Seasonal burden of severe influenza virus infection in the critically ill patients, using the Assistance Publique-H\xf4pitaux de Paris clinical data warehouse: a pilot study

Morgane Faure,Fabrice Carrat,Marc Humbert,Yacine Tandjaoui-Lambiotte,Nathanaël Lapidus ,Keyvan Razazi,Jean‐François Timsit ,Yves Cohen,Djillali Annane,Benjamin Planquette,Armand Mekontso Dessap,Sarah Benghanem,Jean Louis Teboul,Olivier Sanchez,Jean Damien Ricard,Virginie Lemiale,Nicholas Heming,Jean Paul Mira,Antoine Vieillard‐Baron ,Alexandre Demoule,Étienne De Montmollin ,Jonathan Messika,Michel Djibré,Guillaume Voiriot,Éric Maury ,Laurent Guérin,Bernard Page,Jonathan Marey,Jean‐Luc Diehl ,Nicolás Roche ,Alain Combes,Élie Azoulay ,Laurent Savale,Pierre Trouiller,Muriel Fartoukh

doi:10.1186/s13613-021-00884-8

Abstract

PurposeAt the critical care level, the flu surveillance system is limited in France, with heterogeneous regional modalities of implementation.Materials, patients and methodsWe aimed at assessing the relevance of the Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse for estimating the burden of the influenza epidemic on medical adult critical care units of the AP-HP, and outcome of patients during the flu season 2017–2018. This exploratory multi-site epidemiological study comprised all consecutive adult stays (n = 320) in 18 medical intensive care units (ICU) or intermediate care wards (ICW) for probable or confirmed Influenza virus infection during the 2017–2018 flu season.ResultsPatients admitted to ICU/ICW had low vaccination coverage (21%), required life support in 60% of cases, stayed in the ICU for a median of 8 days, and had high 28-day mortality rate (19.7%; 95% confidence interval 15.5–24.5). Early prognostic factors included age, core temperature, the acute organ failures score, and the early administration of antiviral therapy.ConclusionsData directly extracted from the electronic medical records stored in the data warehouse provide detailed clinical, care pathway and prognosis information. The real-time availability should enable to detect and assess the burden of the most severe cases. By a firmer and more acute monitoring and adjustment of care and patient management, hospitals could generate more ICU/ICW capacities, sensitize their emergency department and contribute to the recommendations from health authorities. This pilot study is of particular relevance in the context of emerging epidemics of severe acute respiratory diseases.

Highlights

Each year, the characteristics of the flu epidemic are likely to evolve [1,2,3,4,5], and may require specific recommendations from the health authorities
In Paris area, individual case report forms of probable or confirmed severe influenza illness are completed by a regional network of 17 sentinel adult medical intensive care units (ICU) and affiliated medical intermediate care wards (ICW) on a voluntary basis, and are sent to SPF every time a new case is diagnosed
During the study period, 320 patients with probable or confirmed influenza infection were admitted to the ICU/ICW of the participating centers, a median of 3 [1,2,3,4,5] days after symptoms onset, and 76 patients (24%) had already started taking oseltamivir before ICU/ICW admission (Table 1)

Summary

Introduction

The characteristics of the flu epidemic are likely to evolve [1,2,3,4,5], and may require specific recommendations from the health authorities. In Paris area, individual case report forms of probable or confirmed severe influenza illness are completed by a regional network of 17 sentinel adult medical intensive care units (ICU) and affiliated medical intermediate care wards (ICW) on a voluntary basis, and are sent to SPF every time a new case is diagnosed. Based on those reports, a regional feedback is weekly available, to provide detection and situational awareness regarding the most severe cases in the Paris area

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Results

Discussion

Conclusion