|
Clinical profile and predictors of mortality of severe pandemic (H1N1) 2009 virus infection needing intensive care: A multi-centre prospective study from South India
Kartik Ramakrishna1, Sriram Sampath2, Jose Chacko3, Binila Chacko1, Deshikar L Narahari2, Hemanth H Veerendra3, Mahesh Moorthy4, Bhuvana Krishna2, VS Chekuri1, Rama Krishna Raju2, Devika Shanmugasundaram5, Kishore Pichamuthu1, Asha M Abraham4, OC Abraham6, Kurien Thomas6, Prasad Mathews6, George M Varghese6, Priscilla Rupali6, John V Peter1
1 Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, India
2 Medical Intensive Care Unit, St. John's Medical College Hospital, Bangalore, India
3 Medical Intensive Care Unit, Manipal Hospital, Bangalore, India
4 Department of Virology, Christian Medical College Hospital, Vellore, India
5 Department of Biostatistics, Christian Medical College Hospital, Vellore, India
6 Department of Medicine, Christian Medical College Hospital, Vellore, India
Correspondence Address:
Kartik Ramakrishna
Medical Intensive Care Unit, Christian Medical College Hospital, Vellore
India
 Source of Support: Financial support for testing of samples was from an ongoing influenza surveillance project funded by the Department of Health and Human Services, USA and Indian council of Medical Research (ICMR) (Co-operative Agreement No. 5U50/C1024407-05). Reagents for testing were supplied by the National Institute of Virology, Pune, India., Conflict of Interest: None  | Check |
DOI: 10.4103/0974-777X.100569
|
|
Background: This multi-center study from India details the profile and outcomes of patients admitted to the intensive care unit (ICU) with pandemic Influenza A (H1N1) 2009 virus [P(H1N1)2009v] infection. Materials and Methods: Over 4 months, adult patients diagnosed to have P(H1N1)2009v infection by real-time RT-PCR of respiratory specimens and requiring ICU admission were followed up until death or hospital discharge. Sequential organ failure assessment (SOFA) scores were calculated daily. Results: Of the 1902 patients screened, 464 (24.4%) tested positive for P(H1N1)2009v; 106 (22.8%) patients aged 35±11.9 (mean±SD) years required ICU admission 5.8±2.7 days after onset of illness. Common symptoms were fever (96.2%), cough (88.7%), and breathlessness (85.9%). The admission APACHE-II and SOFA scores were 14.4±6.5 and 5.5±3.1, respectively. Ninety-six (90.6%) patients required ventilation for 10.1±7.5 days. Of these, 34/96 (35.4%) were non-invasively ventilated; 16/34 were weaned successfully whilst 18/34 required intubation. Sixteen patients (15.1%) needed dialysis. The duration of hospitalization was 14.0±8.0 days. Hospital mortality was 49%. Mortality in pregnant/puerperal women was 52.6% (10/19). Patients requiring invasive ventilation at admission had a higher mortality than those managed with non-invasive ventilation and those not requiring ventilation (44/62 vs. 8/44, P<0.001). Need for dialysis was independently associated with mortality (P=0.019). Although admission APACHE-II and SOFA scores were significantly (P<0.02) higher in non-survivors compared with survivors on univariate analysis, individually, neither were predictive on multivariate analysis. Conclusions: In our setting, a high mortality was observed in patients admitted to ICU with severe P(H1N1)2009v infection. The need for invasive ventilation and dialysis were associated with a poor outcome. |
