Prognosis of 18 H7N9 Avian Influenza Patients in Shanghai

Abstract

PurposeTo provide prognosis of an 18 patient cohort who were confirmed to have H7N9 lung infection in Shanghai.MethodsPatients' history, clinical manifestation, laboratory test, treatment strategy and mortality were followed and recorded for data analysis.ResultsA total of 18 patients had been admitted into Shanghai Public Health Clinical Center from April 8th to July 29, 2013. 22.2% of the patients were found to have live poultry contact history and 80% were aged male patients with multiple co-morbidities including diabetes, hypertension and/or chronic obstructive pulmonary disease (COPD). This group of patients was admitted to the clinical center around 10 days after disease onset. According to laboratory examinations, increased C reactive protein (CRP), Procalcitonin (PCT), Plasma thromboplastin antecedent (PTA) and virus positive time (days) were indicative of patients' mortality. After multivariate analysis, only CRP level showed significant prediction of mortality (P = 0.013) while results of prothrombin time (PT) analysis almost reached statistical significance (P = 0.056).ConclusionsH7N9 infection induced pneumonia of different severity ranging from mild to severe pneumonia or acute lung injury/acute respiratory distress syndrome to multiple organ failure. Certain laboratory parameters such as plasma CRP, PCT, PTA and virus positive days predicted mortality of H7N9 infection and plasma CRP is an independent predictor of mortality in these patients.

Pandemic potential of avian influenza A (H7N9) viruses

“…Epidemiological studies have shown that H7N9 virus infections have affected mainly middle-aged or older individuals (Figure 2C; i.e., the median age at infection is 63 years) 19–29 . Interestingly, two-thirds of the infected individuals have been male 19, 20, 22–24, 27–29 (Figure 2C).…”

“…Interestingly, two-thirds of the infected individuals have been male 19, 20, 22–24, 27–29 (Figure 2C). The high number of cases among elderly men may reflect socio-economical differences among age groups and genders since elderly men may have frequent work-related or non-job-related contact with poultry.…”

“…The high number of cases among elderly men may reflect socio-economical differences among age groups and genders since elderly men may have frequent work-related or non-job-related contact with poultry. Most H7N9 influenza patients exhibit general influenza-like symptoms, including fever and cough, and more than half of the infections typically progress to severe pneumonia, acute respiratory distress syndrome (ARDS), and multi-organ failure 8, 11, 19, 21, 23, 25, 27, 30–38 . Most H7N9 virus-infected patients possessed at least one underlying medical condition, such as chronic obstructive pulmonary disease (COPD), diabetes, hypertension, obesity, and/or chronic lung and heart disease 19, 21–23, 25, 26, 28, 31, 39, 40 , suggesting that these comorbidities may increase the risk of severe H7N9 virus infection.…”

“…The following lines of evidence suggest that contact with live poultry is the source of human H7N9 virus infection: (i) most H7N9 patients had been exposed to live poultry prior to the onset of illness 10, 11, 19–21, 27–29, 31–33, 37–43 ; (ii) surveillance in live bird markets resulted in the isolation of H7N9 viruses with close homology to the H7N9 viruses isolated from humans in the same area 9–13, 41 ; (iii) a worker who had culled H7N9 virus-infected poultry developed a mild illness that was traced to a confirmed H7N9 virus infection 44 ; and (iv) serological surveillance of poultry workers in areas where human cases had been reported revealed antibodies to H7N9 viruses in >6% of the individuals tested, whereas no antibodies to H7N9 viruses were detected in the general population 45 . Collectively, these findings suggest an association between human H7N9 infections and poultry, likely in live bird markets, as underscored by the rapid decline in human H7N9 infections upon closure of these markets in mid-April, 2013 15–17 .…”

Genotyping and detection of common avian and human origin-influenza viruses using a portable chemiluminescence imaging microarray

“…Clinical data suggested that H7N9 caused pneumonia with various degrees of severity, acute lung injury, acute respiratory distress syndrome, and even multiple organ failure. Increased concentrations of C reactive protein were found to be closely associated with mortality (Lu et al 2014). According to published reports, the median age of patients who died of H7N9 was significantly higher than that of patients with nonfatal cases.…”