Clinical findings and demographic factors associated with intensive care unit admission in Utah due to 2009 novel influenza A (H1N1) infection.
Chest. 2009 Nov 20;
Authors: Miller RR, Markewitz BA, Rolfs RT, Brown SM, Dascomb KK, Grissom CK, Friedrichs MD, Mayer J, Hirshberg EL, Conklin J, Paine R, Dean NC
BACKGROUND: Novel influenza A H1N1 2009 (novel H1N1) infection has significantly affected intensive care units (ICU). We sought to characterize our region's clinical findings and demographic associations with ICU admission due to novel H1N1. METHODS: Observational study from May 19, 2009 to June 30, 2009 of descriptive clinical course, inpatient mortality, financial data, and demographic characteristics of an ICU cohort. Case-control study comparing the ICU cohort to Salt Lake County residents. RESULTS: The ICU cohort of 47 influenza patients had a median age of 34, APACHE II score of 21, and body mass index (BMI) of 35. Mortality was 17% (8/47). All 8 deaths occurred among the 64% of patients (n=30) with acute respiratory distress syndrome, twenty-six (87%) of whom also developed multiorgan failure. Compared to the Salt Lake County population, novel H1N1 patients were more likely to be obese (22% versus 74%; p<0.001), medically uninsured (14% versus 45%; p<0.001), and Hispanic (13% versus 23%; p<0.01) or Pacific Islander (1% versus 26%; p<0.001). Observed ICU admissions were 15-fold greater than expected for those with BMI >/=40 (SMR 15.8, 95% CI 8.3, 23.4) and 1.5-fold greater among those with BMI 30-39 than expected for age- and sex-adjusted rates for Salt Lake County. CONCLUSION: Severe ARDS with multiorgan dysfunction in the absence of bacterial infection was a common clinical presentation. In this cohort, young non-whites without medical insurance were disproportionately likely to require ICU care. Obese patients were particularly susceptible to critical illness due to novel H1N1 infection.
PMID: 19933372 [PubMed - as supplied by publisher]