Novel avian-origin influenza A (H7N9) in critically ill patients in China*
Yi Yang1, Fengmei Guo, Wei Zhao
11Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China. 2Department of Critical Care Medicine, the Second Affiliated Hospital of Southeast University, Nanjing, People's Republic of China. 3Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, People's Republic of China. 4Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China. 5Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China. 6Department of Respiratory Medicine, Nanjing General Hospital of Nanjing Military Command, People's Liberation Army, Nanjing, People's Republic of China. 7Department of Infectious Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China. 8Department of Critical Care Medicine, the First Affiliated Hospital of Suzhou University, Suzhou, People's Republic of China. 9Department of Critical Care Medicine, Wuxi People's Hospital, Wuxi, People's Republic of China. 10Department of Critical Care Medicine, Zhenjiang First People's Hospital, Zhenjiang, People's Republic of China. 11Department of Critical Care Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, People's Republic of China. 12Department of Critical Care Medicine, Yancheng City No. 1 People's Hospital, Yancheng, People's Republic of China. 13Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University (Nanjing First Hospital), Nanjing, People's Republic of China. 14Department of Respiratory Medicine, Nanjing Drum Tower Hospital, Nanjing, People's Republic of China. 15Department of Respiratory Medicine, the First Affiliated Hospital of Suzhou University, Suzhou, People's Republic of China. 16Department of Critical Care Medicine, Nanjing General Hospital of Nanjing Military C
Objectives:
In March 2013, human infection with a novel avian-origin reassortment influenza A (H7N9) virus was identified in China. A total of 26 cases were confirmed and treated in Jiangsu. All the patients had findings consistent with pneumonia and were admitted to an ICU, which pose a threat to human health. We aimed to provide the clinical features, treatment, and prognosis of the critically ill patients with H7N9 viral infection.
Design:
A retrospective cohort study.
Setting:
Eight closed ICUs in general hospitals distributed throughout the Jiangsu Provincial, China.
Patients:
Patients infected with influenza A (H7N9) virus from March 20, 2013, through May 1, 2013, in Jiangsu Province were included.
Interventions:
None.
Measurements And Main Results:
Twenty-seven patients infected with H7N9 virus were identified in Jiangsu. Of these, 26 were hospitalized. The median age was 54.5 years, and 18 patients (69.2%) were men. The most common symptoms at the onset of illness were high fever and cough. White cell counts were normal or decreased. All the patients had findings consistent with pneumonia. Twenty-four patients (92.3%) developed acute respiratory distress syndrome, and 10 (38.5%) developed septic shock quickly after the onset of illness. Treatment with antiviral drugs was initiated in all the patients at a median of 8 days after the onset of illness. Mortality was 19.2% at 28 days and 30.8% at 90 days. Based on multiple logistic regression analysis, septic shock associated with severe hypoxemia was the only independent risk factor for mortality.
Conclusions:
Infection with novel avian-origin reassortment influenza A (H7N9) virus is characterized by high fever, cough, and severe respiratory failure and is associated with a high mortality. These data provide some general understandings for the early identification, ICU treatment, and short-term prognosis of hospitalized critical patients with H7N9.
Insights
Novel avian-origin influenza A (H7N9) virus infection caused severe pneumonia and high mortality in critically ill patients. Septic shock and hypoxemia were key risk factors for death in H7N9 cases.
Area of Science:
- Infectious Diseases
- Virology
- Critical Care Medicine
Background:
- A novel avian-origin influenza A (H7N9) virus emerged in China in March 2013.
- Human infections with H7N9 posed a significant public health threat, necessitating clinical characterization.
Purpose of the Study:
- To describe the clinical features, treatment strategies, and prognosis of critically ill patients with H7N9 infection.
- To identify risk factors associated with mortality in H7N9 cases.
Main Methods:
- Retrospective cohort study.
- Involved 26 hospitalized patients with confirmed influenza A (H7N9) virus infection in Jiangsu Province, China.
- Data collected from eight intensive care units (ICUs) between March 20 and May 1, 2013.
Main Results:
- The median age of patients was 54.5 years, with a majority being male (69.2%).
- Common symptoms included high fever and cough, leading to pneumonia in all cases.
- High rates of acute respiratory distress syndrome (92.3%) and septic shock (38.5%) were observed.
- Mortality was 19.2% at 28 days and 30.8% at 90 days.
- Septic shock and severe hypoxemia were independent risk factors for mortality.
Conclusions:
- Influenza A (H7N9) virus infection presents with severe respiratory failure and carries a high mortality rate.
- Early identification and intensive care unit (ICU) management are crucial for H7N9 patients.
- Understanding risk factors aids in predicting short-term prognosis for critical H7N9 cases.
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