Abstract
Elderly patients and patients with different comorbid conditions are at a higher risk of developing severe clinical course and lethal influenza outcome. The aim of this study was to define comorbid conditions in patients with a severe form of seasonal influenza, and to define their influence on lethal outcome. The study was a prospective, group comparison and was conducted at the University Clinic for Infectious Diseases in Skopje, Macedonia, during the period of January 01, 2012 to January 01, 2015. The study included 87 adult patients with a severe form of seasonal influenza, who were further categorized in to a group of either survived patients (n=75) and a group of deceased patients (n=12). Demographic parameters of the patients, as well as any comorbid medical conditions, such as cardiovascular disease, chronic lung disease, neurological diseases, weakened immune system, endocrine disorders, kidney disorders, liver disorders, pregnancy, overweight were noted upon admission in the hospital. The variables of the univariate analysis that showed a significant difference in terms of the outcome were used for creating multivariate logistic and regression analysis to identify independent predictors for lethal outcome in severe cases of influenza. Multivariate analysis identified cardiovascular comorbid diseases (p=0.014), as an independent predictor of the outcome in patients with severe form of seasonal influenza. Influenza patients with cardiovascular diseases had 2.024 times greater risk of death from influenza in comparison to patients having influenza without a history of such a disease (OR=2.024 95% CI 1.842-17.337).
Highlights
Influenza is a serious disease with significant morbidity and mortality which clinical presentation ranges from relatively mild and self-limiting respiratory infections to severe clinical manifestations (Thompson et al, 2009)
The variables of the univariate analysis that showed a significant difference in terms of the outcome were used for creating multivariate logistic and regression analysis to identify independent predictors for lethal outcome in severe cases of influenza
The largest number of studies has evaluated isolated risk factors leading to lethal outcome and only a few of them have been focused on the complete palette of predictors for development of a severe form of the disease and lethal outcome (Kumar et al, 2009; Li et al, 2009; Liu et al, 2009; Yokota, 2011)
Summary
Influenza is a serious disease with significant morbidity and mortality which clinical presentation ranges from relatively mild and self-limiting respiratory infections to severe clinical manifestations (Thompson et al, 2009). In most studies delayed antiviral treatment, severe hypoxemia and multisystem organ failure are most commonly referred as leading risk factors for lethal outcome (Damak et al, 2011; Webb et al, 2009). The largest number of studies has evaluated isolated risk factors leading to lethal outcome and only a few of them have been focused on the complete palette of predictors for development of a severe form of the disease and lethal outcome (Kumar et al, 2009; Li et al, 2009; Liu et al, 2009; Yokota, 2011). From the clinical practice point of view, the recognition of the risk factors and predictors for lethal outcome of influenza is of particular importance in bringing timely and exact decision for hospitalization, treatment or undertaking special measures for intensive monitoring of these patients
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