• Journal of critical care · Dec 2018

    Multicenter Study Observational Study

    Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit.

    • José Garnacho-Montero, Cristina León-Moya, Antonio Gutiérrez-Pizarraya, Angel Arenzana-Seisdedos, Loreto Vidaur, José Eugenio Guerrero, Mónica Gordón, Ignacio Martín-Loeches, Alejandro Rodriguez, and on Behalf GETGAG Study Group.
    • Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Instituto de Biomedicina. Sevilla (IBIS), Seville, Spain. Electronic address: jgarnachom@gmail.com.
    • J Crit Care. 2018 Dec 1; 48: 172-177.

    PurposeInformation about immunocompromised patients infected with influenza A (H1N1) virus and requiring admission to the ICU is lacking. Our objective was to know the clinical characteristics of these patients and to identify treatment-related variables associated with mortality.Material And MethodsA prospective multicenter observational cohort study was based on data from a Spanish registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU with the diagnosis of influenza A (H1N1) virus infection were included. Immunosuppression was clearly defined. Factors associated with mortality in immunocompromised patients were assessed by conventional logistic regression analysis and by a propensity score (PS) adjusted-multivariable analysis.ResultsOf 1899 patients with influenza A (H1N1) infection, 238 (12.5%) were classified as immunocompromised. Mortality was significantly higher in immunosuppressed patients. Four variables independently associated with mortality were identified: SOFA score, need of vasopressor, use of corticosteroids, and acute renal failure, AKIN 3 stage. In the PS-adjusted model, corticosteroid therapy remained as an independent factor associated with increased mortality (OR 2.25;95%CI, 1.15-4.38;p = 0.017). In the subgroup of hematological patients (n = 141), corticosteroid therapy was also associated with increased mortality (OR 3.12; 95%CI, 1.32-7.41; p = 0.010).ConclusionImmunocompromised individuals with influenza A (H1N1) admitted to the ICU have a poor outcome. In this population, the use of corticosteroids is strongly discouraged.Copyright © 2018 Elsevier Inc. All rights reserved.

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