Severe pandemic (H1N1)v influenza A infection: Report on the first deaths in Spain

Ignacio Martin-Loeches, Alejandro Rodriguez, Juan Bonastre, Rafael Zaragoza, Rafael Sierra, Asunción Marques, Jose Juliá-Narvaez, Emili Diaz, Jordi Rello, Pedro Cobo, Javier Martins, Cecilia Carbayo, Emilio Robles-Musso, Antonio Cárdenas, Javier Fierro, Ocaña Fernández, Ma Jesús Huertos, Juan Carlos Pozo, R. Guerrero, Enrique MárquezManuel Rodríguez-Carvajal, Antonio Jareño, José Pomares, José Luis Ballesteros, Yolanda Fernández, Francisco Lobato, José F. Prieto, José Albofedo-Sánchez, Pilar Martínez, Miguel Angel Díaz Castellanos, Guillermo Sevilla, José Garnacho-Montero, Rafael Hinojosa, Esteban Fernández, Ana Loza, Cristóbal León, Angel Arenzana, Dolores Ocaña, Manuel Luis Avellanas, Arantxa Lander, S. Garrido Ramírez De Arellano, M. I.Marquina Lacueva, Pilar Luque, Ignacio González, Ma Jose Montón, Ma Jose Díaz, Pilar López-Reina, Sergio Sáez, Lisardo Iglesias, Carmen Pascual González, Quiroga, Águeda García-Rodríguez, Lorenzo Socias, Pedro Ibánez, Marcío Borges-Sa, A. Socias, A. Del Castillo, Ricard Jordà Marcos, José M. Bonell, Ignacio Amestarán, Sergio Martínez, J. J. Cáceres, Sergio Ruiz-Santana, Juan José Díaz, Sisón, David Hernández, Ana Trujillo, Luis Regalado, Leonardo Lorente, Mar Martín, Borja Suberviola, P. Ugarte, Fernando García-López, Angel Álvaro Alonso, Antonio Pasilla, Ma Luisa Gómez Grande, Antonio Albaya, Alfonso Canabal, Luis Marina, Juan B. López Messa, Ma Jesús López Pueyo, Zulema Ferreras, Santiago Macias, José Ángel Berezo, Jesús Blanco Varela, A. Andaluz Ojeda, Antonio Álvarez Terrero, Fabiola Tena Ezpeleta, Ma Rosa Catalán, Miquel Ferrer, Antoni Torres, Sandra Barbadillo, Lluís Cabré, Assumpta Rovira, Francisco Álvarez-Lerma, Antonia Vázquez, Joan Nolla, Francisco Fernández, Joaquim Ramón Cervelló, Rafael Mañéz

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18 Citations (Scopus)

Abstract

Background and objective: The impact of pandemic influenza A (H1N1)v infection is still unknown but it is associated with a high case-fatality rate. Methods: This was a prospective, observational, multicentre study conducted in 144 Spanish intensive care units. Demographic and clinical datawere reviewed for all cases of pandemic influenza A (H1N1)v infection reported from 23 June 2009 through 11 February 2010 and confirmed by reverse transcriptase PCR assay. Results: Out of 872 cases reported by statewide surveillance, data for the first 131 deceased patients were analysed. Thirty-seven patients (28.2%) died within the first 14 days. The median age of these patients was 46 years (interquartile range 35-58) and 60.3%were male. Twenty-eight patients (21.4%) did not present with any comorbidities on admission. Forty-six per cent of patients were reported to be obese and 22 (16.8%) had COPD. The vast majority of the patients (72.5%) had viral pneumonia; 95.4% of these had bilateral patchy alveolar opacities (predominantly basal), affecting three or four quadrants. One hundred and fifteen patients (87.8%) developed multi-organ dysfunction syndrome. Ninety-seven patients (74%) required vasopressor drugs, 37 (27.2%) received renal replacement therapy, and 47 (35.1%) received intravenous corticosteroids on admission to the intensive care unit. Only 68 patients (51.9%) received empirical antiviral treatment. Conclusions: One-third of patients with pandemic influenza A (H1N1)v infection died within the first two weeks and these were young patients, with rapidly progressive viral pneumonia as the primary cause of admission. Obese patients were at high risk but one in four patients did not present with any risk factors on admission. Only half the patients received empirical antiviral therapy and this was administered late. © 2010 The Authors Respirology © 2010 Asian Pacific Society of Respirology.
Original languageEnglish
Pages (from-to)78-85
JournalRespirology
Volume16
Issue number1
DOIs
Publication statusPublished - 1 Jan 2011

Keywords

  • Clinical epidemiology
  • Critical care medicine
  • H1N1
  • Mortality
  • Pneumonia

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