Abstract
BackgroundThe need for invasive mechanical ventilation (IMV) is linked to significant morbidity and mortality in patients with influenza-related pneumonia (Flu-p). We aimed to develop an assessment tool to predict IMV among Flu-p patients within 14 days of admission.MethodsIn total, 1107 Flu-p patients from five teaching hospitals were retrospectively enrolled from January 2012 to December 2019, including 895 patients in the derivation cohort and 212 patients in the validation cohort. The predictive model was established based on independent risk factors for IMV in the Flu-p patients from the derivation cohort.ResultsOverall, 10.6% (117/1107) of patients underwent IMV within 14 days of admission. Multivariate regression analyses revealed that the following factors were associated with IMV: early neuraminidase inhibitor use (− 3 points), lymphocytes < 0.8 × 109/L (1 point), multi-lobar infiltrates (1 point), systemic corticosteroid use (1 point), age ≥ 65 years old (1 points), PaO2/FiO2 < 300 mmHg (2 points), respiratory rate ≥ 30 breaths/min (3 points), and arterial PH < 7.35 (4 points). A total score of five points was used to identify patients at risk of IMV. This model had a sensitivity of 85.5%, a specificity of 88.8%, and exhibited better predictive performance than the ROX index (AUROC = 0.909 vs. 0.594, p = 0.004), modified ROX index (AUROC = 0.909 vs. 0.633, p = 0.012), and HACOR scale (AUROC = 0.909 vs. 0.622, p < 0.001) using the validation cohort.ConclusionsFlu-IV score is a valuable prediction rule for 14-day IMV rates in Flu-p patients. However, it should be validated in a prospective study before implementation.
Highlights
The need for invasive mechanical ventilation (IMV) is linked to significant morbidity and mortality in patients with influenza-related pneumonia (Flu-p)
Certain assessment tools have been established in an effort to gauge the odds of IMV in individuals suffering from acute hypoxemic respiratory failure, including the ROX index [7], modified ROX index (PaO2/FiO2 to respiratory rate) [8], and HACOR scale [9]
Study definitions Patients with Influenza-related pneumonia (Flu-p) were defined as individuals for whom polymerase chain reaction (PCR) analyses of respiratory specimens were positive for influenza viral RNA, and for whom respiratory symptoms and chest radiographic findings were consistent with newly emergent chest infiltrates
Summary
The need for invasive mechanical ventilation (IMV) is linked to significant morbidity and mortality in patients with influenza-related pneumonia (Flu-p). Certain assessment tools have been established in an effort to gauge the odds of IMV in individuals suffering from acute hypoxemic respiratory failure, including the ROX index (pulse oximetry/FiO2 to respiratory rate) [7], modified ROX index (PaO2/FiO2 to respiratory rate) [8], and HACOR scale (heart rate, respiratory rate, arterial pH, PaO2/FiO2 and Glasgow Coma Scale) [9] These tools, are not specific to Flu-p patients, nor have any studies examined their predictive power in individuals suffering from Flu-p, and there is a clear need for the development of a reliable tool that can predict the requirement for IMV in Flu-p patients at an early time point prior to the onset of potential respiratory failure
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