Purpose To provide prognosis of an 18 patient cohort who were confirmed to have H7N9 lung infection in Shanghai. Methods Patients' history, clinical manifestation, laboratory test, treatment strategy and mortality were followed and recorded for data analysis. Results A total of 18 patients had been admitted into Shanghai Public Health Clinical Center from April 8th to July 29, 2013. 22.2% of the patients were found to have live poultry contact history and 80% were aged male patients with multiple co-morbidities including diabetes, hypertension and/or chronic obstructive pulmonary disease (COPD). This group of patients was admitted to the clinical center around 10 days after disease onset. According to laboratory examinations, increased C reactive protein (CRP), Procalcitonin (PCT), Plasma thromboplastin antecedent (PTA) and virus positive time (days) were indicative of patients' mortality. After multivariate analysis, only CRP level showed significant prediction of mortality (P = 0.013) while results of prothrombin time (PT) analysis almost reached statistical significance (P = 0.056). Conclusions H7N9 infection induced pneumonia of different severity ranging from mild to severe pneumonia or acute lung injury/acute respiratory distress syndrome to multiple organ failure. Certain laboratory parameters such as plasma CRP, PCT, PTA and virus positive days predicted mortality of H7N9 infection and plasma CRP is an independent predictor of mortality in these patients.
References
[1]
Website of National Health and Family Planning Commission of the People's Republic of China. Available: http://www.moh.gov.cn/zhuzhan/yqxx/20130？7/75a172fb9cf54ede8f96da5c3f72efd4.shtml. Accessed 2013 Jul 10.
[2]
Gao R, Cao B, Hu Y, Feng Z, Wang D, et al. (2013) Human infection with a novel avian-origin influenza A (H7N9) virus. N Engl J Med 368: 1888–1897. doi: 10.1056/nejmoa1304459
Mak CM, Lam CW, Fong NC, Siu WK, Lee HC, et al. (2011) Fatal viral infection-associated encephalopathy in two Chinese boys: a genetically determined risk factor of thermolabile carnitine palmitoyltransferase II variants. J Hum Genet 56: 617–621. doi: 10.1038/jhg.2011.63
[5]
Li Q, Zhou L, Zhou M, Chen Z, Li F, et al. (2013) Preliminary report: Epidemiology of the avian influenza A (H7N9) outbreak in China. N Engl J Med [serial online]. Available : http://www.nejm.org/doi/full/10.1056/NEJ？Moa1304617. Accessed 2013 July 10.
[6]
Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, et al. (2007) An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 175 (4) 367–416. doi: 10.1164/rccm.200604-571st
[7]
ARDS Definition Task Force (2012) Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, et al. (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307 (23) 2526–33. doi: 10.1001/2012.jama.11901
[8]
Milbrandt EB, Reade MC, Lee M, Shook SL, Angus DC, et al. (2009) Prevalence and significance of coagulation abnormalities in community-acquired pneumonia. Mol Med 15: 438–45.
[9]
The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators (2009) Davies A, Jones D, Bailey M, Beca J, et al. (2009) Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA 302 (17) 1888–1895. doi: 10.1001/jama.2009.1535
[10]
Morens DM, Taubenberger JK, Fauci AS (2013) H7N9 avian influenza A virus and the perpetual challenge of potential human pandemicity. MBio 9: 4(4). doi: 10.1128/mbio.00445-13
[11]
World Health Organization Website. Available: http://www.who.int/csr/disease/avian_inf？luenza/country/cases_table_2009_05_15/en？/index.html. Accessed 2009 May 15.
[12]
Novel Swine-Origin Influenza A (H1N1) Investigation Team (2009) Dawood FS, Jain S, Finelli L, Shaw MW, et al. (2009) Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 360 (25) 2605–2615. doi: 10.1056/nejmoa0903810
[13]
Beigel JH, Farrar J, Han AM, Hayden FG, Hyer R, et al. (2005) Avian influenza A (H5N1) infection in humans. N Engl J Med 353: 1374–1385. doi: 10.1056/nejmra052211
[14]
Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, Chunsuthiwat S, Sawanpanyalert P, et al. (2005) Human disease from influenza A (H5N1), Thailand, 2004. Emerg Infect Dis 11: 201–209. doi: 10.3201/eid1102.041061
[15]
Mounts AW, Kwong H, Izurieta HS, Ho Y, Au T, et al. (1999) Case-control study of risk factors for avian influenza A (H5N1) disease, Hong Kong, 1997. J Infect Dis 180: 505–508. doi: 10.1086/314903
[16]
Tran TH, Nguyen TL, Nguyen TD, Luong TS, Pham PM, et al. (2004) Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med 350: 1179–1188. doi: 10.1056/nejmoa040419
[17]
de Jong MD, Bach VC, Phan TQ, Vo MH, Tran TT, et al. (2005) Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med 352: 686–691. doi: 10.1056/nejmoa044307
[18]
To KK, Wong SS, Li IW, Hung IF, Tse H, et al. (2010) Concurrent comparison of epidemiology, clinical presentation and outcome between adult patients suffering from the pandemic influenza A (H1N1) 2009 virus and the seasonal influenza A virus infection. Postgrad Med J 86: 515–521. doi: 10.1136/pgmj.2009.096206
[19]
de Jong MD, Simmons CP, Thanh TT, Hien VM, Smith GJ, et al. (2006) Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia. Nat Med 12: 1203–1207. doi: 10.1038/nm1477
[20]
Cheng VC, To KK, Tse H, Hung IF, Yuen KY (2012) Two years after pandemic influenza A/2009/H1N1: what have we learned? Clin Microbiol Rev 25: 223–263. doi: 10.1128/cmr.05012-11
[21]
Peiris JS, Yu WC, Leung CW, Cheung CY, Ng WF, et al. (2004) Re-emergence of fatal human influenza A subtype H5N1 disease. Lancet 363: 617–619. doi: 10.1016/s0140-6736(04)15595-5
[22]
To KF, Chan PK, Chan KF, Lee WK, Lam WY, et al. (2001) Pathology of fatal human infection associated with avian influenza A H5N1 virus. J Med Virol 63: 242–246. doi: 10.1002/1096-9071(200103)63:3<242::aid-jmv1007>3.0.co;2-n
[23]
Oner AF, Bay A, Arslan S, Akdeniz H, Sahin HA, et al. (2006) Avian influenza A (H5N1) infection in eastern Turkey in 2006. N Engl J Med 355: 2179–2185. doi: 10.1056/nejmoa060601
[24]
Yuen KY, Chan PK, Peiris M, Tsang DN, Que TL, et al. (1998) Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus. Lancet 351: 467–471. doi: 10.1016/s0140-6736(98)01182-9
[25]
Chen WW, Xie YX, Zhang YH, Feng YQ, Li BA, et al. (2010) Changes and analysis of peripheral white blood cells and lymphocyte subsets for patients with pandemic influenza A virus (H1N1) infection. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 24: 331–333.
[26]
To KK, Hung IF, Li IW, Lee KL, Koo CK, et al. (2010) Delayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection. Clin Infect Dis 50: 850–859. doi: 10.1086/650581
[27]
Chan JF, To KK, Tse H, Lau CC, Li IW, et al. (2011) The lower serum immunoglobulin G2 level in severe cases than in mild cases of pandemic H1N1 2009 influenza is associated with cytokine dysregulation. Clin Vaccine Immunol 18: 305–310. doi: 10.1128/cvi.00363-10
[28]
Gordon CL, Langan K, Charles PG, Bellomo R, Hart GK, et al. (2011) Pooled human immunoglobulin therapy in critically ill patients with pandemic 2009 influenza A(H1N1) pneumonitis and immunoglobulin G2 subclass (IgG2) deficiency. Clin Infect Dis 52: 422–426. doi: 10.1093/cid/ciq082
[29]
Papic N, Pangercic A, Vargovic M, Barsic B, Vince A, et al. (2012) Liver involvement during influenza infection: perspective on the 2009 influenza pandemic. Influenza Other Respi Viruses 6 (3) e2–5. doi: 10.1111/j.1750-2659.2011.00287.x
[30]
Mu YP, Zhang ZY, Chen XR, Xi XH, Lu YF, et al. (2010) Clinical features, treatments and prognosis of the initial cases of pandemic influenza H1N1 2009 virus infection in Shanghai China. QJM 103 (5) 311–317. doi: 10.1093/qjmed/hcq012
[31]
Jartti A, Rauvala E, Kauma H, Renko M, Kunnari M, et al. (2011) Chest imaging findings in hospitalized patients with H1N1 influenza. Acta Radiol 52: 297–304. doi: 10.1258/ar.2010.100379
[32]
Kim SH, Hong SB, Yun SC, Choi WI, Ahn JJ, et al. (2011) Corticosteroid treatment in critically ill patients with pandemic influenza A/H1N1 2009 infection: analytic strategy using propensity scores. Am J Respir Crit Care Med 183 (9) 1207–1214. doi: 10.1164/rccm.201101-0110oc
[33]
Brun-Buisson C, Richard JC, Mercat A, Thiébaut AC, Brochard L, et al. (2011) Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. Am J Respir Crit Care Med 183 (9) 1200–1206. doi: 10.1164/rccm.201101-0135oc
