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Chen L, Hua J, He X. Bioinformatics analysis identifies a key gene HLA_DPA1 in severe influenza-associated immune infiltration. BMC Genomics 2024; 25:257. [PMID: 38454348 PMCID: PMC10918912 DOI: 10.1186/s12864-024-10184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Severe influenza is a serious global health issue that leads to prolonged hospitalization and mortality on a significant scale. The pathogenesis of this infectious disease is poorly understood. Therefore, this study aimed to identify the key genes associated with severe influenza patients necessitating invasive mechanical ventilation. METHODS The current study utilized two publicly accessible gene expression profiles (GSE111368 and GSE21802) from the Gene Expression Omnibus database. The research focused on identifying the genes exhibiting differential expression between severe and non-severe influenza patients. We employed three machine learning algorithms, namely the Least Absolute Shrinkage and Selection Operator regression model, Random Forest, and Support Vector Machine-Recursive Feature Elimination, to detect potential key genes. The key gene was further selected based on the diagnostic performance of the target genes substantiated in the dataset GSE101702. A single-sample gene set enrichment analysis algorithm was applied to evaluate the participation of immune cell infiltration and their associations with key genes. RESULTS A total of 44 differentially expressed genes were recognized; among them, we focused on 10 common genes, namely PCOLCE2, HLA_DPA1, LOC653061, TDRD9, MPO, HLA_DQA1, MAOA, S100P, RAP1GAP, and CA1. To ensure the robustness of our findings, we employed overlapping LASSO regression, Random Forest, and SVM-RFE algorithms. By utilizing these algorithms, we were able to pinpoint the aforementioned 10 genes as potential biomarkers for distinguishing between both cases of influenza (severe and non-severe). However, the gene HLA_DPA1 has been recognized as a crucial factor in the pathological condition of severe influenza. Notably, the validation dataset revealed that this gene exhibited the highest area under the receiver operating characteristic curve, with a value of 0.891. The use of single-sample gene set enrichment analysis has provided valuable insights into the immune responses of patients afflicted with severe influenza that have further revealed a categorical correlation between the expression of HLA_DPA1 and lymphocytes. CONCLUSION The findings indicated that the HLA_DPA1 gene may play a crucial role in the immune-pathological condition of severe influenza and could serve as a promising therapeutic target for patients infected with severe influenza.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical College of Nanjing University, No 188, Lingshan North Road, Qixia District, Nanjing, 210046, China.
| | - Jie Hua
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaopu He
- Department of Geriatric Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Chen L, Hua J, He X. Genetic analysis of cuproptosis subtypes and immunological features in severe influenza. Microb Pathog 2023; 180:106162. [PMID: 37207785 DOI: 10.1016/j.micpath.2023.106162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/21/2023]
Abstract
The mechanisms regulating cuproptosis in severe influenza are still unknown. We aimed to identify the molecular subtypes of cuproptosis and immunological characteristics associated with severe influenza in patients requiring invasive mechanical ventilation (IMV). The expression of cuproptosis modulatory factors and immunological characteristics of these patients were analyzed using the public datasets (GSE101702, GSE21802, and GSE111368) from the Gene Expression Omnibus (GEO). Seven cuproptotic-associated genes (ATP7B, ATP7A, FDX1, LIAS, DLD, MTF1, DBT) related to active immune responses were identified in patients suffering from severe and non-severe influenza and two cuproptosis-associated molecular subtypes were discovered in severe influenza patients. Singe-set gene set expression analysis (SsGSEA) indicated that compared with subtype 2, subtype 1 was characterized by reduced adaptive cellular immune responses and increased neutrophil activation. Gene set variation assessment revealed that cluster-specific differentially expressed genes (DEGs) in subtype 1 were involved in autophagy, apoptosis, oxidative phosphorylation, and T cell, immune, and inflammatory responses, amongst others. The random forest (RF) model revealed the most differentiating efficiency with relatively small residual and root mean square error and an increased area under the curve value (AUC = 0.857). Lastly, a five-gene-based RF model (CD247, GADD45A, KIF1B, LIN7A, HLA_DPA1) was established, which showed satisfactory efficiency in the test datasets GSE111368 (AUC = 0.819). Nomogram calibration and decision curve analysis demonstrated its accuracy for the prediction of severe influenza. This study suggests that cuproptosis might be associated with the immunopathology of severe influenza. Additionally, an efficient model for the prediction of cuproptosis subtypes was developed which will contribute to the prevention and treatment of severe influenza patients needing IMV.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China.
| | - Jie Hua
- Department of Gastroenterology, Liyang People's Hospital, Liyang Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Xiaopu He
- Department of Geriatric Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Huang W, Niu W, Chen H, Jiang W, Fu Y, Li X, Li M, Hua J, Hu C. Development of a nomogram for severe influenza in previously healthy children: a retrospective cohort study. J Int Med Res 2023; 51:3000605231153768. [PMID: 36802862 PMCID: PMC9941605 DOI: 10.1177/03000605231153768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE We aimed to develop a nomogram to predict the risk of severe influenza in previously healthy children. METHODS In this retrospective cohort study, we reviewed the clinical data of 1135 previously healthy children infected with influenza who were hospitalized in the Children's Hospital of Soochow University between 1 January 2017 and 30 June 2021. Children were randomly assigned in a 7:3 ratio to a training or validation cohort. In the training cohort, univariate and multivariate logistic regression analyses were used to identify risk factors, and a nomogram was established. The validation cohort was used to evaluate the predictive ability of the model. RESULT Wheezing rales, neutrophils, procalcitonin > 0.25 ng/mL, Mycoplasma pneumoniae infection, fever, and albumin were selected as predictors. The areas under the curve were 0.725 (95% CI: 0.686-0.765) and 0.721 (95% CI: 0.659-0.784) for the training and validation cohorts, respectively. The calibration curve showed that the nomogram was well calibrated. CONCLUSION The nomogram may predict the risk of severe influenza in previously healthy children.
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Affiliation(s)
- Wenyun Huang
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Wensi Niu
- Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Hongmei Chen
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Wujun Jiang
- Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Yanbing Fu
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Xiuxiu Li
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Minglei Li
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
| | - Jun Hua
- Department of Emergency Medicine, Children's Hospital of Soochow University, Suzhou, China,Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China,Jun Hua, Children’s Hospital of Soochow University, No. 92 Zhongnan Street, Suzhou Industrial Park, Suzhou, Jiangsu 215025, China.
| | - Chunxia Hu
- Department of Pediatrics, Suzhou Wujiang District Children’s Hospital (Children's Hospital of Soochow University Wujiang Branch), Suzhou, China
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Chen L, Hua J, He X. Co-expression network analysis identifies potential candidate hub genes in severe influenza patients needing invasive mechanical ventilation. BMC Genomics 2022; 23:703. [PMID: 36243706 PMCID: PMC9569050 DOI: 10.1186/s12864-022-08915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Influenza is a contagious disease that affects people of all ages and is linked to considerable mortality during epidemics and occasional outbreaks. Moreover, effective immunological biomarkers are needed for elucidating aetiology and preventing and treating severe influenza. Herein, we aimed to evaluate the key genes linked with the disease severity in influenza patients needing invasive mechanical ventilation (IMV). Three gene microarray data sets (GSE101702, GSE21802, and GSE111368) from blood samples of influenza patients were made available by the Gene Expression Omnibus (GEO) database. The GSE101702 and GSE21802 data sets were combined to create the training set. Hub indicators for IMV patients with severe influenza were determined using differential expression analysis and Weighted correlation network analysis (WGCNA) from the training set. The receiver operating characteristic curve (ROC) was also used to evaluate the hub genes from the test set's diagnostic accuracy. Different immune cells' infiltration levels in the expression profile and their correlation with hub gene markers were examined using single-sample gene set enrichment analysis (ssGSEA). RESULTS In the present study, we evaluated a total of 447 differential genes. WGCNA identified eight co-expression modules, with the red module having the strongest correlation with IMV patients. Differential genes were combined to obtain 3 hub genes (HLA-DPA1, HLA-DRB3, and CECR1). The identified genes were investigated as potential indicators for patients with severe influenza who required IMV using the least absolute shrinkage and selection operator (LASSO) approach. The ROC showed the diagnostic value of the three hub genes in determining the severity of influenza. Using ssGSEA, it has been revealed that the expression of key genes was negatively correlated with neutrophil activation and positively associated with adaptive cellular immune response. CONCLUSION We evaluated three novel hub genes that could be linked to the immunopathological mechanism of severe influenza patients who require IMV treatment and could be used as potential biomarkers for severe influenza prevention and treatment.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Jie Hua
- Department of Gastroenterology, Liyang People's Hospital, Liyang Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Xiaopu He
- Department of Geriatric Gastroenterology, The First Affiliated Hospital With Nanjing Medical University, No.300 Guangzhou Road, Nanjing city, 210029, Jiangsu Province, China.
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Rouzé A, Lemaitre E, Martin-Loeches I, Povoa P, Diaz E, Nyga R, Torres A, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Boulle Geronimi C, Luyt CE, Nyunga M, Pouly O, Thille AW, Megarbane B, Saade A, Magira E, Llitjos JF, Ioannidou I, Pierre A, Reignier J, Garot D, Kreitmann L, Baudel JL, Voiriot G, Plantefeve G, Morawiec E, Asfar P, Boyer A, Mekontso-Dessap A, Makris D, Vinsonneau C, Floch PE, Marois C, Ceccato A, Artigas A, Gaudet A, Nora D, Cornu M, Duhamel A, Labreuche J, Nseir S. Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study. Crit Care 2022; 26:11. [PMID: 34983611 PMCID: PMC8724752 DOI: 10.1186/s13054-021-03874-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/17/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. OBJECTIVES To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. METHODS This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. RESULTS A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53-7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88-5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. CONCLUSIONS Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693 .
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Affiliation(s)
- Anahita Rouzé
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France
- INSERM U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, 59000, Lille, France
| | - Elise Lemaitre
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
- Department of Clinical medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Emili Diaz
- Critical Care Department, Hospital Universitari Parc Tauli, Sabadell, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rémy Nyga
- Service de médecine intensive réanimation, CHU Amiens Picardie, 80000, Amiens, France
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Matthieu Metzelard
- Service de médecine intensive réanimation, CHU Amiens Picardie, 80000, Amiens, France
| | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
| | - Fabien Lambiotte
- Service de réanimation polyvalente, Centre hospitalier de Valenciennes, Valenciennes, France
| | - Fabienne Tamion
- Medical Intensive Care Unit, UNIROUEN, Inserm U1096, FHU- REMOD-VHF, Rouen University Hospital, 76000, Rouen, France
| | - Marie Labruyere
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Claire Boulle Geronimi
- Service de réanimation et de soins intensifs, Centre hospitalier de Douai, Douai, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris Cedex 13, France
| | - Martine Nyunga
- Service de réanimation, Centre hospitalier de Roubaix, Roubaix, France
| | - Olivier Pouly
- Service de médecine intensive réanimation, Hôpital Saint Philibert GHICL, Université catholique, Lille, France
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris University, Paris, France
| | - Anastasia Saade
- Service de médecine intensive réanimation, Hôpital Saint-Louis, 75010, Paris, France
| | - Eleni Magira
- First Department of Critical Care Medicine, Medical School, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jean-François Llitjos
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Iliana Ioannidou
- First Department of Pulmonary Medicine and Intensive Care Unit, Sotiria Chest Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandre Pierre
- Service de réanimation polyvalente, Centre Hospitalier de Lens, Lens, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | - Denis Garot
- Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, 37044, Tours Cedex 9, France
| | - Louis Kreitmann
- Service de Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437, Lyon Cedex 03, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012, Paris, France
| | - Guillaume Voiriot
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Gaëtan Plantefeve
- Service de réanimation polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Elise Morawiec
- Service de Médecine Intensive-Réanimation et Pneumologie, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Inserm UMRS Neurophysiologie respiratoire expérimentale et clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Pierre Asfar
- Département de Médecine Intensive Réanimation, CHU d'Angers, 49933, Angers Cedex 9, France
| | - Alexandre Boyer
- Service de médecine intensive réanimation, CHU de Bordeaux, 33000Bordeaux, France
| | - Armand Mekontso-Dessap
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, CARMAS ; INSERM U955, Institut Mondor de recherche Biomédicale, Université Paris Est Créteil, 94010, Créteil, France
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
| | | | | | - Clémence Marois
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Sorbonne Université, Paris, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France
| | - Adrian Ceccato
- Intensive Care Unit, IDIBAPS, CIBERES, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Antonio Artigas
- Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Alexandre Gaudet
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Univ. Lille, Lille, France
| | - David Nora
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Marjorie Cornu
- INSERM U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, 59000, Lille, France
- Institut de Microbiologie, Service de Parasitologie Mycologie, CHU Lille, Pôle de Biologie-Pathologie-Génétique, 59000, Lille, France
| | - Alain Duhamel
- ULR 2694-METRICS : Evaluation des technologies de santé et des pratiques médicales, Univ. Lille, 59000, Lille, France
- Biostatistics Department, CHU de Lille, 59000, Lille, France
| | - Julien Labreuche
- ULR 2694-METRICS : Evaluation des technologies de santé et des pratiques médicales, Univ. Lille, 59000, Lille, France
- Biostatistics Department, CHU de Lille, 59000, Lille, France
| | - Saad Nseir
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France.
- INSERM U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, 59000, Lille, France.
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Qiu L, Wu XW, Zhang SY, Yang M, Zhang SX, Fu JY, Li C, Zhang ZJ, Zheng PY, Lu ZH. Evaluation of efficacy and safety of Qiangzhu-qinggan formula as an adjunctive therapy in adult patients with severe influenza: study protocol for a randomized parallel placebo-controlled double-blind multicenter trial. Trials 2021; 22:955. [PMID: 34961550 PMCID: PMC8710932 DOI: 10.1186/s13063-021-05929-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background Influenza can fall into three categories according to severity: mild influenza, severe influenza, and critical influenza. Severe influenza can result in critical illness and sometimes death particularly in patients with comorbidities, advanced age, or pregnancy. Neuraminidase inhibitors (NAIs) are the only antiviral drugs in widespread use for influenza. However, the effectiveness of NAIs against severe influenza is uncertain. New effective drugs or regimens are therefore urgently needed. Qiangzhu-qinggan (QZQG) formula has been found to be effective against influenza virus infection during long-term application in China, which lacks support of evidence-based clinical trial till now. This study is designed to assess the efficacy and safety of QZQG formula as an adjuvant therapy in adult patients with severe influenza. Methods This protocol is drawn up in accordance with the SPIRIT guidelines and CONSORT Extension for Chinese herbal medicine formulas. This is a randomized, placebo-controlled, double-blind, multicenter trial. Two hundred twenty-eight adults with severe influenza are randomly assigned in a 1:1 ratio to QZQG or placebo for 7 days. All participants need to receive 1 day of screening before randomization, 7 days of intervention, and 21 days of observation after randomization. The primary outcome is the proportion of clinical improvement, defined as the proportion of patients who met the criteria of 3 points or less in the seven-category ordinal scale or 2 points or less in National Early Warning Score 2 within 7 days after randomization. Discussion This is the first randomized, controlled, parallel, double-blind clinical trial to evaluate the efficacy and safety of traditional Chinese herbal formula granules as an adjuvant therapy in adult patients with severe influenza. This study aims to redefine the value of traditional Chinese herbal medicines in the treatment of virus-related respiratory infectious diseases and serves as an example of evidence-based clinical trials of other Chinese herbal medicines. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05929-8.
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Affiliation(s)
- Lei Qiu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Xian-Wei Wu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Shao-Yan Zhang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Ming Yang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Shun-Xian Zhang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Ji-You Fu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Cui Li
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Zhi-Jie Zhang
- Department of Epidemiology, School of Public Health, Fudan University, 130 Dongan Road, No.8 building, Xuhui District, Shanghai, People's Republic of China
| | - Pei-Yong Zheng
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China.
| | - Zhen-Hui Lu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China.
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Grupo de Trabajo Gripe A Grave (GETGAG) de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC). Spanish Influenza Score (SIS): Usefulness of machine learning in the development of an early mortality prediction score in severe influenza. Med Intensiva 2021; 45:69-79. [PMID: 32798052 DOI: 10.1016/j.medin.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To develop a mortality prediction score (Spanish Influenza Score [SIS]) for patients with severe influenza considering only variables at ICU admission, and compare its performance respect of Random Forest (RF). DESIGN Sub-analysis from the GETGAG/SEMICYUC database. SCOPE Intensive Care Medicine. PATIENTS Patients admitted to 184 Spanish ICUs (2009-2018) with influenza infection Intervention: None. VARIABLES Demographic data, severity of illness, times from symptoms onset until hospital admission (Gap-H), hospital to ICU (Gap-ICU) or hospital to diagnosis (Gap-Dg), antiviral vaccination, number of quadrants infiltrated, acute renal failure, invasive or noninvasive ventilation, shock and comorbidities. The study variable cut-off points and importance were obtained automatically. Logistic regression analysis with cross-validation was performed to develop the SIS score using the output coefficients. Accuracy and discrimination (AUC-ROC) were applied to evaluate SIS and RF. All analyses were performed using R (CRAN-R Project). RESULTS A total of 3959 patients were included. The mean age was 55 years (range 43-67), 60% were men, APACHE II 16 (12-21) and SOFA 5 (4-8), with ICU mortality 21.3%. Mechanical ventilation, shock, APACHE II, SOFA, acute renal failure and Gap-ICU were included in the SIS. The latter was generated according to the ORs obtained by logistic regression, and showed an accuracy of 83% with an AUC-ROC of 82%, similar to RF (AUC-ROC 82%). CONCLUSIONS The SIS score is easy to apply and shows adequate capacity to stratify the risk of ICU mortality. However, further studies are needed to validate the tool prospectively.
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Xu Z, Zhou J, Huang Y, Liu X, Xu Y, Chen S, Liu D, Lin Z, Liu X, Li Y. Efficacy of convalescent plasma for the treatment of severe influenza. Crit Care 2020; 24:469. [PMID: 32727526 PMCID: PMC7388480 DOI: 10.1186/s13054-020-03189-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Convalescent plasma administration may be of clinical benefit in patients with severe influenza, but reports on the efficacy of this therapy vary. METHODS We conducted a systematic review and meta-analysis assessing randomized controlled trials (RCTs) involving the administration of convalescent plasma to treat severe influenza. Healthcare databases were searched in February 2020. All records were screened against eligibility criteria, and the risks of bias were assessed. The primary outcome was the fatality rate. RESULTS A total of 2861 studies were retrieved and screened. Five eligible RCTs were identified. Pooled analyses yielded no evidence that using convalescent plasma to treat severe influenza resulted in significant reductions in mortality (odds ratio, 1.06; 95% CI, 0.51-2·23; P = 0.87; I2 = 35%), number of days in the intensive care unit, or number of days on mechanical ventilation. This treatment may have the possible benefits of increasing hemagglutination inhibition titers and reducing influenza B viral loads and cytokine levels. No serious adverse events were reported. The included studies were generally of high quality with a low risk of bias. CONCLUSIONS The administration of convalescent plasma appears safe but may not reduce the mortality, number of days in the intensive care unit, or number of days on mechanical ventilation in patients with severe influenza.
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Affiliation(s)
- Zhiheng Xu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Jianmeng Zhou
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Yongbo Huang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Xuesong Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Sibei Chen
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Dongdong Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China.
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, 151 Yanjiang Street, West Guangzhou, 510120, Guangdong, China.
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Basile L, Torner N, Martínez A, Mosquera M, Marcos M, Jane M. Seasonal influenza surveillance: Observational study on the 2017-2018 season with predominant B influenza virus circulation. Vacunas 2019; 20:53-59. [PMID: 32288701 PMCID: PMC7140273 DOI: 10.1016/j.vacun.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Influenza is a common respiratory infectious disease affecting population worldwide yearly. The aim of this work is to describe the 2017-2018 influenza season and how it affected elderly population in Catalonia despite moderate vaccine coverage among this age group. METHODS Influenza surveillance based on a primary care sentinel surveillance, virological indicators systematic sampling of ILI attended and severe influenza confirmed cases (SHLCI) admitted to hospital.Analysis of data by Chi-squared, ANOVA, multiple regression and negative control test or case to case for vaccine effectiveness assessment in primary care and SHLCI respectively. RESULTS Moderate-high intensity and early onset season with predominance of influenza B virus (IVB) (63%) followed by an increase of circulation of influenza A virus (IVA). A total of 419 IV from primary care samples. Vaccine effectiveness (VE) in primary care setting was 14% (95%CI: 0-47%). 1306 severe cases (adjusted cumulative incidence 18.54/100,000 inhabitants (95%CI: 17.54-19.55)). The highest proportion of severe cases were in the >64 (65.1%) (aOR 15.70; 95%CI: 12.06-20.46; p < 0.001) followed by 45-64 yo (25.4%) (aOR 6.03; 95%CI: 4.57-7.97). VE in preventing intensive care unit (ICU) admission was 35% (95%CI: 10-54%). Final outcome death while hospitalized occurred in 175 SHLCI cases with a case fatality rate of 13.4%. CONCLUSIONS 2017-2018 influenza season was an unusual epidemic season with an early onset, great predominance of influenza B (Yamagata strain) virus with a high hospitalization rate of severe cases among elderly stressing the need to upgrade vaccine uptake in this age group.
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Affiliation(s)
- L. Basile
- Public Health Agency of Catalonia, Sub Directorate of Surveillance and Response to Public Health Emergencies, Roc Boronat 81-95, 08005 Barcelona, Spain
| | - N. Torner
- Public Health Agency of Catalonia, Sub Directorate of Surveillance and Response to Public Health Emergencies, Roc Boronat 81-95, 08005 Barcelona, Spain
- CIBER Epidemiology and Pubic Health CIBERESP, Instituto Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
- Department of Medicine, University of Barcelona, Casanovas 131, Barcelona, Spain
| | - A. Martínez
- Public Health Agency of Catalonia, Sub Directorate of Surveillance and Response to Public Health Emergencies, Roc Boronat 81-95, 08005 Barcelona, Spain
- CIBER Epidemiology and Pubic Health CIBERESP, Instituto Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
| | - M.M. Mosquera
- Hospital Clínic – Biomedical Diagnostic Center – Microbiology, Virology Department, Villarroel, 170, 08036 Barcelona, Spain
| | - M.A. Marcos
- Hospital Clínic – Biomedical Diagnostic Center – Microbiology, Virology Department, Villarroel, 170, 08036 Barcelona, Spain
| | - M. Jane
- Public Health Agency of Catalonia, Sub Directorate of Surveillance and Response to Public Health Emergencies, Roc Boronat 81-95, 08005 Barcelona, Spain
- CIBER Epidemiology and Pubic Health CIBERESP, Instituto Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
| | - the PIDIRAC sentinell surveillance network
- Public Health Agency of Catalonia, Sub Directorate of Surveillance and Response to Public Health Emergencies, Roc Boronat 81-95, 08005 Barcelona, Spain
- CIBER Epidemiology and Pubic Health CIBERESP, Instituto Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
- Department of Medicine, University of Barcelona, Casanovas 131, Barcelona, Spain
- Hospital Clínic – Biomedical Diagnostic Center – Microbiology, Virology Department, Villarroel, 170, 08036 Barcelona, Spain
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Gutiérrez-González E, Cantero-Escribano JM, Redondo-Bravo L, San Juan-Sanz I, Robustillo-Rodela A, Cendejas-Bueno E. Effect of vaccination, comorbidities and age on mortality and severe disease associated with influenza during the season 2016-2017 in a Spanish tertiary hospital. J Infect Public Health 2019; 12:486-491. [PMID: 30670352 DOI: 10.1016/j.jiph.2018.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/10/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Identifying risk factors for complications or death associated with influenza remains crucial to target preventive interventions. Scores like the Charlson comorbidity index (CCI) may be of help. The aims of this study were to assess the effect of vaccination and comorbidities on severe influenza disease and influenza-related death among hospitalized patients during the season 2016/17; and to evaluate the validity of the CCI to predict death among these patients. METHODS Data from adult patients (≥18 years old) with influenza infection admitted to La Paz University Hospital (LPUH) were recorded during the 2016/17 epidemic. The effect of influenza vaccine to prevent severe influenza or death was evaluated using multivariate logistic regression models. The area under the curve of the CCI and the age-adjusted CCI were compared to assess the predictive effect on mortality. RESULTS A total of 342 adult patients with influenza infection were admitted, of which 83 developed severe influenza and 25 died during hospitalization. There were no differences between patients who survived and those who died concerning the CCI, but the age-adjusted CCI was higher in fatal cases (p-value=0.005). Influenza vaccine had no statistically significant effect on the risk of mortality (p-value=0.162) while age (OR: 1.12, p-value<0.001) and dementia (OR: 3.05, p-value=0.016) proved to be independent predictors for mortality. The seasonal vaccine was found to be protective for severe infection (OR: 0.54, p-value=0.019). The age-adjusted CCI was a better predictor of mortality than the crude CCI. CONCLUSIONS Age and dementia are significant independent risk factors for mortality associated with influenza among hospitalized patients. The age-adjusted CCI seems to be a better predictor of mortality than the crude CCI. Influenza vaccine has shown to be effective in preventing severe influenza in the season 2016/17 among hospitalized patients and should be promoted in population at risk.
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Affiliation(s)
- Enrique Gutiérrez-González
- Unidad Docente de Medicina Preventiva y Salud Pública, Escuela Nacional de Sanidad-Instituto de Salud Carlos III, Madrid, Spain.
| | - José M Cantero-Escribano
- Servicio de Medicina Preventiva Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Lidia Redondo-Bravo
- Servicio de Medicina Preventiva Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Isabel San Juan-Sanz
- Servicio de Medicina Preventiva Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Ana Robustillo-Rodela
- Servicio de Medicina Preventiva Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Emilio Cendejas-Bueno
- Servicio de Microbiología, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
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Zhou F, Li H, Gu L, Liu M, Xue CX, Cao B, Wang C. Risk factors for nosocomial infection among hospitalised severe influenza A(H1N1)pdm09 patients. Respir Med 2017; 134:86-91. [PMID: 29413513 DOI: 10.1016/j.rmed.2017.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Nosocomial infections following influenza are important causes of death, requiring early implementation of preventive measures, but predictors for nosocomial infection in the early stage remained undetermined. We aimed to determine risk factors that can help clinicians identify patients with high risk of nosocomial infection following influenza on admission. METHOD Using a database prospectively collected through a Chinese national network for hospitalised severe influenza A(H1N1)pdm09 patients, we compared the characteristics on admission between patients with and without nosocomial infection. RESULT A total of 2146 patients were enrolled in the final analysis with a median age of 36.0 years, male patients comprising 50.2% of the sample and 232 (10.8%) patients complicated with nosocomial infection. Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Staphylococcus aureus were the leading pathogens, and invasive fungal infection was found in 30 cases (12.9%). The in-hospital mortality was much higher in patients with nosocomial infection than those without (45.7% vs 11.8%, P < 0.001). Need for mechanical ventilation (OR: 3.336; 95% CI 2.362-4.712), sepsis (OR: 2.125; 95% CI 1.236-3.651), ICU admission on first day (OR: 2.074; 95% CI 1.425-3.019), lymphocytopenia (OR: 1.906; 95% CI 1.361-2.671), age > 65 years (OR: 1.83; 95% CI 1.04-3.21) and anaemia (OR: 1.39; 95% CI 1.39-2.79) were independently associated with nosocomial infection. CONCLUSION Need for mechanical ventilation, sepsis, ICU admission on first day, lymphocytopenia, older age and anaemia were independent risk factors that can help clinicians identify severe influenza A(H1N1)pdm09 patients at high risk of nosocomial infection.
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Affiliation(s)
- Fei Zhou
- Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti Road, Chaoyang District, Beijing, 100020, China
| | - Hui Li
- Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Centre for Respiratory Disease, Capital Medical University, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Li Gu
- Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti Road, Chaoyang District, Beijing, 100020, China
| | - Meng Liu
- Respiratory Department, Beijing Hospital of Traditional Chinese Medicine (TCM), Capital Medical University, No 23, Art Museum Backstreet, Dongcheng District, Beijing, 100010, China
| | - Chun-Xue Xue
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, No 82, Xinhua Shouth Road, Tongzhou District, Beijing, 101149, China
| | - Bin Cao
- Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Centre for Respiratory Disease, Capital Medical University, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.
| | - Chen Wang
- Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Centre for Respiratory Disease, Capital Medical University, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
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Shah NS, Greenberg JA, McNulty MC, Gregg KS, Riddell J, Mangino JE, Weber DM, Hebert CL, Marzec NS, Barron MA, Chaparro-Rojas F, Restrepo A, Hemmige V, Prasidthrathsint K, Cobb S, Herwaldt L, Raabe V, Cannavino CR, Hines AG, Bares SH, Antiporta PB, Scardina T, Patel U, Reid G, Mohazabnia P, Kachhdiya S, Le BM, Park CJ, Ostrowsky B, Robicsek A, Smith BA, Schied J, Bhatti MM, Mayer S, Sikka M, Murphy-Aguilu I, Patwari P, Abeles SR, Torriani FJ, Abbas Z, Toya S, Doktor K, Chakrabarti A, Doblecki-Lewis S, Looney DJ, David MZ. Bacterial and viral co-infections complicating severe influenza: Incidence and impact among 507 U.S. patients, 2013-14. J Clin Virol 2016; 80:12-9. [PMID: 27130980 PMCID: PMC7185824 DOI: 10.1016/j.jcv.2016.04.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 12/02/2022]
Abstract
22.5% of adult patients with H1N1 developed bacterial co-infection. Staphylococcus aureus was the most common cause of co-infection. Bacterial and viral co-infections were associated with death in bivariate. Patients with a bacterial co-infection had greater use of resources.
Background Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives To describe the spectrum and clinical impact of co-infections. Study design Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. Results Of 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23–0.73], p = 0.003), leukocytosis (>11 K/μl, OR 3.7 [2.2–6.2], p < 0.001; reference: normal WBC 3.5–11 K/μl) at ICU admission and a higher ICU admission SOFA score (for each increase by 1 in SOFA score, OR 1.1 [1.0–1.2], p = 0.001). Bacterial co-infections (OR 2.2 [1.4–3.6], p = 0.001) and viral co-infections (OR 3.1 [1.3–7.4], p = 0.010) were both associated with death in bivariable analysis. Patients with a bacterial co-infection had a longer hospital stay, a longer ICU stay and were likely to have had a greater delay in the initiation of antiviral administration than patients without co-infection (p < 0.05) in bivariable analysis. Conclusions Bacterial co-infections were common, resulted in delay of antiviral therapy and were associated with increased resource allocation and higher mortality.
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Affiliation(s)
- Nirav S Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States.
| | - Jared A Greenberg
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Moira C McNulty
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Kevin S Gregg
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - James Riddell
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Julie E Mangino
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Devin M Weber
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Courtney L Hebert
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Natalie S Marzec
- Department of Family Medicine, University of Colorado Denver, Denver, CO, United States
| | - Michelle A Barron
- Department of Medicine, University of Colorado Denver, Denver, CO, United States
| | | | - Alejandro Restrepo
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Vagish Hemmige
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | | | - Sandra Cobb
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Loreen Herwaldt
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Vanessa Raabe
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA, United States
| | - Christopher R Cannavino
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA, United States
| | - Andrea Green Hines
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sara H Bares
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Philip B Antiporta
- Department of Medicine, Loyola University Medical Center, Maywood, IL, United States; Department of Medicine, Edward Hines VA Hospital, Maywood, IL, United States
| | - Tonya Scardina
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, United States
| | - Ursula Patel
- Department of Pharmacy, Edward Hines VA Hospital, Maywood, IL, United States
| | - Gail Reid
- Department of Medicine, Loyola University Medical Center, Maywood, IL, United States; Department of Medicine, Edward Hines VA Hospital, Maywood, IL, United States
| | - Parvin Mohazabnia
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Suresh Kachhdiya
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Binh-Minh Le
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Connie J Park
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Belinda Ostrowsky
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ari Robicsek
- Department of Medicine, University of Chicago, Chicago, IL, United States; Department of Medicine, Northshore University HealthSystem, Evanston, IL, United States
| | - Becky A Smith
- Department of Medicine, Northshore University HealthSystem, Evanston, IL, United States
| | - Jeanmarie Schied
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Micah M Bhatti
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Stockton Mayer
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Monica Sikka
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Ivette Murphy-Aguilu
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Priti Patwari
- Department of Medicine, Community Care Networks, Inc., Munster, IN, United States
| | - Shira R Abeles
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Francesca J Torriani
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Zainab Abbas
- Department of Medicine, Methodist Hospitals, Merrillville, IN, United States
| | - Sophie Toya
- Department of Medicine, Methodist Hospitals, Merrillville, IN, United States
| | - Katherine Doktor
- Department of Medicine, University of Miami/Jackson Health System, Miami, FL, United States
| | - Anindita Chakrabarti
- Department of Medicine, University of Miami/Jackson Health System, Miami, FL, United States
| | - Susanne Doblecki-Lewis
- Department of Medicine, University of Miami/Jackson Health System, Miami, FL, United States
| | - David J Looney
- Department of Medicine, VA San Diego/University of California San Diego, San Diego, CA, United States
| | - Michael Z David
- Department of Medicine, University of Chicago, Chicago, IL, United States; Department of Pediatrics, University of Chicago, Chicago, IL, United States
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Braun ES, Crawford FW, Desai MM, Meek J, Kirley PD, Miller L, Anderson EJ, Oni O, Ryan P, Lynfield R, Bargsten M, Bennett NM, Lung KL, Thomas A, Mermel E, Lindegren ML, Schaffner W, Price A, Chaves SS. Obesity not associated with severity among hospitalized adults with seasonal influenza virus infection. Infection 2015; 43:569-75. [PMID: 26148927 DOI: 10.1007/s15010-015-0802-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
We examined seasonal influenza severity [artificial ventilation, intensive care unit (ICU) admission, and radiographic-confirmed pneumonia] by weight category among adults hospitalized with laboratory-confirmed influenza. Using multivariate logistic regression models, we found no association between obesity or severe obesity and artificial ventilation or ICU admission; however, overweight and obese patients had decreased risk of pneumonia. Underweight was associated with pneumonia (adjusted odds ratio 1.31; 95 % confidence interval 1.04, 1.64).
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Affiliation(s)
- Elise S Braun
- Yale School of Public Health, New Haven, CT, USA.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | | | - Lisa Miller
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | - Oluwakemi Oni
- Iowa Department of Public Health, Des Moines, IA, USA
| | - Patricia Ryan
- Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | | | | | - Nancy M Bennett
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Ann Thomas
- Oregon Public Health Division, Portland, OR, USA
| | | | | | | | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, UT, USA
| | - Sandra S Chaves
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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