DOI QR코드

DOI QR Code

Critically Ill Patients with Pandemic Influenza A/H1N1 2009 at a Medical Center in Korea

  • Choi, Eun-Young (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Huh, Jin-Won (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Youn-Suck (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Han (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Sang-Ho (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won-Young (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Mi-Na (Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2010.07.20
  • Accepted : 2010.09.20
  • Published : 2011.01.30

Abstract

Background: The aim of the study was to describe the characteristics, treatments, and outcomes of critically ill patients with pandemic Influenza A/H1N1 2009 at a major medical center in Korea. Methods: This retrospective observational study examined critically ill adult patients with pandemic Influenza A/H1N1 2009, who were admitted to the AMC between August and December 2009. Results: 27 patients with confirmed pandemic Influenza A/H1N1 2009 were admitted to the intensive care unit (ICU) at the Asan Medical Center (AMC). The median age (IQR) was 59 years (41~67), and 66.7% of the patients were older than 51 years. A total of 81.5% of the patients had 2 or more co-morbidities. The median time (IQR) from symptom onset to presentation was 2 days (1~4), and the median time from presentation to ICU admission was 0 days (0~1.5). All patients received oseltamivir (300 mg/day) and 13 patients received triple combination therapy (oseltamivir, amantadine, ribavirin). Twelve patients required mechanical ventilation on the first day of ICU admission. A total of 6 patients (22.2%) died within 28 days of admission. The patients who died had significantly higher acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores at presentation. There were no significant differences in age, co-morbidities, or antiviral regimens between survivors and non-survivors. Conclusion: Critical illness related to pandemic Influenza A/H1N1 2009 was common in elderly patients with chronic co-morbidities. All patients were given high-dose oseltamivir or triple combination antiviral therapy. Nonetheless, patients with critical illnesses associated with pandemic Influenza A/H1N1 2009 had a death rate of 22.2%.

References

  1. Centers for Disease Control and Prevention (CDC). Swine influenza A (H1N1) infection in two children--Southern California, March-April 2009. MMWR Morb Mortal Wkly Rep 2009;58:400-2.
  2. World Health Organization. Global alert and response, pandemic (H1N1) 2009, frequently asked questions: what is phase 6? [Internet]. Geneva: WHO; c2011 [cited 2011 Jan 10]. Available from: http://www.who.int/csr/disease/swineflu/frequently_asked_questions/levels_pandemic_alert/en/index.html.
  3. Korea Centers for Disease Control and Prevention. KCDC Newsletters [Internet]. Cheongwon: KCDC; c2011 [cited 2011 Jan 10]. Available from: http://www.cdc.go.kr/kcdchome/jsp/home/common/brd/COMMBRD0200List.jsp?menuid=100047&contentid=null&boardid=1010&appid=&pageNum=1&sub=1&sub2=2&tabinx=1&q_had01=A&q_had02=2011&loadType=null&boardseq=null.
  4. Dominguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, et al. Critically ill patients with 2009 influenza A (H1N1) in Mexico. JAMA 2009;302:1880-7. https://doi.org/10.1001/jama.2009.1536
  5. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA 2009;302: 1872-9. https://doi.org/10.1001/jama.2009.1496
  6. Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California. JAMA 2009;302:1896-902. https://doi.org/10.1001/jama.2009.1583
  7. Rello J, Rodriguez A, Ibanez P, Socias L, Cebrian J, Marques A, et al. Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain. Crit Care 2009;13:R148. https://doi.org/10.1186/cc8044
  8. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A (H1N1) Acute Respiratory Distress Syndrome. JAMA 2009;302:1888-95. https://doi.org/10.1001/jama.2009.1535
  9. Hancock K, Veguilla V, Lu X, Zhong W, Butler EN, Sun H, et al. Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med 2009; 361:1945-52. https://doi.org/10.1056/NEJMoa0906453
  10. Vaillant L, La Ruche G, Tarantola A, Barboza P; epidemic intelligence team at InVS. Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009. Euro Surveill 2009;14(33). pii:19309.
  11. Cooksley CD, Avritscher EB, Bekele BN, Rolston KV, Geraci JM, Elting LS. Epidemiology and outcomes of serious influenza-related infections in the cancer population. Cancer 2005;104:618-28. https://doi.org/10.1002/cncr.21203
  12. OECD factbook 2009: economic, environmental and social statistics. Paris: OECD; 2009.
  13. Chien YS, Su CP, Tsai HT, Huang AS, Lien CE, Hung MN, et al. Predictors and outcomes of respiratory failure among hospitalized pneumonia patients with 2009 H1N1 influenza in Taiwan. J Infect 2010;60:168-74. https://doi.org/10.1016/j.jinf.2009.12.012
  14. Zarychanski R, Stuart TL, Kumar A, Doucette S, Elliott L, Kettner J, et al. Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection. CMAJ 2010;182:257-64. https://doi.org/10.1503/cmaj.091884
  15. Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus, Abdel- Ghafar AN, Chotpitayasunondh T, Gao Z, Hayden FG, Nguyen DH, de Jong MD, et al. Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med 2008;358:261-73. https://doi.org/10.1056/NEJMra0707279
  16. Nguyen JT, Hoopes JD, Smee DF, Prichard MN, Driebe EM, Engelthaler DM, et al. Triple combination of oseltamivir, amantadine, and ribavirin displays synergistic activity against multiple influenza virus strains in vitro. Antimicrob Agents Chemother 2009;53:4115-26. https://doi.org/10.1128/AAC.00476-09