Survival From Severe Pandemic H1N1 in Urban and Rural Turkey: A Case Series

Abstract

. RESULTS: During the study period, in our ICU we followed 18 patients (10 female) with H1N1. Their median (and IQR) age was 39 y (24 -52 y), their median (and IQR) Acute Physiology and Chronic Health Evaluation (APACHE II) score was 16 (10 -25), and 7 (39%) of them lived in rural places. All 18 patients had acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The most common risk factors for severe H1N1 infection were obesity (33%), COPD (16%), and pregnancy (11%). Thirteen patients (72%) needed mechanical ventilation at ICU admission. Mortality was 50% (9/18) at day 28. Significantly more survivors were urban dwellers than rural (82% vs 0%, P < .001). There were also statistically significant differences between survivors and nonsurvivors in success of noninvasive ventilation, time to confirmation of the H1N1 virus after ICU admission, creatinine, lactate dehydrogenase, pH, P aCO 2 , and P aO 2 /F IO 2 . CONCLUSIONS: The most common clinical presentation was ALI/ARDS in H1N1 patients who needed intensive care. Living in rural areas might have affected those patients' access to advanced ICU facilities and early ventilatory support. Failure of noninvasive ventilation, late diagnosis, late antiviral therapy, high APACHE II score, and living in a rural area were associated with mortality.

General Characteristics and Prognostic Factors of Pneumonia Cases DevelopedDuringPandemic(H1N1)Influenza-AVirus InfectioninTurkey

“…However, obesity, pregnancy, and comorbid conditions such as chronic obstructive pulmonary disease (COPD) were shown to increase the severity of the disease in pandemic (H 1 N 1 ) influenza-A pneumonia (3,4). In the current study, the average age of the cases was 47.5±18.6 years and 52.1% had co-morbid diseases.…”

“…According to the literature, some patients may have a normal chest radiograph at first presentation, but may develop alveolar opacities and bilateral interstitial infiltrates on chest radiographs in the following days (12,21). It was reported that radiological findings were more often bilateral in patients who underwent mechanical ventilation due to severe respiratory failure (4,21,22). Even where no radiological evidence of disease is initially detected, radiological findings may subsequently emerge and serious respiratory failure may develop over a short period.…”

“…ARDS, multiple organ failure and mortality rate was high as expected among patients requiring ICU support. Therefore, mortality rate may differ in ICU patients and was reported to vary between 15% and 62.5% according to the centers (4,23,24). However, in some studies, the mortality rate of pandemic (H 1 N 1 ) influenza-A pneumonia cases not requiring ICU support did not differ from that of CAP with no H 1 N 1 infection (3,15).…”

Determination of the Frequency of Human Bocavirus and Other Respiratory Viruses Among 0-2 Years Age Group Children Diagnosed as Acute Bronchiolitis

“…İnfluenza ve AdV gibi diğer solunum virusları da mevsimsel epidemiler sırasında nadiren akut bronşiyolit ve hospitalizasyonun önemli sebebi olarak rapor edilmektedir 16 . 25,26 . Çalışma-daki örneklerin toplanma periyodu, influenza A H1N1 pandemisine denk gelmiş olup, bu virus RV ile aynı oranda (%29), RSV'den sonra en sık saptanan ikinci virus olmuştur.…”

Morbilidad y mortalidad asociada a hospitalizaciones por influenza pandémica A (H1N1) 2009 en dos hospitales de la Región Metropolitana y evaluación de su impacto económico

“…Diversos autores han explorado la importancia de este aspecto y no han logrado mayoritariamente encontrar una asociación con la gravedad de la evolución del cuadro de influenza o un desenlace fatal 11,13,16,21 . No obstante, una serie española con más de 500 pacientes adultos logró demostrar que el tratamiento antiviral hasta las 72 h del inicio de los síntomas, tuvo un efecto protector sobre ingreso a UCI o muerte (OR 0,32) 22 .…”