Factors Associated With ICU Admission In H1N1 Patients: A Study of 2015 Outbreak In North India

Dr.SUJATA AGARWAL; Dr. C.L. NAWAL; Dr. ABHISHEK AGARWAL; Dr. PRADEEP MITTAL

Volume : VII, Issue : III, March - 2018

Factors Associated With ICU Admission In H1N1 Patients: A Study of 2015 Outbreak In North India

Dr. Sujata Agarwal, Dr. C. L. Nawal, Dr. Abhishek Agarwal, Dr. Pradeep Mittal

Abstract :

Introduction: The resurgence of epidemic of Influenza A (H1N1) pdm 09 was phenomenal in 2015. It was mainly due to antigenic drift and reassortment. As this disease has high mortality, many patients needed ICU care. We tried to access the prognostic factors

affecting the site of patient care and adverse outcome.

Material & Method: A study of 401 patients of Influenza A(H1N1) pdm09 confirmed with RT–PCR, hospitalized during December 2014 to March 2015 were included in the study. The patients were categorized according to requirement of ICU. We compared simple demographic data like age, sex, onset of disease & delay in treatment along with clinical presentation, co–morbidities & laboratory findings in patients requiring ICU and those treated in wards.

Result: Out of 401 patients 148(36.91) required ICU & 253(63.09) were kept in wards. ICU patients were younger (38.10±14.32 years vs 41.72±15.15 years, p <0.05). Delay in start of treatment was more in ICU patient (1.91±1.06 days vs. 0.74±0.47 days, p <0.05), category C patients needed ICU (116/192) more compared to category A (9/94).Lung involvement was higher in ICU patients (56.07±23.12 % compared to 16.69±16.20%). Pregnancy & diabetes were seen in higher number of ICU patients. CPK levels were also significantly high in ICU patients compared to Non–ICU patients (254.67±314.76 IU/L and 182.17±137.26 IU/L respectively, p <0.002). (Table no.2). Similarly, serum levels of LDH were significantly higher in ICU patients compared to non ICU patients (738.65±577.06 IU/L and 608.92±436.71 IU/L respectively, p< 0.011)

Conclusion: Influenza A (H1N1) pdm09 virus affects younger population. Delayed start of treatment causes severe infection and increased mortality. Category C patients needs ICU care. Hypoxia & >50% lung involvement on radiography were associated with ICU admission. Pregnancy and diabetes were significant co–morbid conditions associated with ICU admission with higher mortality and morbidity. CPK & LDH can be used as predictors of mortality