Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients

Hsu, Jui-Chi; Lee, Ing-Kit; Huang, Wen-Chi; Chen, Yi‐Chun; Tsai, Ching-Yen

doi:10.3390/jcm9041073

Cited by 8 publications

(7 citation statements)

References 39 publications

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“…This may be explained by the different ICU capacities or triage among hospitals or countries. Besides, the rate of MV use in our cohort (0.4~1.6% among hospitalized patients) seems lower, compared to that of the US (15.6~25.0%), Spain (8.9%), Canada (8.6%) and Germany (3.4~6.7%) [ 6 , 9 , 27 , 29 , 30 ]. This different rate could be linked to different disease severities or proportions of do-not-intubate orders among countries.…”

Section: Discussioncontrasting

confidence: 63%

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Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea

Hong

Lee

Kim

et al. 2022

JCM

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Background: Long-term trends in influenza-related hospitalizations, critical care resource use, and hospital outcomes since the 2009 H1N1 influenza pandemic season have been rarely studied for adult populations. Materials and Methods: Adult patients from the Korean Health Insurance Review and Assessment Service who were hospitalized with influenza over a 10-year period (2009–2019) were analyzed. The incidence rates of hospitalization, critical care resource use, and in-hospital death were calculated using mid-year population census data. Results: In total, 300,152 hospitalized patients with influenza were identified (men, 35.7%; admission to tertiary hospitals, 9.4%). Although the age-adjusted hospitalization rate initially decreased since the 2009 H1N1 pandemic (52.61/100,000 population in 2009/2010), it began to increase again in 2013/2014 and reached a peak of 169.86/100,000 population in 2017/2018 (p < 0.001). The in-hospital mortality rate showed a similar increasing trend as the hospitalization, with a peak of 1.44/100,000 population in 2017/2018 (vs. 0.35/100,000 population in 2009/2010; p < 0.001). The high incidence rates of both hospitalization and in-hospital mortality were mainly attributable to patients aged ≥60 years. The rate of intensive care unit admission and the use of mechanical ventilation, continuous renal replacement therapy and vasopressors have also increased from the 2013/2014 season. The incidence of heart failure was the most frequent complication investigated, with a three-fold increase in the last two seasons since 2009/2010. In multivariate analysis adjusted for covariates, among hospitalized patients, type of hospitals and 2009 H1N1 pandemic season were associated with in-hospital mortality. Conclusions: We confirmed that the rates of hospitalization, critical care resource use, and in-hospital mortality by influenza have increased again in recent years. Therefore, strategies are needed to reduce infections and optimize resource use with a greater focus on older people.

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Section: Discussioncontrasting

confidence: 63%

“…Epidemics of influenza and its disease burden vary by different regions [ 2 , 3 , 4 , 5 , 6 ]. Hence, nationwide data from countries with different healthcare systems are needed to establish global strategies and prepare for future epidemics or pandemics.…”

Section: Introductionmentioning

confidence: 99%

Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea

Hong

Lee

Kim

et al. 2022

JCM

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“…A direct comparison of our findings with other studies is problematic. Lactate and BE are routinely measured in critically ill patients suffering from various diseases, and both serve as mortality predictors in ICU (for example, in post-cardiac surgery patients or those with cardiogenic shock, ruptured abdominal aortic aneurysms, or trauma) [ 4 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Whether BE or lactate concentrations serve as better predictors of mortality in critical care patients has not yet been determined [ 4 , 33 , 34 , 35 , 36 ], with no studies reporting with certainty whether these predictors are both independent and/or additive.…”

Section: Discussionmentioning

confidence: 99%

Admission Lactate Concentration, Base Excess, and Alactic Base Excess Predict the 28-Day Inward Mortality in Shock Patients

Smuszkiewicz

Jawień

Szrama

et al. 2022

JCM

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Base excess (BE) and lactate concentration may predict mortality in critically ill patients. However, the predictive values of alactic BE (aBE; the sum of BE and lactate), or a combination of BE and lactate are unknown. The study aimed to investigate whether BE, lactate, and aBE measured on admission to ICU may predict the 28-day mortality for patients undergoing any form of shock. In 143 consecutive adults, arterial BE, lactate, and aBE were measured upon ICU admission. Receiver Operating Curve (ROC) characteristics and Cox proportional hazard regression models (adjusted to age, gender, forms of shock, and presence of severe renal failure) were then used to investigate any association between these parameters and 28-day mortality. aBE < −3.63 mmol/L was found to be associated with a hazard ratio of 3.19 (HR; 95% confidence interval (CI): 1.62–6.27) for mortality. Risk of death was higher for BE < −9.5 mmol/L (HR: 4.22; 95% CI: 2.21–8.05), particularly at lactate concentrations > 4.5 mmol/L (HR: 4.62; 95% CI: 2.56–8.33). A 15.71% mortality rate was found for the combined condition of BE > cut-off and lactate < cut-off. When BE was below but lactate above their respective cut-offs, the mortality rate increased to 78.91%. The Cox regression model demonstrated that the predictive values of BE and lactate were mutually independent and additive. The 28-day mortality in shock patients admitted to ICU can be predicted by aBE, but BE and lactate deliver greater prognostic value, particularly when combined. The clinical value of our findings deserves further prospective evaluation.

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“…Studies have shown that routine measurement of lactate in patients with infection can impact clinical assessment of mortality risk [26] . Hsu et al found that high lactate levels were independent predictors of death in critically ill influenza patients [27] . We performed lactate test for patients at admission, which can identify critically ill patients earlier and create conditions for reducing mortality.…”

Section: Discussionmentioning

confidence: 99%

Early Warning Factors of Death in COVID-19 Patients

et al. 2021

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Summary The infectious coronavirus disease 2019 (COVID-19) has spread all over the world and been persistently evolving so far. The number of deaths in the whole world has been rising rapidly. However, the early warning factors for mortality have not been well ascertained. In this retrospective, single-centre cohort study, we included some adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Renmin Hospital of Wuhan University who had been discharged or had died by Apr. 8, 2020. Demographic, clinical and laboratory data at admission were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable analysis, Cox proportional hazard model analysis and receiver operating characteristic (ROC) curve to explore the early warning factors associated with in-hospital death. A total of 159 patients were included in this study, of whom 86 were discharged and 73 died in hospital. Hypertension (52.1% vs. 29.1%, P =0.003) and coronary heart disease (28.8% vs. 12.8%, P =0.012) were more frequent among non-survived patients than among survived patients. The proportions of patients with dyspnoea (67.1% vs. 25.6%, P <0.001), chest distress (58.9% vs. 26.7%, P <0.001) and fatigue (64.4% vs. 25.6%, P <0.001) were significantly higher in the non-survived group than in the survived group. Regression analysis with the Cox proportional hazards mode revealed that increasing odds of in-hospital death were associated with higher IL-6 (odds ratio 10.87, 95% CI 1.41-83.59; P =0.022), lactate (3.59, 1.71–7.54; P =0.001), older age (1.86, 1.03–3.38; P =0.041) and lower lymphopenia (5.44, 2.71–10.93; P <0.001) at admission. The areas under the ROC curve (AUCs) of IL-6, lymphocyte, age and lactate were 0.933, 0.928, 0.786 and 0.753 respectively. The AUC of IL-6 was significantly higher than that of age ( z =3.332, P =0.0009) and lactate ( z =4.441, P <0.0001) for outcome prediction. There was no significant difference between the AUCs of IL-6 and lymphocyte for outcome prediction ( z =0.372, P =0.7101). It was concluded that the potential risk factors of higher IL-6, lactate, older age and lower lymphopenia at admission could help clinicians to identify patients with poor prognosis at an early stage.

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Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients

Cited by 8 publications

References 39 publications

Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea

Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea

Admission Lactate Concentration, Base Excess, and Alactic Base Excess Predict the 28-Day Inward Mortality in Shock Patients

Early Warning Factors of Death in COVID-19 Patients

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