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Predictive factors of severe multilobar pneumonia and shock in patients with influenza
  1. Susana Garcia Gutierrez1,
  2. José Maria Quintana1,
  3. Maretva Baricot2,
  4. Amaia Bilbao3,
  5. Alberto Capelastegui4,
  6. Carlos Gustavo Cilla Eguiluz5,
  7. Angela Domínguez6,7,
  8. Jesús Castilla8,9,
  9. Pere Godoy7,9,
  10. Miguel Delgado-Rodríguez7,10,
  11. Núria Soldevila6,7,
  12. Jenaro Astray11,
  13. José María Mayoral12,
  14. Vicente Martín7,13,
  15. Fernando González-Candelas7,14,
  16. Juan Carlos Galán7,15,
  17. Sonia Tamames16,
  18. Ady Angélica Castro-Acosta17,
  19. Olatz Garín7,18,
  20. Tomás Pumarola19,
  21. the CIBERESP Cases and Controls in Pandemic Influenza Working Group, Spain
  1. 1Unidad de Investigación, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo (Osakidetza), Galdakao, Bizkaia, Spain
  2. 2Departamento de Preventiva y Salud Pública, Universidad del País Vasco, Leioa, Bizkaia, Spain
  3. 3Unidad de Investigación, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Universitario Basurto (Osakidetza), Bilbao, Bizkaia, Spain
  4. 4Servicio de Neumología, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
  5. 5Servicio de Microbiología, Hospital Donostia, Donostia, Gipuzkoa, Spain
  6. 6Department de Salut Pública, Universitat de Barcelona, Barcelona, Barcelona, Spain
  7. 7CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  8. 8Instituto de Salud Pública de Navarra, Pamplona, Navarra, Spain
  9. 9Department de Salut, Generalitat de Catalunya, Barcelona, Spain
  10. 10Medicina Preventiva, Universidad de Jaen, Jaen, Jaen, Spain
  11. 11Área de Epidemiología, Comunidad de Madrid, Madrid, Spain
  12. 12Servicio de Vigilancia de Andalucia, Andalucia, Andalucia, Spain
  13. 13Instituto de Biomedicina, Universidad de Leon, León, León, Spain
  14. 14Centro Superior de Investigación en Salud Pública, Universidad de Valencia, Valencia, Valencia, Spain
  15. 15Virología Molecular, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
  16. 16Dirección General de Salud Pública e Investigación, Desarrollo e Innovación, Junta de Castilla y León, Valladolid, Valladolid, Spain
  17. 17Enfermedades Respiratorias, CIBER, Madrid, Spain
  18. 18Institut Municipal d’ Investigació Mèdica, Barcelona, Barcelona, Spain
  19. 19Red Española de Investigación en Patología Infecciosa (REIPI), Barcelona, Barcelona, Spain
  1. Correspondence to Dr Susana García Gutiérrez, Unidad de Investigación, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Barrio Labeaga s/n, Galdakao, Vizcaya 48960, Spain; susana.garciagutierrez{at}


Purpose To identify risk factors present at admission in adult patients hospitalised due to influenza virus infection during the 2009/10 and 2010/11 seasons—including whether infection was from pandemic or seasonal influenza A infections—that were associated with the likelihood of developing severe pneumonia with multilobar involvement and shock.

Methods Prospective cohort study. Patients hospitalised due to influenza virus infection were recruited. We collected information on sociodemographic characteristics, pre-existing medical conditions, vaccinations, toxic habits, previous medications, exposure to social environments, and EuroQoL-5D (EQ-5D). Severe pneumonia with multilobar involvement and/or shock (SPAS) was the primary outcome of interest. We constructed two multivariate logistic regression models to explain the likelihood of developing SPAS and to create a clinical prediction rule for developing SPAS that includes clinically relevant variables.

Results Laboratory-confirmed A(H1N1)pdm09, EQ-5D utility score 7 days before admission, more than one comorbidity, altered mental status, dyspnoea on arrival, days from onset of symptoms, and influenza season were associated with SPAS. In addition, not being vaccinated against seasonal influenza in the previous year, anaemia, altered mental status, fever and dyspnoea on arrival at hospital, difficulties in performing activities of daily living in the previous 7 days, and days from onset of symptoms to arrival at hospital were related to the likelihood of SPAS (area under the curve value of 0.75; Hosmer–Lemeshow p value of 0.84).

Conclusions These variables should be taken into account by physicians evaluating a patient affected by influenza as additional information to that provided by the usual risk scores.

  • Infectious Diseases, Viral
  • Clinical Management
  • Clinical Care

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