scholarly journals Association between plasma glycocalyx component levels and poor prognosis in severe influenza type A (H1N1)

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Xiao Huang ◽  
Feng Lu ◽  
Huanhuan Tian ◽  
Haoran Hu ◽  
Fangyu Ning ◽  
...  
Keyword(s):  
Heparan Sulfate ◽  
Disease Severity ◽  
Plasma Levels ◽  
Influenza A ◽  
Strong Association ◽  
H1n1 Influenza ◽  
Endothelial Glycocalyx ◽  
Inflammatory Factors ◽  
Severe Influenza ◽  
Influenza A H1n1

AbstractInfluenza A virus infection causes a series of diseases, but the factors associated with disease severity are not fully understood. Disruption of the endothelial glycocalyx contributes to acute lung injury in sepsis, but has not been well studied in H1N1 influenza. We aim to determine whether the plasma glycocalyx components levels are predictive of disease severity in H1N1 influenza. This prospective observational study included 53 patients with influenza A (H1N1) during the influenza season, and 30 healthy controls in our hospital. Patients were grouped by severity and survival. We collected clinical data and blood samples at admission. Inflammatory factors (tumor necrosis factor-α, interleukin-6, interleukin-10) and endothelial glycocalyx components (syndecan-1, hyaluronan, heparan sulfate) were measured. The plasma levels of syndecan-1, hyaluronan, and heparan sulfate were significantly higher in patients with severe influenza A (H1N1) than in mild cases. Syndecan-1 and hyaluronan were positively correlated with disease severity, which was indicated by the APACHE II and SOFA scores and lactate levels, and negatively correlated with albumin levels. At a cutoff point ≥ 173.9 ng/mL, syndecan-1 had a 81.3% sensitivity and 70.3% specificity for predicting of 28-day mortality. Kaplan–Meier analysis demonstrated a strong association between syndecan-1 levels and 28-day mortality (log-rank 11.04, P = 0.001). Elevated plasma levels of syndecan-1 has a potential role in systemic organ dysfunction and may be indicative of disease severity in patients with influenza A (H1N1).

scholarly journals Association Between Plasma Glycocalyx Component Levels and Poor Prognosis in Influenza Type A (H1N1)

2021 ◽  
Author(s):  
Xiao Huang ◽  
Feng Lu ◽  
Huanhuuan Tian ◽  
Haoran Hu ◽  
Fangyu Ning ◽  
...  
Keyword(s):  
Heparan Sulfate ◽  
Disease Severity ◽  
Influenza A ◽  
Area Under The Curve ◽  
H1n1 Influenza ◽  
Interleukin 10 ◽  
Endothelial Glycocalyx ◽  
Inflammatory Factors ◽  
Influenza A H1n1 ◽  
Lactate Levels

Abstract Background: Influenza A virus infection causes a series of diseases, but the factors associated with disease severity are not fully understood. Disruption of the endothelial glycocalyx contributes to acute lung injury in sepsis, but has not been well studied in H1N1 influenza. We aim to determine whether the plasma glycocalyx components levels are predictive of disease severity in H1N1 influenza.Methods: This prospective observational study included 53 patients with influenza A (H1N1), who were admitted to the Pulmonary and Critical Care Medicine and Intensive Care Unit, and 30 healthy controls between November 2017 and March 2019 in our hospital. Patients were grouped by severity and survival. We collected clinical data and blood samples at admission. Inflammatory factors (tumor necrosis factor-α, interleukin-6, interleukin-10) and endothelial glycocalyx components (syndecan-1, hyaluronan, heparan sulfate) were measured.Results: The plasma levels of syndecan-1, hyaluronan, and heparan sulfate were significantly higher in patients with severe influenza A (H1N1) than in mild cases. At a cutoff point >81.0 ng/mL, syndecan-1 had a 92.1% sensitivity and 86.7% specificity for diagnosing severe H1N1. Syndecan-1 and hyaluronan were positively correlated with disease severity, which was indicated by the APACHE II and SOFA scores and lactate levels, and negatively correlated with albumin levels. Non-survivors had higher syndecan-1 levels than did survivors, and syndecan-1 was strongly predictive of 28-day mortality (area under the curve, 0.855).Conclusions: An increased plasma syndecan-1 level was an independent risk factor for mortality and may be indicative of disease severity in patients with influenza A (H1N1).Trial registration: CHINA, ChiCTR2000040921. Retrospectively registered

scholarly journals Pulmonary Thromboembolism and Pulmonary Fibrosis due to H1N1 Pneumonia with Acute Respiratory Distress Syndrome :: Not ALL is COVID

2021 ◽  
Vol 5 (4) ◽  
pp. 01-05
Author(s):  
Unnati Desai ◽  
Ramesh Bharmal ◽  
Dharani M ◽  
Ketaki Utpat ◽  
Vinod L. Pal ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Influenza A ◽  
Pulmonary Thromboembolism ◽  
Strong Association ◽  
Lung Parenchyma ◽  
H1n1 Influenza ◽  
Pulmonary Vasculature ◽  
High Propensity ◽  
Influenza A H1n1 ◽  
Predominant Strain

Novel influenza A H1N1 virus (pH1N1) was the predominant strain in the 2009 pandemic. It continues to circulate along with other influenza strains in the post pandemic era. This new virus is nevertheless well known for its strong association with high cardiovascular mortality and a high propensity to preferentially affect young and otherwise healthy adults, resulting in a clustering of severe and even fatal cases in patients of the productive age group. H1N1 infection is a multifaceted disease. It affects the lung parenchyma as well as the pulmonary vasculature. It also affects the multisystemic vasculature and can cause other embolic events not strictly falling in the “usual” thrombotic category. We herein present a case of H1N1 influenza pneumonia induced severe ARDS with pulmonary thromboembolism (PTE) and pulmonary fibrosis.

scholarly journals Comparable Disease Severity by Influenza Virus Subtype in the Acute Respiratory Infection Consortium Natural History Study

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1008-e1015
Author(s):  
Christina Schofield ◽  
Rhonda E Colombo ◽  
Stephanie A Richard ◽  
Wei-Ju Chen ◽  
Mary P Fairchok ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Disease Severity ◽  
Department Of Defense ◽  
Symptom Severity ◽  
Influenza A ◽  
H1n1 Influenza ◽  
Influenza B ◽  
Prevention Measures ◽  
Severity Scores ◽  
Influenza A H1n1

Abstract Introduction Since the influenza A/H1N1 pandemic of 2009 to 2010, numerous studies have described the clinical course and outcome of the different subtypes of influenza (A/H1N1, A/H3N2, and B). A recent systematic literature review concluded that there were no appreciable differences in either clinical presentation or disease severity among these subtypes, but study parameters limit the applicability of these results to military populations. We sought to evaluate differences in disease severity among influenza subtypes in a cohort of healthy, primarily outpatient adult U.S. Department of Defense beneficiaries. Materials and Methods From 2009 to 2014, we enrolled otherwise healthy adults age 18 to 65 years with influenza-like illness in an observational cohort study based in 5 U.S. military medical centers. Serial nasopharyngeal swabs were collected for determination of etiology and viral shedding by polymerase chain reaction. The presence and severity of symptoms was assessed by interview and patient diary. Results Over a 5-year period, a total of 157 adults with laboratory-confirmed influenza and influenza subtype were enrolled. Of these, 69 (44%) were positive for influenza A(H1N1), 69 (44%) for influenza A(H3N2), and 19 (12%) for influenza B. About 61% were male, 64% were active duty military personnel, and 72% had received influenza vaccine in the past 8 months. Almost 10% were hospitalized with influenza. Seasonal influenza virus distribution among enrollees mirrored that of nationwide trends each year of study. Individuals with A/H1N1 had upper respiratory composite scores that were lower than those with A/H3N2. Multivariate models indicated that individuals with A(H1N1) and B had increased lower respiratory symptom scores when compared to influenza A(H3N2) (A[H1N1]: 1.51 [95% CI 0.47, 2.55]; B: 1.46 [95% CI 0.09, 2.83]), whereas no other differences in symptom severity scores among influenza A(H1N1), influenza A(H3N2), and influenza B infection were observed. Overall, influenza season (maximum in 2012–2013 season) and female sex of the participant were found to be associated with increased influenza symptom severity. Conclusions Our study of influenza in a cohort of otherwise healthy, outpatient adult Department of Defense beneficiaries over 5 influenza seasons revealed few differences between influenza A(H1N1), influenza A(H3N2), and influenza B infection with respect to self-reported disease severity or clinical outcomes. This study highlights the importance of routine, active, and laboratory-based surveillance to monitor ongoing trends and severity of influenza in various populations to inform prevention measures.

scholarly journals Plasma Levels of IL-8 and Microparticle Tissue Factor Activity Are Associated with Mortality in Patients with Primary Influenza A/H1N1 Infection

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3544-3544
Author(s):  
Matthew T. Rondina ◽  
Kohei Tatsumi ◽  
Julie A. Bastarache ◽  
Nigel Mackman
Keyword(s):  
Plasma Levels ◽  
Influenza A ◽  
H1n1 Influenza ◽  
Apache Ii ◽  
Apache Ii Score ◽  
H1n1 Infection ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Influenza A H1n1 ◽  
D Dimer

Abstract Background and Objective: Treatment and triage decisions during influenza remain difficult due to lack of reliable severity of illness predictive score. Influenza A/H1N1 induces the expression and release of tissue-factor bearing microparticles (MP-TF), contributing to a prothrombic milieu. However, there are no studies reporting levels of circulating TF-expressing MPs during the course of human influenza. We sought to determine if MP-TF are an early predictor of mortality in critically ill patients with influenza A/H1N1. Methods: This was a prospective, multicenter, case-cohort pilot study of three academic intensive care units. We prospectively studied 15 patients with primary influenza A/H1N1 that included 7 survivors and 8 non-survivors. For comparison, 27 healthy, medication-free, age- and gender-matched control subjects were also prospectively studied. Plasma was prepared from blood drawn upon ICU admission in influenza patients. MP-TF activity, thrombin-antithrombin complexes (TATc), and D-dimers were measured as markers of activation of coagulation. Plasma cytokine levels were measured on the same blood samples. Patients were followed for the primary outcome of 28-day mortality. Results: The average admission APACHE II score of the influenza patients was 25.5±9.3, 60% of patients had shock, and the 28-day mortality rate was 53.3% (n=8/15). Compared to healthy controls, influenza patients had significantly higher plasma fibrinogen, C-reactive protein (CRP) MP-TF activity, TATc, D-dimer and a prolonged prothrombin time. However, of these procoagulant markers, only MP-TF activity predicted influenza related mortality (5.6±1.2 pg/ml in non-survivors vs. 1.8±0.8 pg/mL in survivors, p < 0.05; Table 1 and Fig. 1A). MP-TF activity, TATc levels, and D-dimer did not correlate with APACHE II score, platelet count, fibrinogen levels, CRP, or age or between patients with severe sepsis versus septic shock. Influenza non-survivors also had significantly higher plasma IL-8 levels compared with survivors (71.8±29.1 pg/ml vs. 17.3±3.7 pg/mL, p < 0.05; Figure 1B). MP-TF activity and IL-8 levels were significantly and positively correlated (r2 = 0.60, P =0.003; Figure 1C). Other cytokines, TATc, and D-dimer were not different between non-survivors and survivors. Conclusions: This study demonstrates that plasma IL-8 and MP-TF activity measured upon admission in patients with severe, primary influenza A/H1N1 infection is associated with subsequent mortality. Thus, these biomarkers may serve as very early prognostic markers for patients with influenza A/H1N1. Table 1. Characteristics of the influenza patients. Laboratory values, coagulation markers, and plasma cytokines were measured within 24 hours of ICU admission. All Influenza A/H1N1 Patients(n=15) Influenza Non-Survivors(n=8) Influenza Survivors(n=7) P value Admission Characteristic Age, years 43.3±11.0 45.8±4.6 40.4±15.5 0.37 Male Gender, n (%) 7 (47%) 3 (38%) 4 (57%) 0.45 Weight, kg 95.5±25.2 86.6±20.9 105.7±27.4 0.15 BMI, kg/m2 33.3±7.2 31.5±5.0 35.4±9.1 0.31 Obesity (BMI³30 kg/m2) 10 (67%) 5 (63%) 5 (71%) 0.71 Tobacco Use, n (%) 4 (27%) 3 (38%) 1 (14%) 0.31 APACHE II Score 25.5±9.3 27.9±9.1 22.9±9.4 0.31 Mechanically Ventilated, n (%) 15 (100%) 8 (100%) 7 (100%) -- Shock, n (%) 9 (60%) 6 (75%) 3 (43%) 0.21 P/F Ratio 83±28 84±34 82±22 0.89 Clinical Outcomes ICU Length of Stay, days 21.9±7.7 23.0±7.9 20.7±7.8 0.58 Duration of Ventilation, days 8.2±1.0 8.5±0.9 7.6±0.9 0.11 Secondary Bacterial Infection, n (%) 5 (33%) 4 (50%) 1 (14%) 0.28 Overt DIC, n (%) 15 (100%) 8 (100%) 7 (100%) -- Laboratory Values Platelets, 103/µL 213±138 154±104 280±150 0.08 White Blood Cells, K/µL 7.3±4.4 8.5±4.9 5.9±3.5 0.28 Hemoglobin, g/dL 11.7±1.9 11.5±2.0 12.0±1.8 0.66 Serum Creatinine, mg/dL 1.1±0.7 1.14±0.74 1.07±0.59 0.84 Coagulation Markers Fibrinogen, mg/dL 571±240 461±253 700±157 0.07 C-reactive Protein, mg/L 11.0±7.6 11.8±7.4 10.2±8.2 0.70 PT, sec 20±7.0 19.2±4.7 20.9±9.3 0.67 aPTT, sec 53.0±22.9 55.1±29.0 50.7±15.0 0.72 MP-TF, pg/mL 3.8±0.9 5.6±1.2 1.8±0.8 < 0.05 TATc, ng/mL 11.8±2.7 14.3±3.5 9.1±4.1 0.35 D-dimer, ng/mL 2439±86 2568±98 2292±134 0.11 Figure 1. MP-TF activity and IL-8 predict mortality in patients with influenza A/H1N1. (A) Plasma levels of MP-TF activity and (B) IL-8 levels in survivors and non-survivors. (C) Correlation between MP TF activity and IL-8 levelsin H1N1 influenza-infected patients (*P <0.05). Figure 1. MP-TF activity and IL-8 predict mortality in patients with influenza A/H1N1. / (A) Plasma levels of MP-TF activity and (B) IL-8 levels in survivors and non-survivors. (C) Correlation between MP TF activity and IL-8 levelsin H1N1 influenza-infected patients (*P <0.05). Disclosures No relevant conflicts of interest to declare.

Clinical predictors of disease severity during the 2009–2010 A(HIN1) influenza virus pandemic in a paediatric population

2015 ◽  
Vol 143 (14) ◽  
pp. 2939-2949 ◽  
Author(s):  
M. N. GARCIA ◽  
D. C. PHILPOTT ◽  
K. O. MURRAY ◽  
A. ONTIVEROS ◽  
P. A. REVELL ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Disease Severity ◽  
Influenza A ◽  
Severe Disease ◽  
Paediatric Population ◽  
The United States ◽  
Clinical Predictors ◽  
Presenting Symptoms ◽  
Severe Influenza ◽  
Influenza A H1n1

SUMMARYA novel influenza virus emerged in the United States in spring 2009, rapidly becoming a global pandemic. Children were disproportionally affected by the novel influenza A(H1N1) pandemic virus [A(H1N1)pdm]. This retrospective electronic medical record review study aimed to identify clinical predictors of disease severity of influenza A(HIN1)pdm infection in paediatric patients. Disease severity was defined on an increasing three-level scale from non-hospitalized, hospitalized, and admitted to the intensive care unit (ICU). From April 2009 to June 2010, 696 children presented to Texas Children's Hospital's emergency department, 38% were hospitalized, and 17% were admitted to the ICU. Presenting symptoms associated with severe influenza were dyspnoea [odds ratio (OR) 5·82], tachycardia (OR 2·61) and fatigue (OR 1·96). Pre-existing health conditions associated with disease severity included seizure disorder (OR 4·71), obesity (OR 3·28), lung disease (OR 2·84), premature birth (OR 2·53), haematological disease (OR 2·22), and developmental delay (OR 2·20). According to model fitness tests, presenting symptoms were more likely to predict severe influenza than underlying medical conditions. However, both are important risk factors. Recognition of clinical characteristics associated with severe disease can be used for triaging case management of children during future influenza outbreaks.

Impact of influenza virus during pregnancy: from disease severity to vaccine efficacy

2020 ◽  
Vol 15 (7) ◽  
pp. 441-453
Author(s):  
Ana Vazquez-Pagan ◽  
Rebekah Honce ◽  
Stacey Schultz-Cherry
Keyword(s):  
Influenza Virus ◽  
Virus Infection ◽  
Immune Responses ◽  
Pregnant Women ◽  
Disease Severity ◽  
Influenza A ◽  
Antiviral Treatment ◽  
Influenza Virus Infection ◽  
Severe Influenza ◽  
The Impact

Pregnant women are among the individuals at the highest risk for severe influenza virus infection. Infection of the mother during pregnancy increases the probability of adverse fetal outcomes such as small for gestational age, preterm birth and fetal death. Animal models of syngeneic and allogeneic mating can recapitulate the increased disease severity observed in pregnant women and are used to define the mechanism(s) of that increased severity. This review focuses on influenza A virus pathogenesis, the unique immunological landscape during pregnancy, the impact of maternal influenza virus infection on the fetus and the immune responses at the maternal–fetal interface. Finally, we summarize the importance of immunization and antiviral treatment in this population and highlight issues that warrant further investigation.

Epidemiological analysis of critically ill adult patients with pandemic influenza A(H1N1) in South Korea

2012 ◽  
Vol 141 (5) ◽  
pp. 1070-1079 ◽  
Author(s):  
S. B. HONG ◽  
E. Y. CHOI ◽  
S. H. KIM ◽  
G. Y. SUH ◽  
M. S. PARK ◽  
...  
Keyword(s):  
South Korea ◽  
Influenza A ◽  
Multivariate Logistic Regression Analysis ◽  
H1n1 Influenza ◽  
Epidemiological Analysis ◽  
Influenza A H1n1 ◽  
Failure Assessment ◽  
2009 H1n1 ◽  
Independent Risk Factors ◽  
Chronic Comorbidities

SUMMARYA total of 245 patients with confirmed 2009 H1N1 influenza were admitted to the intensive-care units of 28 hospitals (South Korea). Their mean age was 55·3 years with 68·6% aged >50 years, and 54·7% male. Nine were obese and three were pregnant. One or more comorbidities were present in 83·7%, and nosocomial acquisition occurred in 14·3%. In total, 107 (43·7%) patients received corticosteroids and 66·1% required mechanical ventilation. Eighty (32·7%) patients died within 30 days after onset of symptoms and 99 (40·4%) within 90 days. Multivariate logistic regression analysis showed that the clinician's decision to prescribe corticosteroids, older age, Sequential Organ Failure Assessment score and nosocomial bacterial pneumonia were independent risk factors for 90-day mortality. In contrast with Western countries, critical illness in Korea in relation to 2009 H1N1 was most common in older patients with chronic comorbidities; nosocomial acquisition occurred occasionally but disease in obese or pregnant patients was uncommon.

scholarly journals A Pregnant Case with Severe Influenza A (H1N1) Virus Infection-Related ARDS

2011 ◽  
Vol 8 (2) ◽  
Author(s):  
Turgut Teke ◽  
Ümmiye Duran ◽  
Emin Maden ◽  
Kazım Gezginç ◽  
Mehmet D Yavşan ◽  
...  
Keyword(s):  
Virus Infection ◽  
Influenza A ◽  
H1n1 Virus ◽  
Severe Influenza ◽  
Influenza A H1n1 ◽  
H1n1 Virus Infection

scholarly journals Clinical outcomes of patients treated with intravenous zanamivir for severe influenza A(H1N1)pdm09 infection: a case report series

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carlo Torti ◽  
◽  
Maria Mazzitelli ◽  
Federico Longhini ◽  
Eugenio Garofalo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Influenza A ◽  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Viral Clearance ◽  
Pcr Analysis ◽  
Suitable Alternative ◽  
Severe Influenza ◽  
Influenza A H1n1

Abstract Background Intravenous (IV) zanamivir could be a suitable alternative for the treatment of severe influenza A(H1N1)pdm09 infection in patients who are unable to take oral or inhaled medication, for example, those on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, data on the clinical outcomes of such patients is limited. Case presentation We report the clinical outcomes of four patients who were admitted at the intensive care unit during the 2017–2018 influenza season with severe sepsis (SOFA score > 11) and acute respiratory distress syndrome requiring ECMO and mechanical ventilation. Two patients were immune-compromised. The A(H1N1)pdm09 genome was confirmed by polymerase chain reaction (PCR) on nasopharyngeal specimen swabs prior to administration of IV zanamivir at a dose of 600 mg twice daily. Weekly qualitative PCR analysis was done to monitor viral clearance, with zanamivir treatment being discontinued upon receipt of negative results. In addition, the patients were managed for concomitant multidrug-resistant bacterial infections, with infection resolution confirmed with blood cultures. The median time for zanamivir treatment was 10 days (IQR 10–17). The clinical outcome was favourable with all four patients surviving and improving clinically. All four patients achieved viral clearance of A(H1N1)pdm09 genome, and resolution of multidrug-resistant bacterial infections. Conclusions IV zanamivir could be a good therapeutic option in patients with severe influenza A(H1N1)pdm09 infection who are unable to take oral or aerosolised antiviral medication. We recommend prospective randomized control trials to support this hypothesis.

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