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- Title
Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome.
- Authors
Álvarez-Lerma, Francisco; Marín-Corral, Judith; Vila, Clara; Masclans, Joan Ramón; González de Molina, Francisco Javier; Martín Loeches, Ignacio; Barbadillo, Sandra; Rodríguez, Alejandro; H1N1 GETGAG/SEMICYUC Study Group
- Abstract
<bold>Background: </bold>Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU.<bold>Methods: </bold>A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis.<bold>Results: </bold>In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001).<bold>Conclusions: </bold>Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.
- Subjects
SPAIN; INFLUENZA diagnosis; CATASTROPHIC illness; CHI-squared test; DIAGNOSIS; LENGTH of stay in hospitals; INTENSIVE care units; LONGITUDINAL method; MEDICAL errors; NONPARAMETRIC statistics; LOGISTIC regression analysis; INFLUENZA A virus, H1N1 subtype; HOSPITAL mortality; ODDS ratio
- Publication
Critical Care, 2016, Vol 20, p337
- ISSN
1364-8535
- Publication type
journal article