Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment

Papadimitriou-Olivgeris, Matthaios; Gkikopoulos, Nikitas; Wüst, Melissa; Ballif, Aurelie; Simonin, Valentin; Maulini, M; Nusbaumer, Charly; Monnerat, Luce Bertaiola; Tschopp, Jonathan; Kampouri, Eleftheria; Wilson, Patrick C.; Duplain, Hervé

doi:10.1016/j.ejim.2019.12.022

Cited by 24 publications

(21 citation statements)

References 20 publications

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“…Pneumonia on infection presentation was very frequent, in line with more recent reports [9][10][11][12][13][14][15][16][17], revealing how an important proportion of patients showed a direct viral injury in lung parenchyma and/or bacterial co-infection. However, despite being a life-threatening condition, it was neither predictive of NIV use nor of IHD.…”

Section: Discussionsupporting

confidence: 84%

“…Overall, the number of hospitalizations over the study period was remarkable comparing to recent reports [9], showing that over two years one out of five admissions with influenza and/or RSV infections involved oldest-old. Moreover, in our study, hospital-acquired influenza and/or RSV infections were not identified as predictors of pneumonia, use of NIV, and IHD for patients aged 65 years and older, moving away from evidence available so far [9,10].…”

Section: Discussioncontrasting

confidence: 77%

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Influenza and respiratory syncytial virus infections in the oldest-old continent

Boattini

Almeida

Christaki

et al. 2020

Eur J Clin Microbiol Infect Dis

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SARS-CoV-2 dramatically revealed the sudden impact of respiratory viruses in our lives. Influenza and respiratory syncytial virus (RSV) infections are associated with high rates of morbidity, mortality, and an important burden on healthcare systems worldwide, especially in elderly patients. The aim of this study was to identify severity predictors in the oldest-old admitted with influenza and/or RSV infections. This is a multicenter, retrospective study of all oldest-old patients (≥ 85 years old) admitted for laboratory-confirmed influenza and/or RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons. The outcomes included the following: pneumonia on infection presentation, use of non-invasive ventilation (NIV), and in-hospital death (IHD). The association with possible predictors, including clinical features and type of virus infection, was assessed using uni-and multivariable analyses. A total of 251 oldest-old patients were included in the study. Pneumonia was evident in 32.3% (n = 81). NIV was implemented in 8.8% (n = 22), and IHD occurred in 13.9% (n = 35). Multivariable analyses revealed that chronic obstructive pulmonary disease (COPD) or asthma was associated with pneumonia (OR 1.86; 95% CI 1.02-3.43; p = 0.045). COPD or asthma (OR 4.4; 95% CI 1.67-11.6; p = 0.003), RSV (OR 3.12; 95% CI 1.09-8.92; p = 0.023), and influenza B infections (OR 3.77; 95% CI 1.06-13.5; p = 0.041) were associated with NIV use, respectively, while chronic kidney disease was associated with IHD (OR 2.50; 95% CI 1.14-5.51; p = 0.023). Among the oldest-old, chronic organ failure, such as COPD or asthma, and CKD predicted pneumonia and IHD, respectively, beyond the importance of viral virulence itself. These findings could impact on public health policies, such as fostering influenza immunization campaigns, home-based care programs, and end-of-life care. Filling knowledge gaps is crucial to set priorities and advise on transition model of care that best fits the oldest-old.

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Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 77%

Influenza and respiratory syncytial virus infections in the oldest-old continent

Boattini

Almeida

Christaki

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…24,25,26,27,28 We considered CURB-65 to be predictive of poor prognosis when three of the five variables (confusion, BUN >7 mmol/L, respiratory rate ≥30 bpm, systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg, and age ≥65 years) were positive. 21,22,23,24 The MuLBSTA score is a newly designed score for viral pneumonia 11 points or more is related with poor prognosis, as defined in the original study. 11 qSOFA was considered positive when two of the three variables (altered mental status, respiratory rate ≥22 brpm, and/or systolic blood pressure <100 mmHg) were met, according to the Sepsis-3 definition.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…Recent works indicate that qSOFA is also a useful tool for identifying patients with poor prognoses in viral infections such as influenza. 20,21,22 In addition, qSOFA has shown good performance in predicting prognosis in pneumonia, both in the emergency department 23,24,25,26,27 and in wards. 28 The advantage of the qSOFA score is that the variables are clinical and thus laboratory tests are not required.…”

Section: Introductionmentioning

confidence: 99%

Severity scores in COVID-19 pneumonia: a multicenter, retrospective, cohort study

Artero

Madrazo

Fernández-Garcés

et al. 2020

Preprint

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BackgroundIdentification of patients on admission to hospital with Coronavirus infectious disease 2019 (COVID-19) pneumonia who can develop poor outcomes have not yet ben comprehensively assessed.ObjectiveTo compare severity scores used for community acquired pneumonia to identify high-risk patients.DesignPSI, CURB-65, qSOFA and MuLBSTA, a new score for viral pneumonia, were calculated on admission to hospital to identify high-risk patients for in-hospital mortality. Area under receiver operating characteristics curve (AUROC), sensitivity and specificity for each score were determined and AUROC were compared among them.ParticipantsPatients with COVID-19 pneumonia included in the SEMI-COVID-19 Network.Key resultsWe examined 10,238 patients with COVID-19. Mean age of patients was 66.6 years and 57.9% were males. The most common comorbidities were: hypertension (49.2%), diabetes (18.8%) and chronic obstructive pulmonary disease (12.8%). Acute respiratory distress syndrome (34.7%) and acute kidney injury (13.9%) were the most common complications. In-hospital mortality was 20.9%. PSI and CURB-65 showed the highest AUROC (0.835 and0.825, respectively). qSOFA and MuLBSTA had a lower AUROC (0.728 and 0.715, respectively). qSOFA was the most specific score (specificity 95.7%) albeit its sensitivity was only 26.2%. PSI had the highest sensitivity (84.1%) and a specificity of 72.2%.ConclusionsPSI and CURB-65, specific severity scores for pneumonia, were the best scores for COVID-19 pneumonia and were better than qSOFA and MuLBSTA. Additionally, qSOFA, the simplest score to perform, was the most specific albeit the least sensitive.

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“…In our study, the risk of mechanical ventilation increased with higher score values for NEWS, CRB-65 and qSOFA. qSOFA has been proven a useful predictor of mortality among patients with suspected infection [9], mainly of bacterial aetiology [20], but also influenza [21,22]. We opted for including qSOFA in our final multivariate analysis, since it is widely used by clinicians in our institution, and is quick and easy to apply.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, risk factors and clinical course of SARS-CoV-2 infected patients in a Swiss university hospital: An observational retrospective study

Regina

Papadimitriou-Olivgeris

Burger

et al. 2020

PLoS ONE

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Background This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital. Methods This retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days. Results 145 patients were included in the multivariate model, of whom 36 (24.8%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9·5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation with age (OR 1.09 per year, 95% CI 1.03–1.16, p = 0.002), in males (OR 6.99, 95% CI 1.68–29.03, p = 0.007), in patients who presented with a qSOFA score ≥2 (OR 7.24, 95% CI 1.64–32.03, p = 0.009), with bilateral infiltrate (OR 18.92, 3.94–98.23, p<0.001) or with a CRP of 40 mg/l or greater (OR 5.44, 1.18–25.25; p = 0.030) on admission. Patients with more than seven days of symptoms on admission had decreased odds of mechanical ventilation (0.087, 95% CI 0.02–0.38, p = 0.001). Conclusions This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Age, male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.

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Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment

Cited by 24 publications

References 20 publications

Influenza and respiratory syncytial virus infections in the oldest-old continent

Influenza and respiratory syncytial virus infections in the oldest-old continent

Severity scores in COVID-19 pneumonia: a multicenter, retrospective, cohort study

Epidemiology, risk factors and clinical course of SARS-CoV-2 infected patients in a Swiss university hospital: An observational retrospective study

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