J Korean Med Sci.  2011 Apr;26(4):499-506. 10.3346/jkms.2011.26.4.499.

A Prediction Rule to Identify Severe Cases among Adult Patients Hospitalized with Pandemic Influenza A (H1N1) 2009

Affiliations
  • 1Department of Internal Medicine, Kangwon National University School of Medicine, Chucheon, Korea.
  • 2Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
  • 3Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
  • 4Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
  • 5Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
  • 6Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
  • 8Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 9Department of Internal Medicine, Kwandong University Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
  • 10Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea.
  • 11Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 12Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea.
  • 13Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 14Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 15Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.
  • 16Department of Internal Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 17Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. mdohmd@snu.ac.kr

Abstract

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 < or = 250), bilateral lung infiltration, and old age (> or = 65 yr) were independent risk factors for severe cases (all P < 0.001). The area under the ROC curve (0.834 [95% CI, 0.778-0.890]) of the number of risk factors were not significantly different with that of APACHE II score (0.840 [95% CI, 0.790-0.891]) (P = 0.496). The presence of > or = 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of > or = 13. As a prediction rule, the presence of > or = 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.

Keyword

pandemic influenza A (H1N1) 2009; Severity; Risk Factors; Prediction Rule

MeSH Terms

APACHE
Adult
Aged
Antiviral Agents/therapeutic use
Female
Hospitalization
Humans
Influenza A Virus, H1N1 Subtype/*isolation & purification
Influenza, Human/drug therapy/*epidemiology/mortality
Intensive Care Units
Male
Middle Aged
Pandemics
Predictive Value of Tests
ROC Curve
Respiration, Artificial
Risk Factors
Severity of Illness Index

Figure

  • Fig. 1 Receiver operating characteristic (ROC) curves for the number of risk factors and APACHE II score. The areas under the ROC curves are 0.834 (95% confidence interval [CI], 0.778-0.890) for the number of risk factors and 0.840 (95% CI, 0.790-0.891) for the APACHE II score (P = 0.496 for each pairwise comparison).


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