Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

Francisco Álvarez-Lerma; Judith Marín-Corral; Clara Vila; Joan Ramón Masclans; Francisco Javier González de Molina; Ignacio Martín Loeches; Sandra Barbadillo; Alejandro Rodríguez; Pedro Cobo; Javier Martins; Cecilia Carbayo; Emilio Robles-Musso; Antonio Cárdenas; Javier Fierro; Dolores Ocaña Fernández; Rafael Sierra; Ma Jesús Huertos; Ma Luz Carmona Pérez; Juan Carlos Pozo Laderas; R. Guerrero; Juan Carlos Robles; Melissa Echevarría León; Alberto Bermejo Gómez; Enrique Márquez; Manuel Rodríguez-Carvajal; ángel Estella; José Pomares; José Luis Ballesteros; Olga Moreno Romero; Yolanda Fernández; Francisco Lobato; José F. Prieto; José Albofedo-Sánchez; Pilar Martínez; María Victoria de la Torre; María Nieto; Estefanía Cámara Sola; Miguel ángel Díaz Castellanos; Guillermo Sevilla Soler; Carlos Ortiz Leyba; José Garnacho-Montero; Rafael Hinojosa; Esteban Fernández; Ana Loza; Cristóbal León; Samuel González López; ángel Arenzana; Dolores Ocaña; Inés Navarrete; Medhi Zaheri Beryanaki; Ignacio Sánchez; Manuel Pérez Alé; Ana Ma Poullet Brea; Juan Francisco Machado Casas; Carlos Serón; Manuel Luis Avellanas; Arantxa Lander; S. Garrido Ramírez de Arellano; M. I. Marquina Lacueva; Pilar Luque; Elena Plumed Serrano; Juan Francisco Martín Lázaro; Carlos Sánchez Polo; Isabel Gutiérrez Cía; Belén Jiménez Bartolomé; Carlos López Núñez; Ignacio González; José Ignacio Tomás Marsilla; Clara Jaques Andrés; Pablo Gutiérrez Ibañes; Pilar Araujo Aguilar; Jose Ma Montón; Paloma Dorado Regil; Lisardo Iglesias; Carmen Pascual González; Brígida Quindós Fernández; Lorena Martín Iglesias; Lucía Viña Soria; Raquel Yano Escudero; Ma del Rosario Martínez Revuelta; José Ma Quiroga Ruiz; águeda García-Rodríguez; Marta Martín Cuadrado; Ana Luz Balán Mariño; Lorenzo Socias; Pedro Ibáñez; Marcío Borges-Sa; A. Socias; A. Del Castillo; Ricard Jordà Marcos; Cristina Muñoz; José M.Bonell Goytisolo; José Antonio Morales Carbonero; Ignacio Ayestarán; M. ángeles González López; Cecilia Vilanova Pàmies; Rossana Pérez Senoff; Marta Generelo López de Medrano; Sergio Ruiz-Santana; Juan José Díaz

doi:10.1186/s13054-016-1512-1

Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

Francisco Álvarez-Lerma, Judith Marín-Corral, Clara Vila, Joan Ramón Masclans, Francisco Javier González de Molina, Ignacio Martín Loeches, Sandra Barbadillo, Alejandro Rodríguez, Pedro Cobo, Javier Martins, Cecilia Carbayo, Emilio Robles-Musso, Antonio Cárdenas, Javier Fierro, Dolores Ocaña Fernández, Rafael Sierra, Ma Jesús Huertos, Ma Luz Carmona Pérez, Juan Carlos Pozo Laderas, R. GuerreroJuan Carlos Robles, Melissa Echevarría León, Alberto Bermejo Gómez, Enrique Márquez, Manuel Rodríguez-Carvajal, ángel Estella, José Pomares, José Luis Ballesteros, Olga Moreno Romero, Yolanda Fernández, Francisco Lobato, José F. Prieto, José Albofedo-Sánchez, Pilar Martínez, María Victoria de la Torre, María Nieto, Estefanía Cámara Sola, Miguel ángel Díaz Castellanos, Guillermo Sevilla Soler, Carlos Ortiz Leyba, José Garnacho-Montero, Rafael Hinojosa, Esteban Fernández, Ana Loza, Cristóbal León, Samuel González López, ángel Arenzana, Dolores Ocaña, Inés Navarrete, Medhi Zaheri Beryanaki, Ignacio Sánchez, Manuel Pérez Alé, Ana Ma Poullet Brea, Juan Francisco Machado Casas, Carlos Serón, Manuel Luis Avellanas, Arantxa Lander, S. Garrido Ramírez de Arellano, M. I. Marquina Lacueva, Pilar Luque, Elena Plumed Serrano, Juan Francisco Martín Lázaro, Carlos Sánchez Polo, Isabel Gutiérrez Cía, Belén Jiménez Bartolomé, Carlos López Núñez, Ignacio González, José Ignacio Tomás Marsilla, Clara Jaques Andrés, Pablo Gutiérrez Ibañes, Pilar Araujo Aguilar, Jose Ma Montón, Paloma Dorado Regil, Lisardo Iglesias, Carmen Pascual González, Brígida Quindós Fernández, Lorena Martín Iglesias, Lucía Viña Soria, Raquel Yano Escudero, Ma del Rosario Martínez Revuelta, José Ma Quiroga Ruiz, águeda García-Rodríguez, Marta Martín Cuadrado, Ana Luz Balán Mariño, Lorenzo Socias, Pedro Ibáñez, Marcío Borges-Sa, A. Socias, A. Del Castillo, Ricard Jordà Marcos, Cristina Muñoz, José M.Bonell Goytisolo, José Antonio Morales Carbonero, Ignacio Ayestarán, M. ángeles González López, Cecilia Vilanova Pàmies, Rossana Pérez Senoff, Marta Generelo López de Medrano, Sergio Ruiz-Santana, Juan José Díaz

Departament de Medicina

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33 Cites (Scopus)

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© 2016 The Author(s). Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.

Idioma original	Anglès
Número d’article	337
Revista	Critical Care
Volum	20
Número	1
DOIs	https://doi.org/10.1186/s13054-016-1512-1
Estat de la publicació	Publicada - 23 d’oct. 2016

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10.1186/s13054-016-1512-1

https://ddd.uab.cat/record/254256

Com citar-ho

Álvarez-Lerma, F., Marín-Corral, J., Vila, C., Masclans, J. R., González de Molina, F. J., Martín Loeches, I., Barbadillo, S., Rodríguez, A., Cobo, P., Martins, J., Carbayo, C., Robles-Musso, E., Cárdenas, A., Fierro, J., Fernández, D. O., Sierra, R., Huertos, M. J., Pérez, M. L. C., Laderas, J. C. P., ... Díaz, J. J. (2016). Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome. Critical Care, 20(1), Article 337. https://doi.org/10.1186/s13054-016-1512-1

@article{42e401fb0ad9418a9d5f236690ab0642,

title = "Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome",

abstract = "{\textcopyright} 2016 The Author(s). Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.",

keywords = "Critically ill, Early diagnosis, ICU, Influenza A (H1N1)pdm09 virus infection, Late diagnosis, Mortality, Outcome",

author = "Francisco {\'A}lvarez-Lerma and Judith Mar{\'i}n-Corral and Clara Vila and Masclans, {Joan Ram{\'o}n} and {Gonz{\'a}lez de Molina}, {Francisco Javier} and {Mart{\'i}n Loeches}, Ignacio and Sandra Barbadillo and Alejandro Rodr{\'i}guez and Pedro Cobo and Javier Martins and Cecilia Carbayo and Emilio Robles-Musso and Antonio C{\'a}rdenas and Javier Fierro and Fern{\'a}ndez, {Dolores Oca{\~n}a} and Rafael Sierra and Huertos, {Ma Jes{\'u}s} and P{\'e}rez, {Ma Luz Carmona} and Laderas, {Juan Carlos Pozo} and R. Guerrero and Robles, {Juan Carlos} and Le{\'o}n, {Melissa Echevarr{\'i}a} and G{\'o}mez, {Alberto Bermejo} and Enrique M{\'a}rquez and Manuel Rodr{\'i}guez-Carvajal and {\'a}ngel Estella and Jos{\'e} Pomares and Ballesteros, {Jos{\'e} Luis} and Romero, {Olga Moreno} and Yolanda Fern{\'a}ndez and Francisco Lobato and Prieto, {Jos{\'e} F.} and Jos{\'e} Albofedo-S{\'a}nchez and Pilar Mart{\'i}nez and {de la Torre}, {Mar{\'i}a Victoria} and Mar{\'i}a Nieto and Sola, {Estefan{\'i}a C{\'a}mara} and Castellanos, {Miguel {\'a}ngel D{\'i}az} and Soler, {Guillermo Sevilla} and Leyba, {Carlos Ortiz} and Jos{\'e} Garnacho-Montero and Rafael Hinojosa and Esteban Fern{\'a}ndez and Ana Loza and Crist{\'o}bal Le{\'o}n and L{\'o}pez, {Samuel Gonz{\'a}lez} and {\'a}ngel Arenzana and Dolores Oca{\~n}a and In{\'e}s Navarrete and Beryanaki, {Medhi Zaheri} and Ignacio S{\'a}nchez and Al{\'e}, {Manuel P{\'e}rez} and Brea, {Ana Ma Poullet} and Casas, {Juan Francisco Machado} and Carlos Ser{\'o}n and Avellanas, {Manuel Luis} and Arantxa Lander and {de Arellano}, {S. Garrido Ram{\'i}rez} and {Marquina Lacueva}, {M. I.} and Pilar Luque and Serrano, {Elena Plumed} and L{\'a}zaro, {Juan Francisco Mart{\'i}n} and Polo, {Carlos S{\'a}nchez} and C{\'i}a, {Isabel Guti{\'e}rrez} and Bartolom{\'e}, {Bel{\'e}n Jim{\'e}nez} and N{\'u}{\~n}ez, {Carlos L{\'o}pez} and Ignacio Gonz{\'a}lez and Marsilla, {Jos{\'e} Ignacio Tom{\'a}s} and Andr{\'e}s, {Clara Jaques} and Iba{\~n}es, {Pablo Guti{\'e}rrez} and Aguilar, {Pilar Araujo} and Mont{\'o}n, {Jose Ma} and Regil, {Paloma Dorado} and Lisardo Iglesias and Gonz{\'a}lez, {Carmen Pascual} and Fern{\'a}ndez, {Br{\'i}gida Quind{\'o}s} and Iglesias, {Lorena Mart{\'i}n} and Soria, {Luc{\'i}a Vi{\~n}a} and Escudero, {Raquel Yano} and Revuelta, {Ma del Rosario Mart{\'i}nez} and Ruiz, {Jos{\'e} Ma Quiroga} and {\'a}gueda Garc{\'i}a-Rodr{\'i}guez and Cuadrado, {Marta Mart{\'i}n} and Mari{\~n}o, {Ana Luz Bal{\'a}n} and Lorenzo Socias and Pedro Ib{\'a}{\~n}ez and Marc{\'i}o Borges-Sa and A. Socias and {Del Castillo}, A. and Marcos, {Ricard Jord{\`a}} and Cristina Mu{\~n}oz and Goytisolo, {Jos{\'e} M.Bonell} and Carbonero, {Jos{\'e} Antonio Morales} and Ignacio Ayestar{\'a}n and L{\'o}pez, {M. {\'a}ngeles Gonz{\'a}lez} and P{\`a}mies, {Cecilia Vilanova} and Senoff, {Rossana P{\'e}rez} and {de Medrano}, {Marta Generelo L{\'o}pez} and Sergio Ruiz-Santana and D{\'i}az, {Juan Jos{\'e}}",

year = "2016",

month = oct,

day = "23",

doi = "10.1186/s13054-016-1512-1",

language = "English",

volume = "20",

number = "1",

}

Álvarez-Lerma, F, Marín-Corral, J, Vila, C, Masclans, JR, González de Molina, FJ, Martín Loeches, I, Barbadillo, S, Rodríguez, A, Cobo, P, Martins, J, Carbayo, C, Robles-Musso, E, Cárdenas, A, Fierro, J, Fernández, DO, Sierra, R, Huertos, MJ, Pérez, MLC, Laderas, JCP, Guerrero, R, Robles, JC, León, ME, Gómez, AB, Márquez, E, Rodríguez-Carvajal, M, Estella, Á, Pomares, J, Ballesteros, JL, Romero, OM, Fernández, Y, Lobato, F, Prieto, JF, Albofedo-Sánchez, J, Martínez, P, de la Torre, MV, Nieto, M, Sola, EC, Castellanos, MÁD, Soler, GS, Leyba, CO, Garnacho-Montero, J, Hinojosa, R, Fernández, E, Loza, A, León, C, López, SG, Arenzana, Á, Ocaña, D, Navarrete, I, Beryanaki, MZ, Sánchez, I, Alé, MP, Brea, AMP, Casas, JFM, Serón, C, Avellanas, ML, Lander, A, de Arellano, SGR, Marquina Lacueva, MI, Luque, P, Serrano, EP, Lázaro, JFM, Polo, CS, Cía, IG, Bartolomé, BJ, Núñez, CL, González, I, Marsilla, JIT, Andrés, CJ, Ibañes, PG, Aguilar, PA, Montón, JM, Regil, PD, Iglesias, L, González, CP, Fernández, BQ, Iglesias, LM, Soria, LV, Escudero, RY, Revuelta, MDRM, Ruiz, JMQ, García-Rodríguez, Á, Cuadrado, MM, Mariño, ALB, Socias, L, Ibáñez, P, Borges-Sa, M, Socias, A, Del Castillo, A, Marcos, RJ, Muñoz, C, Goytisolo, JMB, Carbonero, JAM, Ayestarán, I, López, MÁG, Pàmies, CV, Senoff, RP, de Medrano, MGL, Ruiz-Santana, S & Díaz, JJ 2016, 'Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome', Critical Care, vol. 20, núm. 1, 337. https://doi.org/10.1186/s13054-016-1512-1

TY - JOUR

T1 - Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

AU - Álvarez-Lerma, Francisco

AU - Marín-Corral, Judith

AU - Vila, Clara

AU - Masclans, Joan Ramón

AU - González de Molina, Francisco Javier

AU - Martín Loeches, Ignacio

AU - Barbadillo, Sandra

AU - Rodríguez, Alejandro

AU - Cobo, Pedro

AU - Martins, Javier

AU - Carbayo, Cecilia

AU - Robles-Musso, Emilio

AU - Cárdenas, Antonio

AU - Fierro, Javier

AU - Fernández, Dolores Ocaña

AU - Sierra, Rafael

AU - Huertos, Ma Jesús

AU - Pérez, Ma Luz Carmona

AU - Laderas, Juan Carlos Pozo

AU - Guerrero, R.

AU - Robles, Juan Carlos

AU - León, Melissa Echevarría

AU - Gómez, Alberto Bermejo

AU - Márquez, Enrique

AU - Rodríguez-Carvajal, Manuel

AU - Estella, ángel

AU - Pomares, José

AU - Ballesteros, José Luis

AU - Romero, Olga Moreno

AU - Fernández, Yolanda

AU - Lobato, Francisco

AU - Prieto, José F.

AU - Albofedo-Sánchez, José

AU - Martínez, Pilar

AU - de la Torre, María Victoria

AU - Nieto, María

AU - Sola, Estefanía Cámara

AU - Castellanos, Miguel ángel Díaz

AU - Soler, Guillermo Sevilla

AU - Leyba, Carlos Ortiz

AU - Garnacho-Montero, José

AU - Hinojosa, Rafael

AU - Fernández, Esteban

AU - Loza, Ana

AU - León, Cristóbal

AU - López, Samuel González

AU - Arenzana, ángel

AU - Ocaña, Dolores

AU - Navarrete, Inés

AU - Beryanaki, Medhi Zaheri

AU - Sánchez, Ignacio

AU - Alé, Manuel Pérez

AU - Brea, Ana Ma Poullet

AU - Casas, Juan Francisco Machado

AU - Serón, Carlos

AU - Avellanas, Manuel Luis

AU - Lander, Arantxa

AU - de Arellano, S. Garrido Ramírez

AU - Marquina Lacueva, M. I.

AU - Luque, Pilar

AU - Serrano, Elena Plumed

AU - Lázaro, Juan Francisco Martín

AU - Polo, Carlos Sánchez

AU - Cía, Isabel Gutiérrez

AU - Bartolomé, Belén Jiménez

AU - Núñez, Carlos López

AU - González, Ignacio

AU - Marsilla, José Ignacio Tomás

AU - Andrés, Clara Jaques

AU - Ibañes, Pablo Gutiérrez

AU - Aguilar, Pilar Araujo

AU - Montón, Jose Ma

AU - Regil, Paloma Dorado

AU - Iglesias, Lisardo

AU - González, Carmen Pascual

AU - Fernández, Brígida Quindós

AU - Iglesias, Lorena Martín

AU - Soria, Lucía Viña

AU - Escudero, Raquel Yano

AU - Revuelta, Ma del Rosario Martínez

AU - Ruiz, José Ma Quiroga

AU - García-Rodríguez, águeda

AU - Cuadrado, Marta Martín

AU - Mariño, Ana Luz Balán

AU - Socias, Lorenzo

AU - Ibáñez, Pedro

AU - Borges-Sa, Marcío

AU - Socias, A.

AU - Del Castillo, A.

AU - Marcos, Ricard Jordà

AU - Muñoz, Cristina

AU - Goytisolo, José M.Bonell

AU - Carbonero, José Antonio Morales

AU - Ayestarán, Ignacio

AU - López, M. ángeles González

AU - Pàmies, Cecilia Vilanova

AU - Senoff, Rossana Pérez

AU - de Medrano, Marta Generelo López

AU - Ruiz-Santana, Sergio

AU - Díaz, Juan José

PY - 2016/10/23

Y1 - 2016/10/23

N2 - © 2016 The Author(s). Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.

AB - © 2016 The Author(s). Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.

KW - Critically ill

KW - Early diagnosis

KW - ICU

KW - Influenza A (H1N1)pdm09 virus infection

KW - Late diagnosis

KW - Mortality

KW - Outcome

U2 - 10.1186/s13054-016-1512-1

DO - 10.1186/s13054-016-1512-1

M3 - Article

SN - 1364-8535

VL - 20

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 337

ER -

Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

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