Casos graves de influenza H1N1 en embarazadas: perspectiva China

Casos graves de influenza H1N1 en embarazadas: perspectiva China. Severe and critical cases of H1N1 influenza in pregnancy: A chinese perspective. Liu J, Li Q, Cui H, Liu C J Postgrad Med [serial online] 2011 [cited 2011 Nov 22];57:298-301. Context : In 2009, an outbreak of A/H1N1 influenza spread worldwide. Following the start of winter in Liaoning province in China, the number of pregnant women infected with influenza increased significantly. Some of them developed respiratory failure and multiple organ failure. Aims : The aim of this study was to determine the high-risk factors associated with the development of critical illness in the hospitalized pregnant women with A/H1N1 infection. Settings and Design : This retrospective cohort study was carried out in the tertiary care obstetric department of a large general hospital. Materials and Methods : The clinical data of H1N1 pregnant women hospitalized from November 2009 to January 2010 was reviewed. We classified these cases into severe and critical grades according to H1N1 influenza treatment guidelines. We selected maternal age, gestational age, and the time interval between symptom-onset and hospital admission as related factors of critical illness. Statistical Analysis : Logistic regression analyses to determine the relevance and importance of factors significantly associated with critical illness. Results : Eighteen cases of H1N1 influenza pregnant women were admitted. Ten pregnant women were severe cases and eight pregnant women were critical cases. The maternal age (OR=0.979, 95% CI: 0.749~1.279)and the time interval between symptom-onset and hospital admission (OR=1.41, 95% CI: 0.917~2.169) were not found to be risk factors for critical cases. The significant risk factor associated with critical illness is gestational age (OR=53.726, 95% CI: 131.165~2477.918). The risk varied by weeks of gestation, with an odds ratio of 1.034 (95% CI: 0.968-1.106) during the first trimester, 9.667 (95% CI: 0.750-124.59) during the second trimester, and 87 (95% CI: 6.750-1121.39) during the third trimester. Conclusions : Gestational age is associated with the risk of developing critical infection. The risk increases with increasing weeks of gestation. http://www.jpgmonline.com/text.asp?2011/57/4/298/90079  Infección pandémica y post pandémica de influenza (H1N1) en pacientes graves. Pandemic and post-pandemic Influenza A (H1N1) infection in critically ill patients Ignacio Martin-Loeches, Emilio Diaz, Loreto Vidaur, Antoni Torres, Cesar Laborda, Rosa Granada, Juan Bonastre, Mar Martin, Josu Insausti, Angel Arenzana, Jose Eugenio Guerrero, Ines Navarrete, Jesus Bermejo-Martin, David Suarez, Alejandro Rodriguez. Critical Care 2011, 15:R286 doi:10.1186/cc10573 Background. There is a vast amount of information published regarding the impact of 2009 pandemic influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-11 post-pandemic period has not been described. Methods A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-11 post-pandemic period. Results. Nine hundred and ninety seven patients patients with confirmed An/H1N1 infection were included. Six hundred and forty eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (APACHE II and SOFA) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Conclusion. Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection. http://ccforum.com/content/pdf/cc10573.pdf

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