Secondary Logo

Institutional members access full text with Ovid®

Novel Avian-Origin Influenza A (H7N9) in Critically Ill Patients in China*

Yang, Yi MD1; Guo, Fengmei MD1; Zhao, Wei MD2; Gu, Qin MD3; Huang, Mao MD4; Cao, Quan MD5; Shi, Yi MD6; Li, Jun MD7; Chen, Jun MD8; Yan, Jie MD9; Jin, Zhaochen MD10; Wang, Xing MD11; Deng, Yijun MD12; Sun, Lihua MD13; Cai, Hourong MD14; Huang, Jianan MD15; Zheng, Yishan MD2; Li, Weiqin MD16; Liu, Airan MD1; Chen, Bingwei PhD17; Zhou, Minghao PhD18; Qiu, Haibo MD1; Slutsky, Arthur S. MD19

doi: 10.1097/CCM.0000000000000695
Clinical Investigations
Buy
SDC

Objectives: In March 2013, human infection with a novel avian-origin reassortment influenza A (H7N9) virus was identified in China. A total of 26 cases were confirmed and treated in Jiangsu. All the patients had findings consistent with pneumonia and were admitted to an ICU, which pose a threat to human health. We aimed to provide the clinical features, treatment, and prognosis of the critically ill patients with H7N9 viral infection.

Design: A retrospective cohort study.

Setting: Eight closed ICUs in general hospitals distributed throughout the Jiangsu Provincial, China.

Patients: Patients infected with influenza A (H7N9) virus from March 20, 2013, through May 1, 2013, in Jiangsu Province were included.

Interventions: None.

Measurements and Main Results: Twenty-seven patients infected with H7N9 virus were identified in Jiangsu. Of these, 26 were hospitalized. The median age was 54.5 years, and 18 patients (69.2%) were men. The most common symptoms at the onset of illness were high fever and cough. White cell counts were normal or decreased. All the patients had findings consistent with pneumonia. Twenty-four patients (92.3%) developed acute respiratory distress syndrome, and 10 (38.5%) developed septic shock quickly after the onset of illness. Treatment with antiviral drugs was initiated in all the patients at a median of 8 days after the onset of illness. Mortality was 19.2% at 28 days and 30.8% at 90 days. Based on multiple logistic regression analysis, septic shock associated with severe hypoxemia was the only independent risk factor for mortality.

Conclusions: Infection with novel avian-origin reassortment influenza A (H7N9) virus is characterized by high fever, cough, and severe respiratory failure and is associated with a high mortality. These data provide some general understandings for the early identification, ICU treatment, and short-term prognosis of hospitalized critical patients with H7N9.

Supplemental Digital Content is available in the text.

1Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People’s Republic of China.

2Department of Critical Care Medicine, the Second Affiliated Hospital of Southeast University, Nanjing, People’s Republic of China.

3Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China.

4Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China.

5Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China.

6Department of Respiratory Medicine, Nanjing General Hospital of Nanjing Military Command, People’s Liberation Army, Nanjing, People’s Republic of China.

7Department of Infectious Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China.

8Department of Critical Care Medicine, the First Affiliated Hospital of Suzhou University, Suzhou, People’s Republic of China.

9Department of Critical Care Medicine, Wuxi People’s Hospital, Wuxi, People’s Republic of China.

10Department of Critical Care Medicine, Zhenjiang First People’s Hospital, Zhenjiang, People’s Republic of China.

11Department of Critical Care Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, People’s Republic of China.

12Department of Critical Care Medicine, Yancheng City No. 1 People’s Hospital, Yancheng, People’s Republic of China.

13Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University (Nanjing First Hospital), Nanjing, People’s Republic of China.

14Department of Respiratory Medicine, Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China.

15Department of Respiratory Medicine, the First Affiliated Hospital of Suzhou University, Suzhou, People’s Republic of China.

16Department of Critical Care Medicine, Nanjing General Hospital of Nanjing Military Command, People’s Liberation Army, Nanjing, People’s Republic of China.

17Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, People’s Republic of China.

18Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People’s Republic of China.

19Department of Critical Care Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada.

* See also p. 487.

Drs. Yang, Guo, Zhao, Gu, Huang, Cao, and Shi contributed equally to this study.

Drs. Yang, Guo, and Qiu contributed to study concept and design. Drs. Guo, Zhao, Gu, M. Huang, Cao, Chen, Yan, Jin, Wang, Deng, and Zheng contributed to acquisition of data. Drs. Guo and Qiu had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Yang, Liu, and Chen contributed to analysis and interpretation of data. Drs. Yang, Guo, Liu, and Slutsky contributed to drafting of the article. Drs. Yang, Qiu, and Slutsky contributed to critical revision of the article for important intellectual content. Drs. Yang, Guo, Gu, Liu, and Chen contributed to statistical analysis. Drs. Zhao, M. Huang, Cao, Shi, Li, Sun, Cai, J. Huang, Li, and Zhou contributed to administrative, technical, or material support. Drs. Qiu and Slutsky contributed to study supervision.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

This study was fully sponsored by the grant of the Health Research Special Funds for Public Welfare Projects of China (201202011). The sponsor had a role in design and conduct of the study and preparation and approval of our article.

The authors’ institutions received grant support from the Health Research Special Funds for Public Welfare Projects of China.

For information regarding this article, E-mail: haiboq2000@163.com

Copyright © by 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.