Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Associated Factor Related to Major Complications of Patients with Hospitalized for 2009 H1N1 Influenza Pneumonia

신종 플루 폐렴으로 입원한 환자들에서 주요 합병증 발생과 관련된 인자

  • Choi, Sang-Sik (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won-Young (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Han (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Youn-Suck (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Kyung-Su (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 최상식 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김원영 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김성한 (울산대학교 의과대학 서울아산병원 감염내과학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 김원 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 임경수 (울산대학교 의과대학 서울아산병원 응급의학교실)
  • Received : 2010.01.26
  • Accepted : 2010.03.10
  • Published : 2010.03.30
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Abstract

Background: To date, there are few data on the risk factors for severe cases and deaths associated with the 2009 pandemic H1N1 influenza A. Here, we describe the clinical and epidemiologic characteristics of patients hospitalized for pneumonia and identify those factors associated with the development of major complications (MC). Methods: We reviewed the medical records of 41 cases of pneumonia admitted to a university-affiliated tertiary hospital between Aug 26 and Dec 10, 2009, and who had confirmed H1N1 influenza A based on real-time reverse transcriptase-polymerase-chain-reaction assay. There were 7,962 patients that fit these criteria. We compared the clinical features and demographic characteristics of patients who developed MC to with those who did not develop MC. Results: During the study period, 10 patients developed MC (required admission to the intensive care unit, n=10; required ventilator therapy, n=6; death, n=4). Patients with MC were significantly older than those without MC and more frequently had underlying medical conditions (90.0% vs 41.9%, p-value <0.01). In the patients with developed MC, the median $PaO_2/FiO_2$ ratio of 230.0 (145.0~347.3) at admission and pneumonia severity index (PSI) score of 141.5 (88.3~158.5) were higher than patients without MC. However, no differences were observed in laboratory findings or in viral shedding between the 2 groups. Conclusion: In hospitalized pneumonia patients of 2009 H1N1 influenza, old age, a history of malignancy, initial hypoxemia, $PaO_2/FiO_2$ ratio, and PSI score appear to be risk factor significantly related to developing MC. These findings might be the basis to influence strategies for admitting patients to an intensive or intermediate care unit and for pre-emptive antiviral therapy.

Keywords

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