tetano
Editor, Senior Moderator
Clin Infect Dis. 2019 Jul 11. pii: ciz638. doi: 10.1093/cid/ciz638. [Epub ahead of print]
[h=1]Outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011-2015.[/h] Collins JP[SUP]1,[/SUP][SUP]2[/SUP], Campbell AP[SUP]3[/SUP], Openo K[SUP]2[/SUP], Farley MM[SUP]2,[/SUP][SUP]4[/SUP], Cummings CN[SUP]3[/SUP], Hill M[SUP]5[/SUP], Schaffner W[SUP]6[/SUP], Lindegren ML[SUP]6[/SUP], Thomas A[SUP]7[/SUP], Billing L[SUP]8[/SUP], Bennett N[SUP]9[/SUP], Spina N[SUP]10[/SUP], Bargsten M[SUP]11[/SUP], Lynfield R[SUP]12[/SUP], Eckel S[SUP]13[/SUP], Ryan P[SUP]14[/SUP], Yousey-Hindes K[SUP]15[/SUP], Herlihy R[SUP]16[/SUP], Kirley PD[SUP]17[/SUP], Garg S[SUP]3[/SUP], Anderson EJ[SUP]1,[/SUP][SUP]2,[/SUP][SUP]4[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-immunocompromised adults.
[h=4]METHODS:[/h] We identified adults (≥18 years) hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had ≥1: HIV/AIDS, cancer, stem cell or organ transplantation, non-steroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics and used multivariable logistic regression and Cox proportional hazards models to control for confounding by patient demographic characteristics, pre-existing medical conditions, influenza vaccination, and other factors.
[h=4]RESULTS:[/h] Among 35,348 adults, 3633 (10%) were IC; cancer (44%), non-steroid immunosuppressive therapy (44%), and HIV (17%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs. 46%; p<0.001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 1.46 [1.20-1.76]). Intensive care was more likely among IC patients 65-79 years (aOR [95% CI]: 1.25 [1.06-1.48]) and >80 years (aOR [95% CI]: 1.35 [1.06-1.73]) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge [95% CI]: 0.86 [0.83-0.88]) and were more likely to require mechanical ventilation (aOR [95% CI] 1.19 [1.05-1.36]).
[h=4]CONCLUSIONS:[/h] Substantial morbidity and mortality occurred among IC adults hospitalized with influenza. Influenza vaccination and antiviral administration could be increased in both IC and non-IC adults.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] HIV; cancer; immunosuppression; immunosuppressive; influenza
PMID: 31298691 DOI: 10.1093/cid/ciz638
[h=1]Outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011-2015.[/h] Collins JP[SUP]1,[/SUP][SUP]2[/SUP], Campbell AP[SUP]3[/SUP], Openo K[SUP]2[/SUP], Farley MM[SUP]2,[/SUP][SUP]4[/SUP], Cummings CN[SUP]3[/SUP], Hill M[SUP]5[/SUP], Schaffner W[SUP]6[/SUP], Lindegren ML[SUP]6[/SUP], Thomas A[SUP]7[/SUP], Billing L[SUP]8[/SUP], Bennett N[SUP]9[/SUP], Spina N[SUP]10[/SUP], Bargsten M[SUP]11[/SUP], Lynfield R[SUP]12[/SUP], Eckel S[SUP]13[/SUP], Ryan P[SUP]14[/SUP], Yousey-Hindes K[SUP]15[/SUP], Herlihy R[SUP]16[/SUP], Kirley PD[SUP]17[/SUP], Garg S[SUP]3[/SUP], Anderson EJ[SUP]1,[/SUP][SUP]2,[/SUP][SUP]4[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Hospitalized immunocompromised (IC) adults with influenza may have worse outcomes than hospitalized non-immunocompromised adults.
[h=4]METHODS:[/h] We identified adults (≥18 years) hospitalized with laboratory-confirmed influenza during 2011-2015 seasons through CDC's Influenza Hospitalization Surveillance Network. IC patients had ≥1: HIV/AIDS, cancer, stem cell or organ transplantation, non-steroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, or other rare conditions. We compared demographic and clinical characteristics of IC and non-IC adults using descriptive statistics and used multivariable logistic regression and Cox proportional hazards models to control for confounding by patient demographic characteristics, pre-existing medical conditions, influenza vaccination, and other factors.
[h=4]RESULTS:[/h] Among 35,348 adults, 3633 (10%) were IC; cancer (44%), non-steroid immunosuppressive therapy (44%), and HIV (17%) were most common. IC patients were more likely than non-IC patients to have received influenza vaccination (53% vs. 46%; p<0.001), and ~85% of both groups received antivirals. In multivariable analysis, IC adults had higher mortality (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 1.46 [1.20-1.76]). Intensive care was more likely among IC patients 65-79 years (aOR [95% CI]: 1.25 [1.06-1.48]) and >80 years (aOR [95% CI]: 1.35 [1.06-1.73]) compared with non-IC patients in those age groups. IC patients were hospitalized longer (adjusted hazard ratio of discharge [95% CI]: 0.86 [0.83-0.88]) and were more likely to require mechanical ventilation (aOR [95% CI] 1.19 [1.05-1.36]).
[h=4]CONCLUSIONS:[/h] Substantial morbidity and mortality occurred among IC adults hospitalized with influenza. Influenza vaccination and antiviral administration could be increased in both IC and non-IC adults.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] HIV; cancer; immunosuppression; immunosuppressive; influenza
PMID: 31298691 DOI: 10.1093/cid/ciz638