Severe Novel Influenza A (H1N1) in Shanghai:Clinical Features, Therapeutic Management and Risk Factors for Mortality

摘要

Objective To analyze the clinical features,therapeutic management and risk factors for mortality of patients with severe novel A(H1N1)influenza in Shanghai,China.Methods All patients were diagnosed by influenza A(H1N1)virus mRNA detection.Chest CT scan,routine blood,hepatic function,humoral and cellular immunity,sputum smears,and sputum cultures were performed.Logistic analysis was applied to identify risk factors for mortality.Results Total of 68 patients were enrolled in this study,the primary clinical symptoms including cough(66,97.1%),expectoration(41,60.3%),and polypnea(41,60.3%).Altogether,37(54.4%)and 11(16.2%)patients were infected with bacterial and fungal,respectively.CT scan demonstrated that 67(98.6%)patients had pneumonia.Oxygen therapy,oseltamivir,antibiotic and antifungal drugs were performed in 68(100%),66(97.1%),39(57.4%),and 11(16.2%)patients,respectively.Finally,4 of 68 patients died.Logistic analysis demonstrated that there was a significant correlation between the percentage of neutrophils and mortality before therapy and direct bilirubin content and mortality after therapy,respectively.Conclusions Patients with severe H1N1 influenza were susceptible to bacterial and/or fungal infection.The risk factors for mortality may be associated with pre-therapeutic neutrophil percentage and post-therapeutic direct bilirubin content.