Giuseppe
Emeritus
[Source: Chest, full text: (LINK). Abstract, edited.]
Clinical Features of Pneumonia Caused by 2009 Influenza A(H1N1) Virus in Beijing, China
Background: Data on symptoms and radiographic changes in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) pneumonia during convalescence have not been reported.
Methods: During October 26, 2009, and January 23, 2010, adult patients with pneumonia with laboratory-confirmed or clinically suspected A(H1N1) infections were observed for clinical characteristics, high-resolution chest CT scan, and lung function test changes during acute and 3-month convalescent phases.
Results: Of the 65 case subjects, the median age was 41 (interquartile range [IQR], 28-57) years, 60.0% were men, and 55.4% had at least one underlying medical condition. Sixty-two patients started oseltamivir therapy within a median of 5 (IQR, 4-6) days from the onset of illness, and 31 received IV corticosteroids. ARDS developed in 33 patients, and 24 were treated initially with noninvasive positive pressure ventilation (NPPV). In this group, NPPV was successful in 13 patients (54.2%). Nine patients died at a median of 16 (IQR, 10-24) days after onset of illness. Multivariate Cox regression identified two independent risk factors for death: progressive dyspnea after resolution of fever (relative risk, 5.852; 95% CI, 1.395-24.541; P = .016) and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score on presentation (relative risk for each point, 1.312; 95% CI, 1.140-1.511; P < .001). At 3-month follow-up of survivors with A(H1N1), ground-glass opacities were still present, although diminished, in 85.7%, and diffusing capacity for carbon monoxide was mildly reduced in 61.5%.
Conclusions: Ground-glass opacities and decreased diffusing capacity were the main abnormalities observed at 3-month follow-up of survivors of A(H1N1).
Footnotes
<DL><DT>A(H1N1) <DD>pandemic 2009 influenza A(H1N1) <DT>APACHE <DD>Acute Physiology and Chronic Health Evaluation <DT>Dlco <DD>diffusing capacity for carbon monoxide <DT>GGOs <DD>ground-glass opacities <DT>HRCT <DD>high-resolution CT <DT>IQR <DD>interquartile range <DT>LFT <DD>lung function test <DT>NPPV <DD>noninvasive positive pressure ventilation <DT>RT-PCR <DD>reverse transcriptase polymerase chain reaction <DT>SARS <DD>severe acute respiratory syndrome</DD></DL>
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- Lu Bai, MD, 2 Li Gu, MD, 3 Bin Cao, MD, 4 Xiao-Li Zhai, MD, 5 Min Lu, MD, 6 Yong Lu, MD, 7 Li-Rong Liang, MD, 8 Lei Zhang, MD, 9 Zi-Fen Gao, MD, 10 Ke-Wu Huang, MD, 11 Ying-Mei Liu, MD, 12 Shu-Fan Song, MD, 13 Lin Wu, MD, 14 Yu-Dong Yin, MD and 15 Chen Wang, MD, FCCP
- From the Department of Infectious Diseases and Clinical Microbiology (Drs Bai, Gu, Cao, Liu, Song, Wu, and Yin), the Department of Radiology (Drs Zhai and Zhang), and the Department of Respiratory and Intensive Care Medicine, Beijing Institute of Respiratory Medicine (Drs Y. Lu, Liang, Huang, and Wang), Beijing Chao-Yang Hospital, Capital Medical University; the Department of Pathology (Drs M. Lu and Gao), School of Basic Medical Sciences, Peking University; and Beijing Key Laboratory of Respiratory and Pulmonary Circulation (Drs Cao and Wang), Beijing, People?s Republic of China.
- Correspondence to:
Chen Wang, MD, FCCP, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People?s Republic of China; e-mail: cyh-birm@263.net
- Drs Bai, Gu, and Cao contributed equally to this article.
Background: Data on symptoms and radiographic changes in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) pneumonia during convalescence have not been reported.
Methods: During October 26, 2009, and January 23, 2010, adult patients with pneumonia with laboratory-confirmed or clinically suspected A(H1N1) infections were observed for clinical characteristics, high-resolution chest CT scan, and lung function test changes during acute and 3-month convalescent phases.
Results: Of the 65 case subjects, the median age was 41 (interquartile range [IQR], 28-57) years, 60.0% were men, and 55.4% had at least one underlying medical condition. Sixty-two patients started oseltamivir therapy within a median of 5 (IQR, 4-6) days from the onset of illness, and 31 received IV corticosteroids. ARDS developed in 33 patients, and 24 were treated initially with noninvasive positive pressure ventilation (NPPV). In this group, NPPV was successful in 13 patients (54.2%). Nine patients died at a median of 16 (IQR, 10-24) days after onset of illness. Multivariate Cox regression identified two independent risk factors for death: progressive dyspnea after resolution of fever (relative risk, 5.852; 95% CI, 1.395-24.541; P = .016) and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score on presentation (relative risk for each point, 1.312; 95% CI, 1.140-1.511; P < .001). At 3-month follow-up of survivors with A(H1N1), ground-glass opacities were still present, although diminished, in 85.7%, and diffusing capacity for carbon monoxide was mildly reduced in 61.5%.
Conclusions: Ground-glass opacities and decreased diffusing capacity were the main abnormalities observed at 3-month follow-up of survivors of A(H1N1).
Footnotes
- Funding/Support: This study was supported by grants from Beijing Science and Technology [Grant Z08050700020801] and the Beijing Nova Programme [Grant 2007A037], and the Major State Basic Research Development Program [Grant 2009CB522107].
- Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
<DL><DT>A(H1N1) <DD>pandemic 2009 influenza A(H1N1) <DT>APACHE <DD>Acute Physiology and Chronic Health Evaluation <DT>Dlco <DD>diffusing capacity for carbon monoxide <DT>GGOs <DD>ground-glass opacities <DT>HRCT <DD>high-resolution CT <DT>IQR <DD>interquartile range <DT>LFT <DD>lung function test <DT>NPPV <DD>noninvasive positive pressure ventilation <DT>RT-PCR <DD>reverse transcriptase polymerase chain reaction <DT>SARS <DD>severe acute respiratory syndrome</DD></DL>
- Received April 21, 2010.
- Accepted August 12, 2010.
- ? 2011 American College of Chest Physicians
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