Email updates

Keep up to date with the latest news and content from BMC Infectious Diseases and BioMed Central.

Open Access Highly Accessed Research article

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

Önder Ergönül1*, Servet Alan2, Öznur Ak3, Fatman Sargın4, Arzu Kantürk5, Alper Gündüz6, Derya Engin7, Oral Öncül8, Ilker Inanc Balkan9, Bahadir Ceylan10, Nur Benzonana3, Saadet Yazıcı4, Funda Şimşek5, Nuray Uzun6, Asuman İnan7, Eren Gulhan10, Meral Ciblak11, Kenan Midilli12, Mustafa Ozyurt13, Selim Badur11, Serap Gencer14, Ozcan Nazlıcan2, Serdar Özer3, Nail Özgüneş4, Taner Yıldırmak5, Turan Aslan15, Pasa Göktaş7, Nese Saltoğlu9, Muzaffer Fincancı10, Ali Ihsan Dokucu14, Haluk Eraksoy16 and Turkish Society of Clinical Microbiology and Infectious Diseases (KLIMIK), Pandemic Influenza Study Group

Author Affiliations

1 Department of Infectious Diseases and Clinical Microbiology, Koç University, School of Medicine, Istanbul, Turkey

2 Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Haseki Training and Research Hospital, Istanbul, Turkey

3 Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Kartal Training and Research Hospital, Istanbul, Turkey

4 Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Göztepe Training and Research Hospital, Istanbul, Turkey

5 Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Okmeydanı Training and Research Hospital, Istanbul, Turkey

6 Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Şişli Etfal Training and Research Hospital, Istanbul, Turkey

7 Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Haydarpaşa Training and Research Hospital, Istanbul, Turkey

8 Department of Infectious Diseases and Clinical Microbiology, Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey

9 Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey

10 Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Istanbul Training and Research Hospital, Istanbul, Turkey

11 Department of Microbiology and Clinical Microbiology, National Influenza Reference Laboratory, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey

12 Microbiology Department, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey

13 Clinical Microbiology Department, Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey

14 Ministry of Health, Istanbul Health Directorate, Istanbul, Turkey

15 Infectious Diseases and Clinical Microbiology Department, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey

16 Infectious Diseases and Clinical Microbiology Department, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey

For all author emails, please log on.

BMC Infectious Diseases 2014, 14:317  doi:10.1186/1471-2334-14-317

Published: 10 June 2014

Abstract

Background

The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients.

Methods

This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality.

Results

In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality.

Conclusions

Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.