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Respiratory microbes detected in hospitalized adults with acute respiratory infections: associations between influenza A(H1N1)pdm09 virus and intensive care unit admission or fatal outcome in Vietnam (2015-2017). BMC Infect Dis 2021; 21:320. [PMID: 33823790 PMCID: PMC8023524 DOI: 10.1186/s12879-021-05988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acute respiratory tract infection (ARI) is a leading cause of hospitalization, morbidity, and mortality worldwide. Respiratory microbes that were simultaneously detected in the respiratory tracts of hospitalized adult ARI patients were investigated. Associations between influenza A(H1N1)pdm09 virus (H1N1pdm) detection and intensive care unit (ICU) admission or fatal outcome were determined. Methods This prospective observational study was conducted between September 2015 and June 2017 at Bach Mai Hospital, Hanoi, Vietnam. Inclusion criteria were hospitalized patients aged ≥15 years; one or more of symptoms including shortness of breath, sore throat, runny nose, headache, and muscle pain/arthralgia in addition to cough and fever > 37.5 °C; and ≤ 10 days from the onset of symptoms. Twenty-two viruses, 11 bacteria, and one fungus in airway specimens were examined using a commercial multiplex real-time PCR assay. Associations between H1N1pdm detection and ICU admission or fatal outcome were investigated by univariate and multivariate logistic regression analyses. Results The total of 269 patients (57.6% male; median age, 51 years) included 69 ICU patients. One or more microbes were detected in the airways of 214 patients (79.6%). Single and multiple microbes were detected in 41.3 and 38.3% of patients, respectively. Influenza A(H3N2) virus was the most frequently detected (35 cases; 13.0%), followed by H1N1pdm (29 cases; 10.8%). Hematological disease was associated with ICU admission (p < 0.001) and fatal outcomes (p < 0.001) using the corrected significance level (p = 0.0033). Sex, age, duration from onset to sampling, or number of detected microbes were not significantly associated with ICU admission or fatal outcomes. H1N1pdm detection was associated with ICU admission (odds ratio [OR] 3.911; 95% confidence interval [CI] 1.671–9.154) and fatal outcome (OR 5.496; 95% CI 1.814–16.653) after adjusting for the confounding factors of comorbidities, bacteria/Pneumocystis jirovecii co-detection, and age. Conclusions H1N1pdm was associated with severe morbidity and death in adult patients hospitalized with respiratory symptoms. The diagnosis of subtype of influenza virus may be epidemiologically important. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05988-x.
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The impact of obesity on seasonal influenza: a single-center, retrospective study conducted in Israel. Eur J Clin Microbiol Infect Dis 2021; 40:1471-1476. [PMID: 33575963 PMCID: PMC7877522 DOI: 10.1007/s10096-021-04174-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
Obesity is associated with an increased susceptibility to infections. Several studies have reported adverse clinical outcomes of influenza among obese individuals. Our aim was to examine the association between obesity and the clinical outcomes of hospitalized adult patients ill with seasonal influenza. Consecutive hospitalized adult patients between 10/2017 and 4/2018 with laboratory confirmed influenza A and B were divided into an obese group (body mass index (BMI) ≥ 30 kg/m2) and controls. The primary outcome was a composite endpoint of 30-day all-cause mortality, vasopressor use, mechanical ventilation, ICU admission, and severe influenza complication (myocarditis and encephalitis). Secondary outcomes encompassed all the components of the primary outcome, 90-day all-cause mortality, occurrence of pneumonia, length of hospital stay, and 90-day readmission rates. The study comprised 512 hospitalized adults diagnosed with laboratory-confirmed influenza A (195/512) and B (317/512). Within this group, 17% (86/512) were classified obese; the remaining 83% (426/512) were controls. Results of the composite outcome (7/85, 8% vs. 45/422, 11%; p=0.5) and the crude 30-day all-cause mortality rate (5/86, 6% vs. 34/426, 8%, p=0.5) were similar between the two groups. The multivariate analysis demonstrated that obesity was not a significant risk factor for influenza adverse events (OR=1.3, CI 95% 0.3–3.3; p=0.5), whereas advanced age, chronic kidney disease, and hypoalbuminemia were significant risk factors (OR=1.03, OR=2.7, and OR=5.4, respectively). Obesity was not associated with influenza-related morbidity and mortality among the hospitalized adults during the 2017–2018 influenza season. Further studies researching different influenza seasons are essential.
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Rondón-Quintana HA, Zafra-Mejía CA. Covid 19 death analysis in Colombia. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: This article shows an analysis of the evolution up until date (May 4-2021), of official coronavirus cases statistics (CC) and the total number of deaths (TND) due to SARS-CoV-2 in Colombia. Additionally, said information is shown in correlation to other variables such as Case Fatality Rate (CFR), age range of persons, their typical reported co-morbidities and the cities where there has been highest concentration of cases. Materials and Methods: From March 16 2020 until today, information regarding the daily number of new confirmed cases (DNC) and daily confirmed deaths (DD) was registered in a database with the purpose of estimating the evolution of CC, TND and CFR. The age of deceased was also registered, as well as their gender, prior co-morbidities and city of death. The evolution of TND with the time of other countries were compared to that of Colombia. A mathematical equation that represents the epidemiological curve of TND evolution of different countries across time was defined. Results: In Colombia, the average age of people who die due to COVID-19 is of 69.5±14.7 years (median and mode of 71 and 80 years, respectively), and the virus is less lethal amongst a population under the age of 40. The greater part of deaths have taken place in people with prior co-morbidities and of the male gender. Conclusion: Most of the persons that have deceased are those of senior age, mainly with prior co-morbidities, and predominantly of male gender. Epidemiological peaks of COVID-19 are consistent with the rainy and winter seasons, and with the traditional epidemiological peaks of flu or influenza.
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Soldevila N, Toledo D, Ortiz de Lejarazu R, Tamames S, Castilla J, Astray J, Fernández MA, Martín V, Egurrola M, Morales Suárez-Varela M, Domínguez À. Effect of antiviral treatment in older patients hospitalized with confirmed influenza. Antiviral Res 2020; 178:104785. [PMID: 32234540 DOI: 10.1016/j.antiviral.2020.104785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
Seasonal influenza causes significant morbidity and mortality in people aged ≥65 years. Antiviral treatment can reduce complications and disease severity. The objective of this study was to investigate the effect of antiviral treatment in patients aged ≥65 years hospitalized with confirmed influenza in preventing intensive care unit (ICU) admission or death. A retrospective cohort study was carried out in 20 hospitals from seven Spanish regions during 2013-2015 in patients aged ≥65 years. Hospitalized cases of laboratory-confirmed influenza were selected. To assess the association between antiviral treatment and ICU admission or death, the adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated using multivariate logistic regression. We included 715 hospitalized patients, of whom 640 (87.9%) received antiviral treatment, 77 (10.8%) required ICU admission and 66 (9.2%) died. In the 64-74 years age group, receipt of antiviral treatment ≤48 h (aOR 0.20; 95% CI 0.04-0.89), 3-4 days (aOR 0.23; 95% CI 0.05-0.92) and 5-7 days (aOR 0.24; 95% CI 0.03-0.91) after clinical symptom onset was associated with reduced mortality. Receipt of treatment >7 days after symptom onset was not associated with reduced mortality. No association of antiviral treatment with reduced mortality was observed in the >74 years age group or with the prevention of ICU admission in any age group. Antiviral treatment had a protective effect in avoiding death in patients aged 65-74 years hospitalized due to influenza when administered ≤48 h after symptom onset and when no more than 7 days had elapsed.
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Affiliation(s)
- Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.
| | - Diana Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonia Tamames
- Direccion General de Salud Pública, Investigación, Desarrollo e Innovación, Junta de Castilla y León, León, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jenaro Astray
- Dirección General de Salud Publica Comunidad de Madrid, Madrid, Spain
| | - Maria Amelia Fernández
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Vicente Martín
- Instituto de Biomedicina (BIOMED), Universidad de León, León, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mikel Egurrola
- Servicio de Neumología, Hospital de Galdakao, Usansolo, Spain
| | - María Morales Suárez-Varela
- Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Àngela Domínguez
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Zou Q, Zheng S, Wang X, Liu S, Bao J, Yu F, Wu W, Wang X, Shen B, Zhou T, Zhao Z, Wang Y, Chen R, Wang W, Ma J, Li Y, Wu X, Shen W, Xie F, Vijaykrishna D, Chen Y. Influenza A-associated severe pneumonia in hospitalized patients: Risk factors and NAI treatments. Int J Infect Dis 2020; 92:208-213. [PMID: 31978583 DOI: 10.1016/j.ijid.2020.01.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The risk factors and the impact of NAI treatments in patients with severe influenza A-associated pneumonia remain unclear. METHODS A multicenter, retrospective, observational study was conducted in Zhejiang, China during a severe influenza epidemic in August 2017-May 2018. Clinical records of patients (>14 y) hospitalized with laboratory-confirmed influenza A virus infection and who developed severe pneumonia were compared to those with mild-to-moderate pneumonia. Risk factors related to pneumonia severity and effects of NAI treatments (monotherapy and combination of peramivir and oseltamivir) were analyzed. RESULTS 202 patients with influenza A-associated severe pneumonia were enrolled, of whom 84 (41.6%) had died. Male gender (OR = 1.782; 95% CI: 1.089-2.917; P = 0.022), chronic pulmonary disease (OR = 2.581; 95% CI: 1.447-4.603; P = 0.001) and diabetes mellitus (OR = 2.042; 95% CI: 1.135-3.673; P = 0.017) were risk factors related to influenza A pneumonia severity. In cox proportional hazards model, severe pneumonia patients treated with double dose oseltamivir (300mg/d) had a better survival rate compared to those receiving a single dose (150 mg/d) (HR = 0.475; 95%CI: 0.254-0.887; P = 0.019). However, different doses of peramivir (300 mg/d vs. 600 mg/d) and combination therapy (oseltamivir-peramivir vs. monotherapy) showed no differences in 60-day mortality (P = 0.392 and P = 0.658, respectively). CONCLUSIONS Patients with male gender, chronic pulmonary disease, or diabetes mellitus were at high risk of developing severe pneumonia after influenza A infection. Double dose oseltamivir might be considered in treating influenza A-associated severe pneumonia.
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Affiliation(s)
- Qianda Zou
- Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Shufa Zheng
- Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Xiaochen Wang
- Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Sijia Liu
- Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, PR China
| | - Jiaqi Bao
- Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Fei Yu
- Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Wei Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Xianjun Wang
- Department of Laboratory, Affiliated Hangzhou First People's Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Bo Shen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province, Taizhou Enze Medical Center (Group), Linhai, PR China
| | - Tieli Zhou
- Department of Clinical Laboratory, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, PR China
| | - Zhigang Zhao
- Department of Clinical Laboratory, Lishui Municipal Central Hospital, Lishui, PR China
| | - Yiping Wang
- Department of Clinical Laboratory, Yinzhou People's Hospital, Ningbo, PR China
| | - Ruchang Chen
- Medical Examination and Diagnosis Center, Yiwu Center Hospital, Yiwu, PR China
| | - Wei Wang
- Department of Clinical Laboratory, Lishui People's Hospital, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, PR China
| | - Jianbo Ma
- Department of Laboratory Medicine, the Affiliated Ningbo No.2 Hospital, College of Medicine, Ningbo University, Ningbo, PR China
| | - Yongcheng Li
- Department of Respiratory Diseases, the First People's Hospital of Xiaoshan, Hangzhou, PR China
| | - Xiaoyan Wu
- Department of Laboratory, Second Hospital of Jiaxing, Jiaxing, PR China
| | - Weifeng Shen
- Department of Laboratory, First Hospital of Jiaxing, Jiaxing, PR China
| | - Fuyi Xie
- Clinical Laboratory, Li Huili Hospital, Ningbo Medical Center, Ningbo, PR China
| | - Dhanasekaran Vijaykrishna
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Victoria, Australia; World Health Organization Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Yu Chen
- Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.
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Lorente-Ros A, Monteagudo Ruiz JM, Rincón LM, Ortega Pérez R, Rivas S, Martínez-Moya R, Sanromán MA, Manzano L, Alonso GL, Ibáñez B, Zamorano JL. Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients. Cardiol J 2020; 27:489-496. [PMID: 32589258 PMCID: PMC8078990 DOI: 10.5603/cj.a2020.0089] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients. METHODS Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics. RESULTS In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001-0.037). Use of renin-angiotensin-aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors. CONCLUSIONS Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.
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Affiliation(s)
- Alvaro Lorente-Ros
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.
| | | | - Luis M Rincón
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| | | | - Sonia Rivas
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| | | | | | | | | | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- CIBER Cardiovascular, Spain
- Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Catolicos 2, 28040 Madrid, Spain
| | - Jose Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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