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Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study

BACKGROUND: Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patient...

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Autores principales: Yi, Guangzhao, de Kraker, Marlieke E. A., Buetti, Niccolò, Zhong, Xiaoni, Li, Jinyan, Yuan, Zhe, Zhu, Weimin, Zhou, Jia, Zhou, Hongyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064953/
https://www.ncbi.nlm.nih.gov/pubmed/37004057
http://dx.doi.org/10.1186/s13756-023-01234-y
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author Yi, Guangzhao
de Kraker, Marlieke E. A.
Buetti, Niccolò
Zhong, Xiaoni
Li, Jinyan
Yuan, Zhe
Zhu, Weimin
Zhou, Jia
Zhou, Hongyu
author_facet Yi, Guangzhao
de Kraker, Marlieke E. A.
Buetti, Niccolò
Zhong, Xiaoni
Li, Jinyan
Yuan, Zhe
Zhu, Weimin
Zhou, Jia
Zhou, Hongyu
author_sort Yi, Guangzhao
collection PubMed
description BACKGROUND: Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza. METHODS: A retrospective cohort study was performed at a tertiary teaching hospital in southwest China. The study cohort included all adult hospitalized patients with a laboratory-confirmed, community-acquired influenza virus infection during three consecutive influenza seasons from 2017 to 2020. Cause-specific Cox regression was used to analyze risk factors for mortality and secondary bacterial pneumonia, respectively, accounting for competing events (discharge alive and discharge alive or death without secondary bacterial pneumonia, respectively). RESULTS: Among 174 patients enrolled in this study, 14.4% developed secondary bacterial pneumonia and 11.5% died during hospitalization. For all-cause in-hospital mortality, time-varying secondary bacterial pneumonia was a direct risk factor of death (cause-specific hazard ratio [csHR] 3.38, 95% confidence interval [CI] 1.25–9.17); underlying disease indirectly increased death risk through decreasing the hazard of being discharged alive (csHR 0.55, 95% CI 0.39–0.77). For secondary bacterial pneumonia, the final model only confirmed direct risk factors: age ≥ 65 years (csHR 2.90, 95% CI 1.27–6.62), male gender (csHR 3.78, 95% CI 1.12–12.84) and mechanical ventilation on admission (csHR 2.96, 95% CI 1.32–6.64). CONCLUSIONS: Secondary bacterial pneumonia was a major risk factor for in-hospital mortality among adult hospitalized patients with community-acquired influenza. Prevention strategies for secondary bacterial pneumonia should target elderly male patients and critically ill patients under mechanical ventilation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-023-01234-y.
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spelling pubmed-100649532023-04-03 Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study Yi, Guangzhao de Kraker, Marlieke E. A. Buetti, Niccolò Zhong, Xiaoni Li, Jinyan Yuan, Zhe Zhu, Weimin Zhou, Jia Zhou, Hongyu Antimicrob Resist Infect Control Research BACKGROUND: Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza. METHODS: A retrospective cohort study was performed at a tertiary teaching hospital in southwest China. The study cohort included all adult hospitalized patients with a laboratory-confirmed, community-acquired influenza virus infection during three consecutive influenza seasons from 2017 to 2020. Cause-specific Cox regression was used to analyze risk factors for mortality and secondary bacterial pneumonia, respectively, accounting for competing events (discharge alive and discharge alive or death without secondary bacterial pneumonia, respectively). RESULTS: Among 174 patients enrolled in this study, 14.4% developed secondary bacterial pneumonia and 11.5% died during hospitalization. For all-cause in-hospital mortality, time-varying secondary bacterial pneumonia was a direct risk factor of death (cause-specific hazard ratio [csHR] 3.38, 95% confidence interval [CI] 1.25–9.17); underlying disease indirectly increased death risk through decreasing the hazard of being discharged alive (csHR 0.55, 95% CI 0.39–0.77). For secondary bacterial pneumonia, the final model only confirmed direct risk factors: age ≥ 65 years (csHR 2.90, 95% CI 1.27–6.62), male gender (csHR 3.78, 95% CI 1.12–12.84) and mechanical ventilation on admission (csHR 2.96, 95% CI 1.32–6.64). CONCLUSIONS: Secondary bacterial pneumonia was a major risk factor for in-hospital mortality among adult hospitalized patients with community-acquired influenza. Prevention strategies for secondary bacterial pneumonia should target elderly male patients and critically ill patients under mechanical ventilation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-023-01234-y. BioMed Central 2023-03-31 /pmc/articles/PMC10064953/ /pubmed/37004057 http://dx.doi.org/10.1186/s13756-023-01234-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Yi, Guangzhao
de Kraker, Marlieke E. A.
Buetti, Niccolò
Zhong, Xiaoni
Li, Jinyan
Yuan, Zhe
Zhu, Weimin
Zhou, Jia
Zhou, Hongyu
Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
title Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
title_full Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
title_fullStr Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
title_full_unstemmed Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
title_short Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
title_sort risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064953/
https://www.ncbi.nlm.nih.gov/pubmed/37004057
http://dx.doi.org/10.1186/s13756-023-01234-y
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