OriginalFirst influenza season after the 2009 pandemic influenza: report of the first 300 ICU admissions in SpainPrimera epidemia de gripe estacional después de la pandemia por gripe A en 2009: descripción de los primeros 300 ingresos en UCI españolas
Introduction
During the 2009 influenza pandemic caused by the A(H1N1) 2009 virus, several reports were published regarding the presentation of this disease with severe acute respiratory symptoms in hospitalized patients1, 2, 3, 4. Rapidly progressive viral pneumonia represents the primary cause of intensive care unit (ICU) admission with mortality rates ranging from 17.3% to 46% among different sites1, 2, 3, 5, 6, 7, 8, 9. This disease represented a challenge for critical care physicians worldwide. In the 2010-11 winter a seasonal outbreak of influenza has been detected in Spain with most cases caused by the former A/H1N1 2009 pandemic virus, currently called “new A/H1N1 virus” (An/H1N1). Data on the clinical profiles of critically ill patients with the virus An/H1N1 infection during this outbreak are still lacking. Here, we present our experience in a series of the first 300 critically ill patients admitted to Spanish ICUs.
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Material and methods
This prospective, observational cohort study of ICU patients was conducted across 148 ICUs in Spain. Data were obtained from a voluntary registry created by the Spanish Society of Intensive Care Medicine (SEMICYUC), the Spanish Network for Research on Infectious Disease (REIPI) and the Spanish Biomedical Research Center Network on Respiratory Diseases (CIBERES). The study was approved by the Joan XXIII University Hospital Ethics Committee (IRB NEUMAGRIP/11809). Patient identification remained
Results
Data from the first 300 adults admitted to Spanish ICUs during the winter of 2010-11 due to An/H1N1 infection are the focus of the present report. Patients were young (median 49 years) and 62% were male. The mean APACHE II score was 16.9 ± 7.5 and the mean SOFA score was 6.3 ± 3.5 on admission. The baseline characteristics of the population are shown in Table 1. Comorbidities were present in 76% (n = 228) of cases. The main comorbid condition reported was obesity in 111 patients (37.4%) followed by
Discussion
To the best of our knowledge, this is the first study that presents a relatively large number of patients admitted to the ICU for severe infection due to the An/ H1N1 virus in the 2010-11 seasonal influenza outbreak, this being in the post-pandemic period.
In our series, the presenting features of An/H1N1 influenza during the winter of 2010-11 were quite similar to those described in the past 2009 A/H1N1 virus infection pandemic. Nevertheless some aspects need to be pointed out.
In this report,
Finance
Supported by Instituto de Salud Carlos III (Ministry of Science and Innovation).
Conflict of interests
Authors declare no conflict of interests regarding the present manuscript.
Authors’ contributions
AR assisted in the design of the study, coordinated patient recruitment, analyzed and interpreted the data, and with IML assisted in writing the paper. JB, PO, FAL, RZ, JG, JB, FG, JR made an important contribution to acquisition and analysis of data. JC, JL, IML and EC were involved in revising it critically for important intellectual content. CL, FP and AE made a substantial contribution to the conception and interpretation of data, and revised the final manuscript version. They all approved
H1N1 SEMICYUC/REIPI/CIBERES Working Group investigators
Andalucía: Pedro Cobo (Hospital Punta de Europa, Algeciras); Javier Martins (Hospital Santa Ana Motril, Granada); Cecilia Carbayo (Hospital Torrecardenas, Almería); Emilio Robles-Musso, Antonio Cárdenas, Javier Fierro (Hospital del Poniente, Almería); Dolores Ocaña Fernández (Hospital Huercal, Overa, Almería); Rafael Sierra (Hospital Puerta del Mar, Cádiz); M. Jesús Huertos (Hospital Puerto Real, Cádiz); Juan Carlos Pozo, R. Guerrero (Hospital Reina Sofía, Córdoba); Enrique Márquez (Hospital
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Members are listed in the acknowledgements section.