12 research outputs found
Outcomes of Influenza A(H1N1)pdm09 Virus Infection: Results from Two International Cohort Studies
<div><p>Background</p><p>Data from prospectively planned cohort studies on risk of major clinical outcomes and prognostic factors for patients with influenza A(H1N1)pdm09 virus are limited. In 2009, in order to assess outcomes and evaluate risk factors for progression of illness, two cohort studies were initiated: FLU 002 in outpatients and FLU 003 in hospitalized patients.</p><p>Methods and Findings</p><p>Between October 2009 and December 2012, adults with influenza-like illness (ILI) were enrolled; outpatients were followed for 14 days and inpatients for 60 days. Disease progression was defined as hospitalization and/or death for outpatients, and hospitalization for >28 days, transfer to intensive care unit (ICU) if enrolled from general ward, and/or death for inpatients. Infection was confirmed by RT-PCR. 590 FLU 002 and 392 FLU 003 patients with influenza A (H1N1)pdm09 were enrolled from 81 sites in 17 countries at 2 days (IQR 1–3) and 6 days (IQR 4–10) following ILI onset, respectively. Disease progression was experienced by 29 (1 death) outpatients (5.1%; 95% CI: 3.4–7.2%) and 80 inpatients [death (32), hospitalization >28 days (43) or ICU transfer (20)] (21.6%; 95% CI: 17.5–26.2%). Disease progression (death) for hospitalized patients was 53.1% (26.6%) and 12.8% (3.8%), respectively, for those enrolled in the ICU and general ward. In pooled analyses for both studies, predictors of disease progression were age, longer duration of symptoms at enrollment and immunosuppression. Patients hospitalized during the pandemic period had a poorer prognosis than in subsequent seasons.</p><p>Conclusions</p><p>Patients with influenza A(H1N1)pdm09, particularly when requiring hospital admission, are at high risk for disease progression, especially if they are older, immunodeficient, or admitted late in infection. These data reinforce the need for international trials of novel treatment strategies for influenza infection and serve as a reminder of the need to monitor the severity of seasonal and pandemic influenza epidemics globally.</p><p>Trial Registration</p><p>ClinicalTrials.gov Identifiers: FLU 002- <a href="http://clinicaltrials.gov/ct2/show/NCT01056354" target="_blank">NCT01056354</a>, FLU 003- <a href="http://clinicaltrials.gov/ct2/show/NCT01056185" target="_blank">NCT01056185</a>.</p></div
Major outcomes through 60 days of follow-up for A(H1N1)pdm09-infected patients enrolled in FLU003.
<p>Major outcomes through 60 days of follow-up for A(H1N1)pdm09-infected patients enrolled in FLU003.</p
Frequency distribution of number of days between onset of ILI symptoms and enrollment for patients in FLU 002 and FLU 003.
<p>Frequency distribution of number of days between onset of ILI symptoms and enrollment for patients in FLU 002 and FLU 003.</p
Baseline characteristics associated with disease severity at entry: FLU002 versus FLU003.
<p>*Odds ratio for FLU003 vs. FLU002. OR for age is for 10 years older.</p><p>**Multivariate model using imputed data with adjustment for all variables listed except coinfections.</p><p>***P-value for linear trend from multivariate model = .0010</p><p>****P-value for linear trend from multivariate model = .0000</p><p>*****As above for a subset of patients (n = 333) analyzed for co-infections.</p
Outcomes of influenza A(H1N1)pdm09 virus infection:results from two international cohort studies
Baseline characteristics associated with disease progression: FLU002 and FLU003 pooled.
<p>*Univariate odds ratio for disease progression. OR for age is for 10 years older.</p><p>**Multivariate model using imputed data with adjustment for all variables listed.</p><p>***P-value for linear trend from multivariate model = 0.16</p><p>****P-value for linear trend from multivariate model = 0.10</p
Cumulative percentage of patients with death from any cause in FLU 003 according to location of enrollment.
<p>The number of patients at risk at each timepoint are given below the graph.</p
Baseline characteristics associated with death in FLU003.
<p>*Univariate odds ratio for death. OR for age is for 10 years older.</p><p>**Multivariate model using imputed data with adjustment for all variables listed.</p><p>***P-value for linear trend from multivariate model = 0.07</p><p>****P-value for linear trend from multivariate model = 0.35</p
Baseline characteristics of A(H1N1)pdm09-infected participants enrolled in FLU003.
<p>*Currently or within previous 2 weeks, percent of women ≤45 years.</p><p>**Receipt of influenza vaccine during current season.</p