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KMID : 0191120110260040499
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Journal of Korean Medical Science
2011 Volume.26 No. 4 p.499 ~ p.506
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A Prediction Rule to Identify Severe Cases among Adult Patients Hospitalized with Pandemic Influenza A (H1N1) 2009
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Oh Won-Sup
Lee Seung-Joon
Lee Chang-Seop
Hur Ji-An
Hur Ae-Chung
Park Yoon-Seon
Heo Sang-Taek
Bae In-Gyu
Park Sang-Won
Kim Eu-Suk
Kim Hong-Bin
Song Kyoung-Ho
Lee Kkot-Sil
Lee Sang-Rok
Yeom Joon-Sup
Lee Su-Jin
Kim Baek-Nam
Kwak Yee-Gyung
Lee Jae-Hoon
Kim Yong-Keun
Kim Hyo-Youl
Kim Nam-Joong
Oh Myoung-Don
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Abstract
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The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 ≤ 250), bilateral lung infiltration, and old age (≥ 65 yr) were independent risk factors for severe cases (all P < 0.001). The area under the ROC curve (0.834 [95% CI, 0.778-0.890]) of the number of risk factors were not significantly different with that of APACHE II score (0.840 [95% CI, 0.790-0.891]) (P = 0.496). The presence of ≥ 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of ≥ 13. As a prediction rule, the presence of ≥ 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.
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KEYWORD
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pandemic influenza A (H1N1) 2009, Severity, Risk Factors, Prediction Rule
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