹彬. 中国成人社区获得性肺炎诊断和治疗指南 (2016 版). 中华结核和呼吸杂志, 2016, 39(4): 241-242.
8. World Health Organization (WHO) Weekly Epidemiological Record. Ten things you need to know about pandemic influenza. Available at: http://www.who.int/csr/disease/influenza/pandemicl0things/en/ (accessed 14 October 2005).
9. Oliveira EC, Marik PE, Colice G. Influenza pneumonia: a descriptive study. Chest, 2001, 119(6): 1717-1723.
10. Wi YM, Kim JM, Peck KR. Serum albumin level as a predictor of intensive respiratory or vasopressor support in influenza A (H1N1) virus infection. Int J Clin Pract, 2014, 68(2): 222-229.
11. Maruyama T, Fujisawa T, Suga S, et al. Outcomes and prognostic features of patients with influenza requiring hospitalization and receiving early antiviral therapy: a prospective multicenter cohort study. Chest, 2016, 149(2): 526-534.
12. Foley EF, Borlase BC, Dzik WH, et al. Albumin supplementation in the critically ill: a prospective, randomized trial. Arch Surg, 1990, 125(6): 739-742.
13. Nafisi S, Vishkaee TS. Study on the interaction of tamiflu and oseltamivir carboxylate with human serum albumin. J Photochem Photobiol B, 2011, 105(1): 34-39.
14. Duarte PA, Venazzi A, Youssef NC, et al. Outcome of influenza A (H1N1) patients admitted to intensive care units in the Paraná state, Brazil. Rev Bras Ter Intensiva, 2009, 21(3): 231-236.
15. Djordjević Z, Lazić Z, Gajović O, et al. Risk factors for acute respiratory distress syndrome development in patients with type A influenza (H1N1). Srp Arh Celok Lek, 2012, 140(7): 441-447.
16. Kaya S, Yilmaz G, Arslan M, et al. Predictive factors for fatality in pandemic influenza A (H1N1) virus infected patients. Saudi Med J, 2012, 33(2): 146-151.
17. Tutuncu EE, Ozturk B, Gurbuz Y, et al. Clinical characteristics of 74 pandemic H1N1 influenza patients from Turkey. Risk factors for fatality. Saudi Med J, 2010, 31(9): 993-998.
18. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003, 58(5): 377-382.
19. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med, 1997, 336(4): 243-250.
20. Cunha BA, Pherez FM, Schoch P. Diagnostic importance of relative lymphopenia as a marker of swine influenza (H1N1) in adults. Clin Infect Dis, 2009, 49(9): 1454-1456.
21. Tumpey TM, Lu X, Morken T, et al. Depletion of lymphocytes and diminished cytokine production in mice infected with a highly virulent influenza A (H5N1) virus isolated from humans. J Virol, 2000, 74(13): 6105-6116.
22. Lee ACY, To KKW, Zhu HS, et al. Avian influenza virus A H7N9 infects multiple mononuclear cell types in peripheral blood and induces dysregulated cytokine responses and apoptosis in infected monocytes. J Gen Virol, 2017, 98(5): 922-934.
23. Templeton KE, Scheltinga SA, van den Eeden WCJFM, et al. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis, 2005, 41(3): 345-351.
24. Diederen BMW, Van Der Eerden MM, Vlaspolder F, et al. Detection of respiratory viruses and Legionella spp. by real-time polymerase chain reaction in patients with community acquired pneumonia. Scand J Infect Dis, 2009, 41(1): 45-50.
25. Jennings LC, Anderson TP, Beynon KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax, 2008, 63(1): 42-48.
26. Wang C, Yu H, Horby PW, et al. Comparison of patients hospitalized with influenza A subtypes H7N9, H5N1, and 2009 pandemic H1N1. Clin Infect Dis, 2014, 58(8): 1095-1103.

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