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      Prognosis of 18 H7N9 Avian Influenza Patients in Shanghai

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          Abstract

          Purpose

          To provide prognosis of an 18 patient cohort who were confirmed to have H7N9 lung infection in Shanghai.

          Methods

          Patients' history, clinical manifestation, laboratory test, treatment strategy and mortality were followed and recorded for data analysis.

          Results

          A total of 18 patients had been admitted into Shanghai Public Health Clinical Center from April 8 th to July 29, 2013. 22.2% of the patients were found to have live poultry contact history and 80% were aged male patients with multiple co-morbidities including diabetes, hypertension and/or chronic obstructive pulmonary disease (COPD). This group of patients was admitted to the clinical center around 10 days after disease onset. According to laboratory examinations, increased C reactive protein (CRP), Procalcitonin (PCT), Plasma thromboplastin antecedent (PTA) and virus positive time (days) were indicative of patients' mortality. After multivariate analysis, only CRP level showed significant prediction of mortality (P = 0.013) while results of prothrombin time (PT) analysis almost reached statistical significance (P = 0.056).

          Conclusions

          H7N9 infection induced pneumonia of different severity ranging from mild to severe pneumonia or acute lung injury/acute respiratory distress syndrome to multiple organ failure. Certain laboratory parameters such as plasma CRP, PCT, PTA and virus positive days predicted mortality of H7N9 infection and plasma CRP is an independent predictor of mortality in these patients.

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          Most cited references21

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          Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus

          Rongbao Gao, Bin Cao, Yunwen Hu … (2013)
          New England Journal of Medicine, 368(20), 1888-1897
          Article 0 comments Cited 987 times – based on 0 reviews     Review now
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            Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome.

            Andrew Davies, Daryl Jones, Michael Bailey … (2009)
            The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO). To describe the characteristics of all patients with 2009 influenza A(H1N1)-associated ARDS treated with ECMO and to report incidence, resource utilization, and patient outcomes. An observational study of all patients (n = 68) with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009. Incidence, clinical features, degree of pulmonary dysfunction, technical characteristics, duration of ECMO, complications, and survival. Sixty-eight patients with severe influenza-associated ARDS were treated with ECMO, of whom 61 had either confirmed 2009 influenza A(H1N1) (n = 53) or influenza A not subtyped (n = 8), representing an incidence rate of 2.6 ECMO cases per million population. An additional 133 patients with influenza A received mechanical ventilation but no ECMO in the same ICUs. The 68 patients who received ECMO had a median (interquartile range [IQR]) age of 34.4 (26.6-43.1) years and 34 patients (50%) were men. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a median (IQR) Pao(2)/fraction of inspired oxygen (Fio(2)) ratio of 56 (48-63), positive end-expiratory pressure of 18 (15-20) cm H(2)O, and an acute lung injury score of 3.8 (3.5-4.0). The median (IQR) duration of ECMO support was 10 (7-15) days. At the time of reporting, 48 of the 68 patients (71%; 95% confidence interval [CI], 60%-82%) had survived to ICU discharge, of whom 32 had survived to hospital discharge and 16 remained as hospital inpatients. Fourteen patients (21%; 95% CI, 11%-30%) had died and 6 remained in the ICU, 2 of whom were still receiving ECMO. During June to August 2009 in Australia and New Zealand, the ICUs at regional referral centers provided mechanical ventilation for many patients with 2009 influenza A(H1N1)-associated respiratory failure, one-third of whom received ECMO. These ECMO-treated patients were often young adults with severe hypoxemia and had a 21% mortality rate at the end of the study period.
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              Avian influenza A (H5N1) infection in humans.

              John H Beigel, Jeremy Farrar, Aye Han … (2005)
              Article 0 comments Cited 435 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Roland G. Roberts: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 2 April 2014
                Volume: 9
                Issue: 4
                Electronic Location Identifier: e88728
                Affiliations
                [1 ]Department of Tuberculosis, Shanghai Public Health Clinical Center, Shanghai, China
                [2 ]Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
                [3 ]Department of Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
                [4 ]Department of Pulmonary Medicine, Huadong Hospital, Fudan University, Shanghai, China
                [5 ]Department of Pulmonary Medicine, Zhongshan Hospital, Qingpu Branch, Shanghai, China
                PLOS, United Kingdom
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: SL YS. Performed the experiments: TL XX B. Zhang QC Xuhui Liu JO JL QW B. Zhu Xinian Liu. Analyzed the data: JL JO QW. Contributed reagents/materials/analysis tools: CB JQ HL ZZ. Wrote the paper: YS JO.

                ¶ These authors also contributed equally to this work.

                Article
                Publisher ID: PONE-D-13-44136
                DOI: 10.1371/journal.pone.0088728
                PMC ID: 3973662
                PubMed ID: 24695420
                SO-VID: 91b944da-5106-4dea-ba2a-52ed91a94414
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 28 October 2013
                Date accepted : 9 January 2014
                Page count
                Pages: 8
                Funding
                This research was supported by Shanghai Leading Academic Discipline Project (B115), and National Natural Science Foundation of China (30930090, 81100046, 81170056). Dr. Yuanlin Song was supported by the Program for Professor of Special Appointment (Eastern Scholar) at Shanghai Institutions of Higher Learning and Key Medical grant from Shanghai Science and Technology Committee (11411951102, 12JC1402300). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology and life sciences
                Subject: Microbiology
                Subject: Medical microbiology
                Subject: Microbial pathogens
                Subject: Viral pathogens
                Subject: Orthomyxoviruses
                Subject: Influenza viruses
                Subject: Avian influenza A viruses
                Subject: Veterinary Science
                Subject: Veterinary Diseases
                Subject: Zoonoses
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
                Subject: Diagnostic Medicine
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: Influenza
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Multiple Organ Dysfunction Syndrome
                Subject: Pulmonology
                Subject: Respiratory Failure
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Clinical Research Design
                Subject: Cohort Studies

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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