Epidemiology, Clinical Features, and Prognosis of Elderly Adultswith Severe Forms of Influenza A (H1N1)

Garnacho-Montero, José ; Gutiérrez-Pizarraya, Antonio ; Marquez, Juan A. ; Zaragoza, Rafael ; Granada, Rosa ; Ruiz-Santana, Sergio ; Rello, Jordi ; Rodríguez, Alejandro ; Serón Arbeloa, Carlos ; behalf of the Spanish Society of Intensive Care Medicineand Coronary Units Working Group

Resumen: Objectives: To examine epidemiological and clinical data of individuals aged 65 and older with influenza virus A (H 1N 1) admitted to the intensive care unit (ICU ) and to identify independent predictors of ICU mortality.
Design: Prospective, observational, multicenter study to determine prognostic factors in individuals infected with influenza A (H 1N 1) admitted to the ICU.
Setting: One hundred forty‐eight S panish ICU s.
Participants: Individuals with influenza A (H 1N 1) confirmed using real‐time polymerase chain reaction from A pril 2009 to J uly 2011.
Measurements: Individuals aged 65 and older were compared with younger individuals. A multivariate analysis was conducted to determine independent predictors of mortality in this population.
Results: One thousand one hundred twenty individuals (129 (11.5%) aged ≥65) were included. Prevalence of chronic diseases was more common in older individuals. Viral pneumonitis was more frequent in individuals younger than 65 (70.5% vs 54.3%, P < .001). In older individuals, A cute P hysiology and C hronic H ealth E valuation II score (odds ratio (OR ) = 1.11, 95% confidence interval (CI ) = 1.11–1.20, P = .002), immunosuppression (OR = 3.66, 95% CI , 1.33–10.03, P = .01) and oseltamivir therapy initiated after 48 hours (OR = 3.32, 95% CI = 1.02–10.8, P = .04) were identified as independent variables associated with mortality. Corticosteroid use was associated with a trend toward greater mortality (OR = 2.39, 95% CI = 0.98–5.91, P = .06).
Conclusion: Individuals aged 65 and older with influenza A (H 1N 1) admitted to the ICU have a higher incidence of underlying diseases than younger individuals and differences in clinical presentation. Early oseltamivir therapy is associated with better outcomes in elderly adults.

Idioma: Inglés

DOI: 10.1111/jgs.12152

Año: 2013

Publicado en: Journal of the American Geriatrics Society 61, 3 (2013), 350-366
ISSN: 0002-8614

Factor impacto JCR: 4.216 (2013)

Categ. JCR: GERONTOLOGY rank: 2 / 31 = 0.065 (2013) - Q1 - T1
Categ. JCR: GERIATRICS & GERONTOLOGY rank: 6 / 49 = 0.122 (2013) - Q1 - T1

Tipo y forma: Artículo (Versión definitiva)