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Pereira LA, Lapinscki BA, Santos JS, Debur MC, Petterle RR, Nogueira MB, Vidal LRR, De Almeida SM, Raboni SM. Influenza A infections: predictors of disease severity. Braz J Microbiol 2024; 55:75-86. [PMID: 38049661 PMCID: PMC10920610 DOI: 10.1007/s42770-023-01186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
Influenza affects approximately 10% of the world's population annually. It is associated with high morbidity and mortality rates due to its propensity to progress to severe acute respiratory infection, leading to 10-40% of hospitalized patients needing intensive care. Characterizing the multifactorial predictors of poor prognosis is essential for developing strategies against this disease. This study aimed to identify predictors of disease severity in influenza A-infected (IFA-infected) patients and to propose a prognostic score. A retrospective cross-sectional study was conducted with 142 IFA-infected out- and inpatients treated at a tertiary hospital between 2010 and 2018. The viral subtypes, hemagglutinin mutations, viral load, IL-28B SNPs, and clinical risk factors were evaluated according to the patient's ICU admission. Multivariate analysis identified the following risk factors for disease severity: neuromuscular diseases (OR = 7.02; 95% CI = 1.18-41.75; p = 0.032), cardiovascular diseases (OR = 5.47; 95% CI = 1.96-15.27; p = 0.001), subtype (H1N1) pdm09 infection (OR = 2.29; 95% CI = 1.02-5.15; p = 0.046), and viral load (OR = 1.43; 95% CI = 1.09-1.88; p = 0.009). The prognosis score for ICU admission is based on these predictors of severity presented and ROC curve AUC = 0.812 (p < 0.0001). Our results identified viral and host predictors of disease severity in IFA-infected patients, yielding a prognostic score that had a high performance in predicting the IFA patients' ICU admission and better results than a viral load value alone. However, its implementation in health services needs to be validated in a broader population.
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Affiliation(s)
- L A Pereira
- Graduate Program in Internal Medicine and Health Science, Federal University of Paraná, Curitiba, 82060-240, Brazil
| | - B A Lapinscki
- Graduate Program in Internal Medicine and Health Science, Federal University of Paraná, Curitiba, 82060-240, Brazil
| | - J S Santos
- Public Health Laboratory (LACEN-PR), Curitiba, Brazil
| | - M C Debur
- Public Health Laboratory (LACEN-PR), Curitiba, Brazil
| | - R R Petterle
- Medical School, Sector of Health Sciences, Federal University of Paraná, Curitiba, 82060-240, Brazil
| | - M B Nogueira
- Clinical Analysis Department, Federal University of Parana, Curitiba, 82060-240, Brazil
| | - L R R Vidal
- Virology Laboratory, Federal University of Paraná, Curitiba, 82060-240, Brazil
- Virology Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, 82060-240, Brazil
| | - S M De Almeida
- Department of Medical Pathology, Federal University of Paraná, Curitiba, 82060-240, Brazil
| | - S M Raboni
- Virology Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, 82060-240, Brazil.
- Division of Infectious Diseases, Federal University of Paraná, Curitiba, 82060-240, Brazil.
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