Predictors for fatal human infections with avian H7N9 influenza, evidence from four epidemic waves in Jiangsu Province, Eastern China, 2013‐2016

BACKGROUND: Four epidemic waves of human infection with H7N9 have been recorded in China up to 1 June 2016, including in Jiangsu Province. However, few studies have investigated the differences in patients' characteristics among the four epidemic waves, and the analyses of factors associated with fatal infection lacked statistical power in previous studies due to limited sample size. METHODS: All laboratory‐confirmed A(H7N9) patients in Jiangsu province were analysed. Patients' characteristics were compared across four waves and between survivors and those who died. Multivariate analyses were used to identify independent predictors of death. RESULTS: Significant differences were found in the lengths of several time intervals (from onset of disease to laboratory confirmation, to onset of ARDS and respiratory failure, and to death) and in the development of heart failure. The proportions of overweight patients and rural patients increased significantly across the four waves. Administration of glucocorticoids and double‐dose neuraminidase inhibitors became the norm. Predictors of death included complications such as ARDS, heart failure and septic shock, administration of glucocorticoids, and disease duration. CONCLUSION: Characteristics of H7N9 patients and clinical treatment options changed over time. Particular complications and the use of particular treatment, along with disease duration, could help clinicians predict the outcome of H7N9 infections.