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2014 ; 42
(11
): 2325-32
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The burden of influenza-associated critical illness hospitalizations
#MMPMID25148596
Ortiz JR
; Neuzil KM
; Shay DK
; Rue TC
; Neradilek MB
; Zhou H
; Seymour CW
; Hooper LG
; Cheng PY
; Goss CH
; Cooke CR
Crit Care Med
2014[Nov]; 42
(11
): 2325-32
PMID25148596
show ga
OBJECTIVE: Influenza is the most common vaccine-preventable disease in the United
States; however, little is known about the burden of critical illness due to
influenza virus infection. Our primary objective was to estimate the proportion
of all critical illness hospitalizations that are attributable to seasonal
influenza. DESIGN: Retrospective cohort study. SETTING: Arizona, California, and
Washington from January 2003 to March 2009. PATIENTS: All adults hospitalized
with critical illness, defined by International Classification of Diseases, 9th
Edition, Clinical Modification diagnosis and procedure codes for acute
respiratory failure, severe sepsis, or in-hospital death. MEASUREMENTS AND MAIN
RESULTS: We combined the complete hospitalization discharge databases for three
U.S. states, regional influenza virus surveillance, and state census data. Using
negative binomial regression models, we estimated the incidence rates of adult
influenza-associated critical illness hospitalizations and compared them with
all-cause event rates. We also compared modeled outcomes to International
Classification of Diseases, 9th Edition, Clinical Modification-coded influenza
hospitalizations to assess potential underrecognition of severe influenza
disease. During the study period, we estimated that 26,760 influenza-associated
critical illness hospitalizations (95% CI, 14,541, 47,464) occurred. The
population-based incidence estimate for influenza-associated critical illness was
12.0 per 100,000 person-years (95% CI, 6.6, 21.6) or 1.3% of all critical illness
hospitalizations (95% CI, 0.7%, 2.3%). During the influenza season, 3.4% of all
critical illness hospitalizations (95% CI, 1.9%, 5.8%) were attributable to
influenza. There were only 2,612 critical illness hospitalizations with
International Classification of Diseases, 9th Edition, Clinical
Modification-coded influenza diagnoses, suggesting influenza is either
undiagnosed or undercoded in a substantial proportion of critical illness.
CONCLUSIONS: Extrapolating our data to the 2010 U.S. population, we estimate that
about 28,000 adults are hospitalized for influenza-associated critical illness
annually. Influenza in many of these critically ill patients may be undiagnosed.
Critical care physicians should have a high index of suspicion for influenza in
the ICU, particularly when influenza is known to be circulating in their
communities.
|*Hospital Mortality
[MESH]
|Adult
[MESH]
|Arizona/epidemiology
[MESH]
|California/epidemiology
[MESH]
|Cohort Studies
[MESH]
|Critical Illness/mortality/*therapy
[MESH]
|Databases, Factual
[MESH]
|Female
[MESH]
|Hospitalization/*statistics & numerical data
[MESH]
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free
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