tetano
Editor, Senior Moderator
Swiss Med Wkly. 2013 Apr 18;143:0. doi: 10.4414/smw.2013.13788.
Thrombocytopenia as a mortality risk factor in acute respiratory failure in H1N1 influenza.
Lopez-Delgado JC, Rovira A, Esteve F, Rico N, Ma?ez Mendiluce R, Ball?s Noguera J, Berrade J.
Source
Hospital Universitari Bellvitge,L' Hospitalet de Llobregat, Barcelona, SPAIN; juancarloslopezde@hotmail.com.
Abstract
BACKGROUND:
A small proportion of patients with influenza H1N1 rapidly develop acute respiratory failure and are a problem for intensive care units (ICUs). Although certain clinical risk factors have been identified, few measurable biochemical/haematological markers able to predict poor outcome have been reported. The aims of the present report are to show which variables on and during admission are associated with increased in-hospital mortality in patients admitted to the ICU with acute respiratory failure due to H1N1 influenza.
METHODS:
A prospective observational study at two ICUs was carried out between August 2009 and March 2011. The study period covered two waves of pandemic influenza A H1N1 in Spain. Clinical and laboratory data on and during ICU admission were recorded for the purpose of analysis.
RESULTS:
Sixty patients with acute respiratory failure due to H1N1 influenza were admitted during the period described above; 63.3% (n = 38) were male and the mean age was 49.2 ? 14 years. Regarding comorbidities, 46.7% (n = 28) were smokers, 38% (n = 23) had hypertension, 30% (n = 18) had a body mass index (BMI) >30 kg/m2, 30% (n = 18) had chronic obstructive pulmonary disease and 26% (n = 16) had cardiac insufficiency; 16.6% (n = 10) had bacterial co-infection, 70% (n = 42) required invasive mechanical ventilation and 48.3% (n = 29) non-invasive mechanical ventilation. Mortality was 20% (n = 12). Comparing survivors with non-survivors, univariate analysis revealed significant differences in BMI, creatinine, haemoglobin, platelets, arterial pH, pCO2, and the rate of bacterial co-infection. In the multivariate analysis, only the presence of lower platelet count was statistically significant (214 ? 101 vs 113 ? 82 ?109/L; p = 0.009). Patients with thrombocytopenia showed a lower in-hospital survival rate (55%vs92.5%; Log Rank = 0.008).
CONCLUSIONS:
Thrombocytopenia could be valuable marker of in-hospital mortality in patients with respiratory failure due to H1N1 influenza in the ICU scenario.
PMID:
23739994
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/23739994
Thrombocytopenia as a mortality risk factor in acute respiratory failure in H1N1 influenza.
Lopez-Delgado JC, Rovira A, Esteve F, Rico N, Ma?ez Mendiluce R, Ball?s Noguera J, Berrade J.
Source
Hospital Universitari Bellvitge,L' Hospitalet de Llobregat, Barcelona, SPAIN; juancarloslopezde@hotmail.com.
Abstract
BACKGROUND:
A small proportion of patients with influenza H1N1 rapidly develop acute respiratory failure and are a problem for intensive care units (ICUs). Although certain clinical risk factors have been identified, few measurable biochemical/haematological markers able to predict poor outcome have been reported. The aims of the present report are to show which variables on and during admission are associated with increased in-hospital mortality in patients admitted to the ICU with acute respiratory failure due to H1N1 influenza.
METHODS:
A prospective observational study at two ICUs was carried out between August 2009 and March 2011. The study period covered two waves of pandemic influenza A H1N1 in Spain. Clinical and laboratory data on and during ICU admission were recorded for the purpose of analysis.
RESULTS:
Sixty patients with acute respiratory failure due to H1N1 influenza were admitted during the period described above; 63.3% (n = 38) were male and the mean age was 49.2 ? 14 years. Regarding comorbidities, 46.7% (n = 28) were smokers, 38% (n = 23) had hypertension, 30% (n = 18) had a body mass index (BMI) >30 kg/m2, 30% (n = 18) had chronic obstructive pulmonary disease and 26% (n = 16) had cardiac insufficiency; 16.6% (n = 10) had bacterial co-infection, 70% (n = 42) required invasive mechanical ventilation and 48.3% (n = 29) non-invasive mechanical ventilation. Mortality was 20% (n = 12). Comparing survivors with non-survivors, univariate analysis revealed significant differences in BMI, creatinine, haemoglobin, platelets, arterial pH, pCO2, and the rate of bacterial co-infection. In the multivariate analysis, only the presence of lower platelet count was statistically significant (214 ? 101 vs 113 ? 82 ?109/L; p = 0.009). Patients with thrombocytopenia showed a lower in-hospital survival rate (55%vs92.5%; Log Rank = 0.008).
CONCLUSIONS:
Thrombocytopenia could be valuable marker of in-hospital mortality in patients with respiratory failure due to H1N1 influenza in the ICU scenario.
PMID:
23739994
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/23739994