Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Funck, M.
PCR confirmed influenza A and B infections treated at the intensive care unit of the Department of Internal Medicine of the Medical University of Graz between 2009 and 2020
Epidemiological, clinical and laboratory characteristics, risk factors for cardiovascular/pulmonary complications, bacterial/fungal infections and death
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 95
[OPEN ACCESS]
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Flick Holger
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- Abstract:
- Aim Austria's influenza vaccination rate is low compared to other European countries, this is especially true for patients with chronic cardiopulmonary diseases. These should therefore be more likely to develop a severe influenza infection. However, follow-up data of Austrian ICUs on the burden of severe influenza infections do not exist yet. Therefore, an important aim of this study was to analyze epidemiological clinical characteristics and laboratory parameters of PCR-confirmed influenza infections treated in the ICU during their course. We assumed that these patients would mostly be over 50 years of age and would also have previous cardiovascular or pulmonary disease. We also expected more than 50% to have cardiovascular or pulmonary complications and secondary bacterial or fungal infections. In addition, we aimed to investigate the burden of influenza patients in intensive care units in Styria and the characteristics of these patients. Methods In a retrospective study, clinical data and laboratory parameters of ICU patients with PCR-confirmed influenza infections were evaluated. Patients treated for influenza in the MUG ICU between 2009 and 2020 were included. In total, data from 111 patients from five influenza seasons (2009/2010, 2016/17, 2017/18, 2018/19, 2019/20) were examined and presented in a descriptive analysis. Results The median age of the 111 influenza patients was 69 years. The patient population contained more males than females, with female patients being significantly older than male patients (p=0.037). The median length of stay in the ICU was 6 days, 39.1% of died. Respiratory insufficiency was present in 83.2%, hypercapnia in 43.5%, and lung injury in 43.3%. 19.8% developed cardiac complications during their ICU stay, 82.9% developed increased airspace shadowing (compatible with pulmonary infiltrates) , and 37.8% had secondary infections. Patients with preexisting cardiovascular disease, such as heart failure or valvular heart disease, developed significantly more cardiac complications; arrhythmias and coronary artery disease were also more common in these patients (not significant). In addition, the patients who developed cardiac complications were more likely to be male and older. They had higher body temperature and were more likely to be tachycardic, had a higher leukocyte count, higher PCT and NT-pro-BNP levels, a higher Horowitz index, and were less likely to develop hypercapnia. The group of patients without cardiac complications more often had preexisting conditions such as arterial hypertension, asthma, PAOD and CAOD, diabetes mellitus, gastrointestinal disease, and malignancies. In addition, these patients had a higher BMI. Clinical examination also revealed increased wheezing and crackles. Consistent with this, these patients had a higher incidence of pneumonia and required more often mechanical ventilation. Laboratory analysis revealed higher CRP levels. In addition, secondary infections were more frequent, with bacterial nosocomial pneumonia in particular occurring significantly more frequently. In summary, the high rate of complications in our patient population is striking, especially a high mortality rate of 39.1%. Discussion Based on our analysis, we distinguish between the cardiac and pulmonary phenotypes of severe influenza infection. The cardiac type is older, more often male, significantly more often has previous cardiac disease (heart failure p < 0.001, valvular heart disease p = 0.031) and higher mortality. The pulmonary type more often required invasive ventilation, had more frequent pneumonias. In addition, secondary infections were more frequent, bacterial nosocomial pneumonia was significantly more frequent (p = 0.014).