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Epidemiology, Clinical Features, and Prognosis of Elderly Adults with Severe Forms of Influenza A ( H 1 N 1)
Author(s) -
GarnachoMontero José,
GutiérrezPizarraya Antonio,
Márquez Juan A.,
Zaragoza Rafael,
Granada Rosa,
RuizSantana Sergio,
Rello Jordi,
Rodríguez Alejandro
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12152
Subject(s) - medicine , epidemiology , confidence interval , odds ratio , intensive care unit , hazard ratio , confounding , influenza vaccine , observational study , multivariate analysis , immunology , vaccination
Objectives To examine epidemiological and clinical data of individuals aged 65 and older with influenza virus A ( H 1 N 1) admitted to the intensive care unit ( ICU ) and to identify independent predictors of ICU mortality. Design Prospective, observational, multicenter study to determine prognostic factors in individuals infected with influenza A ( H 1 N 1) admitted to the ICU . Setting One hundred forty‐eight S panish ICU s. Participants Individuals with influenza A ( H 1 N 1) confirmed using real‐time polymerase chain reaction from A pril 2009 to J uly 2011. Measurements Individuals aged 65 and older were compared with younger individuals. A multivariate analysis was conducted to determine independent predictors of mortality in this population. Results One thousand one hundred twenty individuals (129 (11.5%) aged ≥65) were included. Prevalence of chronic diseases was more common in older individuals. Viral pneumonitis was more frequent in individuals younger than 65 (70.5% vs 54.3%, P < .001). In older individuals, A cute P hysiology and C hronic H ealth E valuation II score (odds ratio ( OR ) = 1.11, 95% confidence interval ( CI ) = 1.11–1.20, P = .002), immunosuppression ( OR = 3.66, 95% CI , 1.33–10.03, P = .01) and oseltamivir therapy initiated after 48 hours ( OR = 3.32, 95% CI = 1.02–10.8, P = .04) were identified as independent variables associated with mortality. Corticosteroid use was associated with a trend toward greater mortality ( OR = 2.39, 95% CI = 0.98–5.91, P = .06). Conclusion Individuals aged 65 and older with influenza A ( H 1 N 1) admitted to the ICU have a higher incidence of underlying diseases than younger individuals and differences in clinical presentation. Early oseltamivir therapy is associated with better outcomes in elderly adults.