Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

Álvarez-Lerma, F. ; Marín-Corral, J. ; Vila, C. ; Masclans, J.R. ; González, de Molina ; Martín Loeches, I. ; Barbadillo, S. ; Rodríguez, A. ; Cobo, P. ; Martins, J. ; Carbayo, C. ; Robles-Musso, E. ; Cárdenas, A. ; Fierro, J. ; Fernández, D.O. ; Sierra, R. ; Huertos, M.J. ; Pérez, M.L.C. ; Laderas, J.C.P. ; Guerrero, R. ; Robles, J.C. ; León, M.E. ; Gómez, A.B. ; Márquez, E. ; Rodríguez-Carvajal, M. ; Estella, Á. ; Pomares, J. ; Ballesteros, J.L. ; Romero, O.M. ; Fernández, Y. ; Lobato, F. ; Prieto, J.F. ; Albofedo-Sánchez, J. ; Martínez, P. ; de, la Torre ; Nieto, M. ; Sola, E.C. ; Castellanos, M.Á.D. ; Soler, G.S. ; Leyba, C.O. ; Garnacho-Montero, J. ; Hinojosa, R. ; Fernández, E. ; Loza, A. ; León, C. ; López, S.G. ; Arenzana, Á. ; Ocaña, D. ; Navarrete, I. ; Beryanaki, M.Z. ; Sánchez, I. ; Alé, M.P. ; Brea, A.M.P. ; Casas, J.F.M. ; Serón, C. (Universidad de Zaragoza) ; Avellanas, M.L. ; Lander, A. ; de Arellano, S.G.R. ; Marquina Lacueva, M.I. ; Luque, P. ; Serrano, E.P. ; Lázaro, J.F.M. ; Polo, C.S. ; Cía, I.G. ; Bartolomé, B.J. ; Núñez, C.L. ; González, I. ; Marsilla, J.I.T. ; Andrés, C.J. ; Ibañes, P.G. ; Aguilar, P.A. ; Montón, J.M. ; Regil, P.D. ; Iglesias, L. ; González, C.P. ; Fernández, B.Q. ; Iglesias, L.M. ; Soria, L.V. ; Escudero, R.Y. ; Revuelta, M.R.M. ; Ruiz, J.M.Q. ; García-Rodríguez, Á. ; Cuadrado, M.M. ; Mariño, A.L.B. ; Socias, L. ; Ibáñez, P. ; Borges-Sa, M. ; Socias, A. ; Del Castillo, A. ; Marcos, R.J. ; Muñoz, C. ; Goytisolo, J.M.B. ; Carbonero, J.A.M. ; Ayestarán, I. ; López, M.Á.G. ; Pàmies, C.V. ; Senoff, R.P. ; de Medrano, M.G.L. ; Ruiz-Santana, S. ; Díaz, J.J. ; Ramírez, C.S. ; Sisón, M. ; Hernández, D. ; Trujillo, A. ; Regalado, L. ; Fernández, S.R. ; Lorente, L. ; Rivero, J.C. ; Quintero, M.L.M. ; Martín, M. ; Martínez, S. ; Cáceres, J.J. ; Palacio, M.S. ; Rodríguez, D.G. ; Leria, M.R. ; Suberviola, B. ; Ugarte, P. ; García-López, F. ; Iniesta, R.S. ; Alonso, Á.Á. ; Padilla, A. ; Palacios, B.M. ; Grande, M.L.G. ; Rodríguez, M.C.M. ; álvarez, H.A.H ; Checa, A.A. ; Hernández, H.M. ; Albaya, A. ; Obregón, A.S. ; Crespo, C.M. ; Estrella, C.A. ; Puncel, C.B. ; Oyargue, E.Q. ; Canabal, A. ; Marina, L. ; de Toro, I.L. ; Simón, A. ; Añón, J.M. ; Pueyo, M.J.L. ; Ortiz, M.V. ; Echeverri, S.O. ; Ferreras, Z. ; Herraez, J.C.B. ; Macías, S. ; Berezo, J.Á. ; Varela, J.B. ; Schweizer, P.B. ; Salamanca, Á.G. ; Lomas, L.T. ; Anzález, A.O. ; ávila, R.C. ; Pérez G., F.J. ; Terrero, A.Á. ; Ezpeleta, F.T. ; Sala, C. ; López, O. ; Páez, Z. ; García, Á. ; Ule, D.C. ; Crespo, M.R. ; Rebolledo, J.P. ; Andrés, N.H. ; Zirena, A.C.C. ; García, B.R. ; Messa, J.B.L. ; Catalán, R.M. ; Ferrer, M. ; Torres, A. ; Cilloniz, C. ; Ansorregui, S.B. ; Cabré, L. ; Baeza, I. ; Rovira, A. ; álvarez-Lerma, F. ; Vázquez, A. ; Nolla, J. ; Fernández, F. ; Cervelló, J.R. ; Iglesia, R. ; Mañéz, R. ; Ballús, J. ; Granada, R.M. ; Vallés, J. ; Díaz, E. ; Ortíz, M. ; Guía, C. ; Martín-Loeches, I. ; Páez, J. ; Almirall, J. ; Balanzó, X. ; Güell, E. ; Yébenes, J.C. ; Rello, J. ; Arnau, E. ; Pérez, M. ; Laborda, C. ; Souto, J. ; Lagunes, L. ; Catalán, I. ; Sirvent,

Resumen: Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.

Idioma: Inglés

DOI: 10.1186/s13054-016-1512-1

Año: 2016

Publicado en: Critical care 20, 1 (2016), 337 [11 pp.]
ISSN: 1364-8535

Factor impacto JCR: 5.358 (2016)

Categ. JCR: CRITICAL CARE MEDICINE rank: 6 / 33 = 0.182 (2016) - Q1 - T1

Factor impacto SCIMAGO: 2.373 - Critical Care and Intensive Care Medicine (Q1)

Tipo y forma: Article (Published version)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)