• Susana Garcia Gutierrez, José Maria Quintana, Maretva Baricot, Amaia Bilbao, Alberto Capelastegui, Carlos Gustavo Cilla Eguiluz, Angela Domínguez, Jesús Castilla, Pere Godoy, Miguel Delgado-Rodríguez, Núria Soldevila, Jenaro Astray, José María Mayoral, Vicente Martín, Fernando González-Candelas, Juan Carlos Galán, Sonia Tamames, Ady Angélica Castro-Acosta, Olatz Garín, Tomás Pumarola, and CIBERESP Cases and Controls in Pandemic Influenza Working Group, Spain.
• Unidad de Investigación, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo (Osakidetza), , Galdakao, Bizkaia, Spain.
• Emerg Med J. 2014 Apr 1;31(4):301-7.

PurposeTo identify risk factors present at admission in adult patients hospitalised due to influenza virus infection during the 2009/10 and 2010/11 seasons--including whether infection was from pandemic or seasonal influenza A infections--that were associated with the likelihood of developing severe pneumonia with multilobar involvement and shock.MethodsProspective cohort study. Patients hospitalised due to influenza virus infection were recruited. We collected information on sociodemographic characteristics, pre-existing medical conditions, vaccinations, toxic habits, previous medications, exposure to social environments, and EuroQoL-5D (EQ-5D). Severe pneumonia with multilobar involvement and/or shock (SPAS) was the primary outcome of interest. We constructed two multivariate logistic regression models to explain the likelihood of developing SPAS and to create a clinical prediction rule for developing SPAS that includes clinically relevant variables.ResultsLaboratory-confirmed A(H1N1)pdm09, EQ-5D utility score 7 days before admission, more than one comorbidity, altered mental status, dyspnoea on arrival, days from onset of symptoms, and influenza season were associated with SPAS. In addition, not being vaccinated against seasonal influenza in the previous year, anaemia, altered mental status, fever and dyspnoea on arrival at hospital, difficulties in performing activities of daily living in the previous 7 days, and days from onset of symptoms to arrival at hospital were related to the likelihood of SPAS (area under the curve value of 0.75; Hosmer-Lemeshow p value of 0.84).ConclusionsThese variables should be taken into account by physicians evaluating a patient affected by influenza as additional information to that provided by the usual risk scores.

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