Clinical characteristics, risk factors and antiviral treatments of influenza in immunosuppressed inpatients in Beijing during the 2015–2020 influenza seasons

Abstract Background Compared with immunocompetent patients, immunosuppressed patients have higher morbidity and mortality, a longer duration of viral shedding, more frequent complications, and more antiviral resistance during influenza infections. However, few data on this population in China have been reported. We analysed the clinical characteristics, effects of antiviral therapy, and risk factors for admission to the intensive care unit (ICU) and death in this population after influenza infections and explored the influenza vaccination situation for this population. Methods We analysed 111 immunosuppressed inpatients who were infected with influenza virus during the 2015–2020 influenza seasons. Medical data were collected through the electronic medical record system and analysed. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results The most common cause of immunosuppression was malignancies being treated with chemotherapy (64.0%, 71/111), followed by haematopoietic stem cell transplantation (HSCT) (23.4%, 26/111). The most common presenting symptoms were fever and cough. Dyspnoea, gastrointestinal symptoms and altered mental status were more common in HSCT patients than in patients with immunosuppression due to other causes. Approximately 14.4% (16/111) of patients were admitted to the ICU, and 9.9% (11/111) of patients died. Combined and double doses of neuraminidase inhibitors did not significantly reduce the risk of admission to the ICU or death. Risk factors for admission to the ICU were dyspnoea, coinfection with other pathogens and no antiviral treatment within 48 h. The presence of dyspnoea and altered mental status were independently associated with death. Only 2.7% (3/111) of patients less than 12 months old had received a seasonal influenza vaccine. Conclusion Fever and other classic symptoms of influenza may be absent in immunosuppressed recipients, especially in HSCT patients. Conducting influenza virus detection at the first presentation seems to be a good choice for early diagnosis. Clinicians should pay extra attention to immunosuppressed patients with dyspnoea, altered mental status, coinfection with other pathogens and no antiviral treatment within 48 h because these patients have a high risk of severe illness. Inactivated influenza vaccines are recommended for immunosuppressed patients.

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Clinical Characteristics, Risk Factors and Antiviral Treatments of Influenza in Immunosuppressed Inpatients in Beijing During the 2015-2020 Influenza Seasons

10.21203/rs.3.rs-910455/v1 ◽

2021 ◽

Author(s):

Yafen Liu ◽

Yue Wang ◽

Huan Mai ◽

YuanYuan Chen ◽

Baiyi Liu ◽

...

Keyword(s):

Risk Factors ◽

Influenza Virus ◽

Influenza Vaccination ◽

Mental Status ◽

Clinical Characteristics ◽

Antiviral Treatment ◽

Univariate Analysis ◽

Altered Mental Status ◽

Hematopoietic Stem ◽

Immunosuppressed Patients

Abstract Background Influenza infection was a vital threat to immunosuppressed patients with longer viral shedding; however, data on these populations in China are still lacking. We analyzed clinical characteristics, risk factors and effects of antiviral therapy in these populations. Methods We analyzed 111 immunosuppressed inpatients tested positive for influenza virus using RT-PCR during the 2015–2020 influenza seasons. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results The most common immunosuppression type was malignancies with chemotherapy 87.4% (97/111), then hematopoietic stem cell transplantation 23.4% (26/111). The most common presenting symptom was fever in 92.8% (103/111) patients, then cough 50.6% (44/87). 14.4% (16/111) patients were admitted to ICU and 9.9% (11/111) patients died. Combination and double dose of neuraminidase inhibitors did not significantly reduce the admission to ICU and death. Risk factors for admission to ICU were dyspnea, co-infection with other infections and no antiviral treatment within 48 hours, and presence of dyspnea and altered mental status were independently associated with death through multivariate logistics analysis. Seasonal influenza vaccination in preceding 12 months only took up 2.7% (3/111). Conclusion Fever and other classical symptoms of influenza may be absent in immunosuppressed recipients, and conducting influenza virus detection at the first time is a good choice for early diagnosis. Immunosuppressed patients with dyspnea, altered mental status, co-infection with other infections and no antiviral treatment within 48 hours are of note needed, because these people have high-risk to severe cases. Inactivated influenza vaccination should be taken into account in immunosuppressed patients.

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Influenza infection in immunosuppressed patients: clinical characteristics, risk factors and effect of antiviral therapy

10.21203/rs.2.23062/v1 ◽

2020 ◽

Author(s):

YaFen Liu ◽

Yue Wang ◽

YuanYuan Chen ◽

BaiYi Liu ◽

YiSi Liu ◽

...

Keyword(s):

Risk Factors ◽

Influenza Virus ◽

Influenza Vaccination ◽

Symptom Onset ◽

Clinical Characteristics ◽

Influenza Infection ◽

Antiviral Treatment ◽

Double Dose ◽

Neuraminidase Inhibitors ◽

Immunosuppressed Patients

Abstract Background: Influenza infection was a vital threat to immunosuppressed patients with longer viral shedding; however, data on these populations in China are still lacking. We analyzed clinical characteristics, risk factors for admission to intensive care unit (ICU) and death, and effect of antiviral therapy in these populations.Methods: We analyzed 73 immunosuppressed inpatients tested positive for influenza virus using reverse-transcription polymerase chain reaction during the 2018-2019 influenza season. Medical data were analyzed using descriptive statistics. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results: The most common immunosuppression type was malignancies with chemotherapy 73.9% (54/73), then hematopoietic stem cell transplantation 19.2% (14/73). The most common presenting symptom was fever in 91.8% (67/73) patients, then cough 59.6% (34/57) and muscular soreness 35.1% (20/57). Complications and co-infections were found in 38.4% (28/73) and 17.8% (13/73) patients respectively, which significantly prolonged the hospital stay. Antiviral treatment after 48 hours was significantly associated with admission to ICU, mechanical ventilation and death. Combination and double dose of neuraminidase inhibitors did not significantly reduce the admission to ICU and death. 15.1% (11/73) patients were admitted to ICU and 8.2% (6/73) patients died. Risk factors for admission to ICU were long symptom onset (OR 5.60, P=0.018) and co-infection with other infections (OR 68.66, P=0.019), and presence of dyspnea was independently associated with death (OR 48.00, P=0.003) through multivariate logistics analysis. Seasonal influenza vaccination in preceding 12 months only took up 2.7% (2/73).Conclusion: Fever and other classical symptoms may be absent in immunosuppressed recipients, and conducting influenza virus detection at the first time is a good choice for early diagnosis. Antiviral treatment within 48 hours is of significance; however, patients may not benefit from combination and double dose of neuraminidase inhibitors. Immunosuppressed patients with dyspnea, long symptom onset and co-infection with other infections are of note needed, because these people have high-risk to severe cases. Inactivated influenza vaccination should be taken into account in immunosuppressed patients.

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Clinical Characteristics of Coronavirus Disease 2019 (COVID-19) among Patients at a Movement Disorders Center

Geriatrics ◽

10.3390/geriatrics5030054 ◽

2020 ◽

Vol 5 (3) ◽

pp. 54

Author(s):

Joy Antonelle de Marcaida ◽

Jeffrey Lahrmann ◽

Duarte Machado ◽

Lawrence Bluth ◽

Michelle Dagostine ◽

...

Keyword(s):

Mortality Rate ◽

Mental Status ◽

Movement Disorders ◽

Clinical Characteristics ◽

Altered Mental Status ◽

Atypical Parkinsonism ◽

Health Records ◽

Telephone Interviews ◽

Presenting Symptoms ◽

Idiopathic Parkinson Disease

It is not established whether SARS-CoV-2 (COVID-19) patients with movement disorders, are at greater risk for more serious outcomes than the larger COVID-19 population beyond the susceptibility associated with greater age. We reviewed electronic health records and conducted telephone interviews to collect the demographics and clinical outcomes of patients seen at our Movement Disorders Center who tested positive for COVID-19 from 8 March 2020 through 6 June 2020. Thirty-six patients were identified, 23 men and 13 women, median age of 74.5 years. They primarily carried diagnoses of idiopathic Parkinson disease (n = 22; 61%) and atypical parkinsonism (n = 7; 19%) with the balance having other diagnoses. Twenty-seven patients (75%) exhibited alteration in mental status and fifteen (42%) had abnormalities of movement as common manifestations of COVID-19; in 61% and 31%, respectively, these were the presenting symptoms of the disease. Sixty-seven percent of patients in our cohort required hospitalization, and the mortality rate was 36%. These data demonstrate that in patients with movement disorders, the likelihood of hospitalization and death after contracting COVID-19 was greater than in the general population. Patients with movement disorders frequently presented with altered mental status, generalized weakness, or worsening mobility but not anosmia.

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Clinical characteristics of 106 patients with neurological diseases and co-morbid coronavirus disease 2019: a retrospective study

10.1101/2020.04.29.20085415 ◽

2020 ◽

Cited By ~ 1

Author(s):

Rong Yin ◽

ZhiQi Yang ◽

YaXuan Wei ◽

YuanMing Li ◽

Hui Chen ◽

...

Keyword(s):

Cerebral Infarction ◽

Mental Status ◽

Clinical Characteristics ◽

Neurological Diseases ◽

Case Series ◽

Altered Mental Status ◽

Neurological Symptoms ◽

Severe Illness ◽

Common Symptom ◽

Severe Group

AbstractObjectivesTo describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with co-morbid neurological symptoms.DesignRetrospective case series.SettingHuoshenshan Hospital in Wuhan, China.ParticipantsFrom 4 February to 14 April 2020, 106 patients with neurological diseases were enrolled from all patients in the hospital with confirmed COVID-19 and divided into a severe group and a non-severe group according to their COVID-19 diagnosis.Main outcome measuresClinical characteristics, laboratory results, imaging findings, and treatment methods were all retrieved through an electronic medical records system and recorded in spreadsheets.ResultsThe mean (standard deviation, SD) age of patients was 72.7 (11.8) years, and 64 patients were male (60.4%). Among patients with co-morbid neurological diseases, 81 had a previous cerebral infarction (76.4%), 20 had dementia (18.9%), 10 had acute cerebral infarction (9.4%), 5 had sequelae of cerebral haemorrhage (4.7%), 4 had intracranial mass lesions (3.8%), 3 had epilepsy (2.8%), 2 had Parkinson’s disease (1.9%), and 1 had myelopathy (0.9%). Fever (n = 62, 58.5%) was the most common symptom. The most common neurological symptoms were myalgia (n = 26, 24.5%), followed by extremity paralysis (n = 20, 18.9%), impaired consciousness (n = 17, 16%), and positive focal neurological signs (n = 42, 39.6%). Eight patients (7.5%) died. There were more patients with altered mental status in the severe group than in the non-severe group (6 [10.2%] vs. 0, P = 0.033). The inflammatory response in the severe group was more significant than that in the non-severe group. There were more patients taking anticoagulant drugs (25 [42.4%] vs. 4 [8.5%], P < 0.001) and sedative drugs (22 [37.3%] vs. 9 [19.1%], P = 0.041) in the severe group than in the non-severe group. Amid all 93 patients with cerebrovascular diseases, only 32 (34.4%) were taking aspirin, 13 (14%) taking clopidogrel, and 33 (35.5%) taking statins.ConclusionsPatients with COVID-19 with co-morbid neurological diseases had an advanced age, a high rate of severe illness, and a high mortality rate. Among the neurological symptoms, altered mental status was more common in patients with severe COVID-19 with co-morbid neurological diseases.

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Clinical Characteristics of Coronavirus disease 2019 (COVID-19) Among Patients at a Movement Disorders Center

10.20944/preprints202008.0618.v1 ◽

2020 ◽

Author(s):

J. Antonelle de Marcaida ◽

Jeffrey Lahrmann ◽

Duarte Machado ◽

Lawrence Bluth ◽

Michelle Dagostine ◽

...

Keyword(s):

Mortality Rate ◽

Mental Status ◽

Movement Disorders ◽

Clinical Characteristics ◽

Altered Mental Status ◽

Atypical Parkinsonism ◽

Health Records ◽

Telephone Interviews ◽

Presenting Symptoms ◽

Idiopathic Parkinson Disease

It is not established whether SARS-CoV-2 (COVID-19) patients with movement disorders, are at greater risk for more serious outcomes than the larger COVID-19 population beyond the susceptibility associated with greater age. We reviewed electronic health records and conducted telephone interviews to collect the demographics and clinical outcomes of patients seen at our Movement Disorders Center who tested positive for COVID-19 from 8 March 2020 through 6 June 2020. Thirty-six patients were identified, 23 men and 13 women, median age of 74.5 years. They primarily carried diagnoses of idiopathic Parkinson disease (n=22; 61%) and atypical parkinsonism (n=7; 19%) with the balance having other diagnoses. Twenty-seven patients (75%) exhibited alteration in mental status and fifteen (42%) had abnormalities of movement as common manifestations of COVID-19; in 61% and 31%, these were the presenting symptoms of the disease. 67% of patients in our cohort required hospitalization, and the mortality rate was 39%.. These data demonstrate that in patients with movement disorders, the likelihood of hospitalization and death after contracting COVID-19 was substantially greater than in the general population. Patients with movement disorders frequently presented with altered mental status, generalized weakness, or worsening mobility but not anosmia.

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Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit

Journal of Critical Care ◽

10.1016/j.jcrc.2018.08.017 ◽

2018 ◽

Vol 48 ◽

pp. 172-177 ◽

Cited By ~ 8

Author(s):

José Garnacho-Montero ◽

Cristina León-Moya ◽

Antonio Gutiérrez-Pizarraya ◽

Angel Arenzana-Seisdedos ◽

Loreto Vidaur ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Influenza A ◽

Clinical Characteristics ◽

H1n1 Virus ◽

Related Risk ◽

Influenza A H1n1 ◽

Immunosuppressed Patients

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Identifying risk factors for an abnormal computed tomographic scan of the head among patients with altered mental status in the Emergency Department

European Journal of Emergency Medicine ◽

10.1097/mej.0b013e328331dde5 ◽

2010 ◽

Vol 17 (4) ◽

pp. 219-223 ◽

Cited By ~ 15

Author(s):

Lim Beng Leong ◽

Kenneth Heng Wei Jian ◽

Alicia Vasu ◽

Eillyne Seow

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Mental Status ◽

Altered Mental Status ◽

Computed Tomographic ◽

Computed Tomographic Scan

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Letter to the Editor Regarding “Risk Factors and Independent Predictors of 30-Day Readmission for Altered Mental Status After Elective Spine Surgery for Spine Deformity: A Single Institutional Study of 1090 Patients”

World Neurosurgery ◽

10.1016/j.wneu.2017.03.060 ◽

2017 ◽

Vol 103 ◽

pp. 932 ◽

Cited By ~ 1

Author(s):

Erfan Ayubi ◽

Saeid Safiri

Keyword(s):

Risk Factors ◽

Mental Status ◽

Spine Surgery ◽

Altered Mental Status ◽

Spine Deformity ◽

Letter To The Editor

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Conditions associated with giant pituitary tumors at the time of surgery effecting outcome morbidity and mortality

Surgical Neurology International ◽

10.25259/sni-82-2019 ◽

2019 ◽

Vol 10 ◽

pp. 92

Author(s):

Marc Billings ◽

Robert Dahlin ◽

Bailey Zampella ◽

Raed Sweiss ◽

Shokry Lawandy ◽

...

Keyword(s):

Mental Status ◽

Expectant Management ◽

Pituitary Tumors ◽

Mass Effect ◽

Brain Structures ◽

Altered Mental Status ◽

Time Of Surgery ◽

Presenting Symptoms ◽

Imaging Characteristics ◽

Brainstem Compression

Background: Surgical outcome prediction has assisted physicians in discussing surgical intervention or expectant management. While increasing pituitary tumor size would seem to be associated with increasing challenge of removal and associated complications, that relationship has not been borne in the literature. Methods: We performed a retrospective review of a consecutive cohort of pituitary surgeries completed at our institution. Data included age at the time of surgery, presenting symptoms and Glasgow Coma scale (GCS), GCS at discharge or 7 days postoperatively, GCS at 6 months, adenoma size, imaging characteristics of the tumor and brain before resection, postoperative complications, the presence of preoperative hydrocephalus, brainstem compression, and patient mortality. Results: Patients with giant adenomas were more likely to present with a cranial nerve palsy (P = 0.019), altered mental status (P = 0.0001), hydrocephalus (P = 0.002), and mass effect on the brainstem (P = 0.020). Patients who experienced a postoperative decline in mental status were more likely to present with altered mental (P = 0.006), had an increased prevalence of mass effect on the brainstem (P = 0.005), and were more likely to have either an ischemic stroke (P = 0.0001) and vasospasms or new intraparenchymal hemorrhage (P = 0.013). Conclusion: The results of this study demonstrate that postoperative mental status declines after pituitary adenoma resection can be directly related to brainstem compression and further surgical irritation of the surrounding vasculature. The intraoperative irritation can be multifactorial and may result as the decompressed brain structures assume their anatomical position.

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