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PLoS ONE. Epidemiological and Clinical Characteristics and Risk Factors for Death of Patients with Avian Influenza A H7N9 Virus Infection from Jiangsu Province, Eastern China
[Source: PLoS ONE, full page: (LINK). Abstract, edited.]
Open Access / Peer-Reviewed / Research Article
Epidemiological and Clinical Characteristics and Risk Factors for Death of Patients with Avian Influenza A H7N9 Virus Infection from Jiangsu Province, Eastern China
Hong Ji, Qin Gu, Li-ling Chen, Ke Xu, Xia Ling, Chang-jun Bao, Fen-yang Tang, Xian Qi, Ying-qiu Wu, Jing Ai, Gu-yu Shen, Dan-jiang Dong, Hui-yan Yu, [ ... ], Mao Huang, Quan Cao, Ying Xu, Wei Zhao, Yang-ting Xu, Yu Xia, Shan-hui Chen, Gen-lin Yang, Cai-ling Gu, Guo-xiang Xie, Ye-fei Zhu, Feng-cai Zhu, Ming-hao Zhou
Published: March 04, 2014 / DOI: 10.1371/journal.pone.0089581
Abstract
Background
A novel avian influenza A (H7N9) virus has caused great morbidity as well as mortality since its emergence in Eastern China in February 2013. However, the possible risk factors for death are not yet fully known.
Methods and Findings
Patients with H7N9 virus infection between March 1 and August 14, 2013 in Jiangsu province were enrolled. Data were collected with a standard form. Mean or percentage was used to describe the features, and Fisher's exact test or t-test test was used to compare the differences between fatal and nonfatal cases with H7N9 virus infection. A total of 28 patients with H7N9 virus infection were identified among whom, nine (32.1%) died. The median age of fatal cases was significant higher than nonfatal cases (P<0.05). Patients with older age were more strongly associated with increased odds of death (OR = 30.0; 95% CI, 2.85?315.62). Co-morbidity with chronic lung disease and hypertension were risk factors for mortality (OR = 14.40; 95% CI, 1.30?159.52, OR = 6.67; 95% CI, 1.09?40.43, respectively). Moreover, the presence of either bilateral lung inflammation or pulmonary consolidation on chest imaging on admission was related with fatal outcome (OR = 7.00; 95%CI, 1.10?44.61). Finally, dynamic monitoring showed that lymphopenia was more significant in fatal group than in nonfatal group from day 11 to week five (P<0.05). The decrease in oxygenation indexes were observed in most cases and more significantly in fatal cases after week three (P<0.05), and the value of early all fatal cases were below 200 mmHg during our evaluation period.
Conclusions
Among cases with H7N9 virus infection, increased age accompanied by co-morbidities was the risk of death. The severity of lung infection at admission, the persistence of lymphocytopenia, and the extended duration of lower oxygenation index all contributed to worsened outcomes of patients with H7N9 virus infection.
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Citation: Ji H, Gu Q, Chen L-l, Xu K, Ling X, et al. (2014) Epidemiological and Clinical Characteristics and Risk Factors for Death of Patients with Avian Influenza A H7N9 Virus Infection from Jiangsu Province, Eastern China. PLoS ONE 9(3): e89581. doi:10.1371/journal.pone.0089581
Editor: Srinand Sreevatsan, University of Minnesota, United States of America
Received: October 4, 2013; Accepted: January 21, 2014; Published: March 4, 2014
Copyright: ? 2014 Ji et al. 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.
Funding: This study was funded by Jiangsu Province Health Development Project with Science and Education (ZX201109 and RC2011085); Natural Science Foundation of China (No. 81373055); Jiangsu Province Science and Technology Support Program (social development: BE2012769); National Ministry of Science and Technology Emergency Research Project on human infection with avian influenza H7N9 virus (No. KJYJ-2013-01-02). M.H. Zhou and Y.F. Zhu are partly supported by Jiangsu Province Health Development Project with Science and Education (ZX201109 and RC2011085). C.J. Bao is partly supported by Natural Science Foundation of China (No. 81373055), Jiangsu Province Science and Technology Support Program (social development: BE2012769), and the 10th Summit of Six Top Talents of Jiangsu Province. F.Y. Tang is supported by National Ministry of Science and Technology Emergency Research Project on human infection with avian influenza H7N9 virus (No. KJYJ-2013-01-02). The contents of this article are solely the responsibility of the authors and do not necessarily represent the views of the Jiangsu Provincial Centers for Disease Control and Prevention or other organizations. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Competing interests: The authors have declared that no competing interests exist.
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Open Access / Peer-Reviewed / Research Article
Epidemiological and Clinical Characteristics and Risk Factors for Death of Patients with Avian Influenza A H7N9 Virus Infection from Jiangsu Province, Eastern China
Hong Ji, Qin Gu, Li-ling Chen, Ke Xu, Xia Ling, Chang-jun Bao, Fen-yang Tang, Xian Qi, Ying-qiu Wu, Jing Ai, Gu-yu Shen, Dan-jiang Dong, Hui-yan Yu, [ ... ], Mao Huang, Quan Cao, Ying Xu, Wei Zhao, Yang-ting Xu, Yu Xia, Shan-hui Chen, Gen-lin Yang, Cai-ling Gu, Guo-xiang Xie, Ye-fei Zhu, Feng-cai Zhu, Ming-hao Zhou
Published: March 04, 2014 / DOI: 10.1371/journal.pone.0089581
Abstract
Background
A novel avian influenza A (H7N9) virus has caused great morbidity as well as mortality since its emergence in Eastern China in February 2013. However, the possible risk factors for death are not yet fully known.
Methods and Findings
Patients with H7N9 virus infection between March 1 and August 14, 2013 in Jiangsu province were enrolled. Data were collected with a standard form. Mean or percentage was used to describe the features, and Fisher's exact test or t-test test was used to compare the differences between fatal and nonfatal cases with H7N9 virus infection. A total of 28 patients with H7N9 virus infection were identified among whom, nine (32.1%) died. The median age of fatal cases was significant higher than nonfatal cases (P<0.05). Patients with older age were more strongly associated with increased odds of death (OR = 30.0; 95% CI, 2.85?315.62). Co-morbidity with chronic lung disease and hypertension were risk factors for mortality (OR = 14.40; 95% CI, 1.30?159.52, OR = 6.67; 95% CI, 1.09?40.43, respectively). Moreover, the presence of either bilateral lung inflammation or pulmonary consolidation on chest imaging on admission was related with fatal outcome (OR = 7.00; 95%CI, 1.10?44.61). Finally, dynamic monitoring showed that lymphopenia was more significant in fatal group than in nonfatal group from day 11 to week five (P<0.05). The decrease in oxygenation indexes were observed in most cases and more significantly in fatal cases after week three (P<0.05), and the value of early all fatal cases were below 200 mmHg during our evaluation period.
Conclusions
Among cases with H7N9 virus infection, increased age accompanied by co-morbidities was the risk of death. The severity of lung infection at admission, the persistence of lymphocytopenia, and the extended duration of lower oxygenation index all contributed to worsened outcomes of patients with H7N9 virus infection.
_____
Citation: Ji H, Gu Q, Chen L-l, Xu K, Ling X, et al. (2014) Epidemiological and Clinical Characteristics and Risk Factors for Death of Patients with Avian Influenza A H7N9 Virus Infection from Jiangsu Province, Eastern China. PLoS ONE 9(3): e89581. doi:10.1371/journal.pone.0089581
Editor: Srinand Sreevatsan, University of Minnesota, United States of America
Received: October 4, 2013; Accepted: January 21, 2014; Published: March 4, 2014
Copyright: ? 2014 Ji et al. 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.
Funding: This study was funded by Jiangsu Province Health Development Project with Science and Education (ZX201109 and RC2011085); Natural Science Foundation of China (No. 81373055); Jiangsu Province Science and Technology Support Program (social development: BE2012769); National Ministry of Science and Technology Emergency Research Project on human infection with avian influenza H7N9 virus (No. KJYJ-2013-01-02). M.H. Zhou and Y.F. Zhu are partly supported by Jiangsu Province Health Development Project with Science and Education (ZX201109 and RC2011085). C.J. Bao is partly supported by Natural Science Foundation of China (No. 81373055), Jiangsu Province Science and Technology Support Program (social development: BE2012769), and the 10th Summit of Six Top Talents of Jiangsu Province. F.Y. Tang is supported by National Ministry of Science and Technology Emergency Research Project on human infection with avian influenza H7N9 virus (No. KJYJ-2013-01-02). The contents of this article are solely the responsibility of the authors and do not necessarily represent the views of the Jiangsu Provincial Centers for Disease Control and Prevention or other organizations. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Competing interests: The authors have declared that no competing interests exist.
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