Characteristics of severe influenza B virus-associated pneumonia in adults_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Dongmei ¹ ^# , GAO Lijuan ² ^# , TANG Xiao ¹ , ZHANG Jiaying ² , LI Xuyan ¹ , WANG Rui ¹ , LIU Guangyun ¹ ,  LIANG Lianchun ² , TONG Zhaohui ¹ ,  SUN Bing ¹

1. Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, (Beijing Chaoyang Hospital), Beijing 100020, P. R. China;
2. Beijing Youan Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing 100069, P. R. China;

Corresponding author：

LIANG Lianchun, Email: llc1215@ccmu.edu.cn; SUN Bing, Email: ricusunbing@126.com

Keywords：

Influenza B; pneumonia; respiratory failure; adult

DOI：

10.7507/1671-6205.202207060

Video：

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Objective To identify the clinical features and risk factors for mortality associated with severe influenza B pneumonia of adults admitted to respiratory intensive care unit (ICU). Methods Patients with confirmed influenza B infection and respiratory failure between February 2020 and February 2022 who were admitted to the ICU were sequentially included. Demographic features, clinical data, microbiological data, complications, and outcomes were collected. Univariate logistic regression analysis was performed to identify risk factors associated with hospital mortality. A comparison with severe influenza A pneumonia was made to explore the characteristics of influenza B virus-associated pneumonia. Results A total of 23 patients with influenza B pneumonia were included. The survival group included 18 patients and the death group included 5 patients, with an ICU mortality of 21.7%. The median age in the death group was 64 (64, 72.5) years, which was significantly older than the survival group, with a median age 59 (30.25, 64.25) years (P=0.030). Univariate logistic regression analysis indicated that SOFA score [odds ratio (OR) 1.307, 95% confidential interval (CI) 1.013 - 1.686, P=0.039], decreased hemoglobin (OR 0.845, 95%CI 0.715 - 0.997, P=0.046), and high blood urea nitrogen (BUN) (OR 1.432, 95%CI 1.044 - 1.963, P=0.026) were independent risk factors for hospital mortality. Compared with influenza A pneumonia, patients with severe influenza B pneumonia had more complications (60.0% vs. 87.0%, P=0.023). Conclusions The mortality of severe influenza B virus-associated pneumonia with was high. Increased SOFA score, anemia, and high BUN were risk factors for ICU mortality of severe influenza B infection in adults.

Citation： ZHANG Dongmei, GAO Lijuan, TANG Xiao, ZHANG Jiaying, LI Xuyan, WANG Rui, LIU Guangyun, LIANG Lianchun, TONG Zhaohui, SUN Bing. Characteristics of severe influenza B virus-associated pneumonia in adults. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(8): 552-558. doi: 10.7507/1671-6205.202207060 Copy

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1. 中国国家流感中心 (chinacdc.cn). 流感监测周报. 2022, 8(698). https://ivdc.chinacdc.cn/cnic/zyzx/lgzb/202203/t20220305_257446.htm.
2. Zapf AJ, Hardick J, McBryde B, et al. Impact of coinfection status and comorbidity on disease severity in adult emergency department patients with influenza B. Influenza Other Respir Viruses, 2022, 16(2): 236-246.
3. Zaraket H, Hurt AC, Clinch B, et al. Burden of influenza B virus infection and considerations for clinical management. Antiviral Res, 2021, 185: 104970.
4. Qi L, Li Q, Ding XB, et al. Mortality burden from seasonal influenza in Chongqing, China, 2012 - 2018. Hum Vaccin Immunother, 2020, 16(7): 1668-1674.
5. 中华人民共和国国家卫生健康委员会国家中医药管理局. 流行性感冒诊疗方案(2020年版). 中华临床感染病杂志, 2020, 13(6): 401-405, 411.
6. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
7. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med, 2021, 49(11): e1063-e1143.
8. 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
9. Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 63(4): e1-e60.
10. 孙兵, 唐晓, 李绪言, 等. 2017—2018年冬春季重症流感病毒性肺炎所致急性呼吸窘迫综合征的临床特点及预后危险因素分析. 中华结核和呼吸杂志, 2019, 42(1): 9-14.
11. Parums DV. Editorial: a decline in influenza during the COVID-19 pandemic and the emergence of potential epidemic and pandemic influenza viruses. Med Sci Monit, 2021, 27: e934949.
12. Yazici Özkaya P, Turanli EE, Metin H, et al. Severe influenza virus infection in children admitted to the PICU: comparison of influenza A and influenza B virus infection. J Med Virol, 2022, 94(2): 575-581.
13. Ozsurekci Y, Aykac K, Bal F, et al. Outcome predictors of influenza for hospitalization and mortality in children. J Med Virol, 2021, 93(11): 6148-6154.
14. 王优雅, 李冉, 高占成. 2014 至2018 年69 例流感肺炎临床特点研究. 中国呼吸与危重监护杂志, 2020, 19(3): 251-257.
15. Ono S, Ono Y, Matsui H, et al. Factors associated with hospitalization for seasonal influenza in a Japanese nonelderly cohort. BMC Public Health, 2016, 16(1): 922.
16. Likos AM, Kelvin DJ, Cameron CM, et al. Influenza viremia and the potential for blood-borne transmission. Transfusion, 2007, 47(6): 1080-1088.
17. Özlu T, Bülbül Y, Taşbakan S, et al. General characteristics and prognostic factors of pneumonia cases developed during pandemic (H1N1) influenza-A virus infection in Turkey. Balkan Med J, 2013, 30(1): 68-73.
18. 王菊, 伍义兰, 张龙举. 国内三十年甲型 H1N1 流感临床及流行特点分析. 中国呼吸与危重监护杂志, 2021, 20(3): 164-169.
19. Basheer M, Saad E, Hagai R, et al. Clinical predictors of mortality and critical illness in patients with COVID-19 pneumonia. Metabolites, 2021, 11(10): 679.
20. Hu L, Zhang Y, Wang J, et al. A prognostic model for in-hospital mortality in critically ill patients with pneumonia. Infect Drug Resist, 2022, 15: 6441-6450.
21. Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA, 2001, 286(14): 1754-1758.
22. Shah NS, Greenberg JA, McNulty MC, et al. Severe influenza in 33 US hospitals, 2013 - 2014: complications and risk factors for death in 507 patients. Infect Control Hosp Epidemiol, 2015, 36(11): 1251-1260.
23. Guesneau C, Boureau AS, Bourigault C, et al. Risk factors associated with 30-day mortality in older patients with influenza. J Clin Med, 2021, 10(16): 3521.
24. Gutiérrez-Pizarraya A, Pérez-Romero P, Alvarez R, et al. Unexpected severity of cases of influenza B infection in patients that required hospitalization during the first postpandemic wave. J Infect, 2012, 65(5): 423-430.

Chinese Journal of Respiratory and Critical Care Medicine

Characteristics of severe influenza B virus-associated pneumonia in adults

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