Objectives

The purpose of this prospective surveillance registry was to characterize the demographics, clinical features, outcomes, and resource utilization of patients with H1N1 influenza infection who require intensive care.

Background

There are no pertinent animal studies of H1N1 influenza. Human studies are limited to case reports or case series which report on relatively limited number of patients. These reports suggest that although severe disease requiring critical care is rare among patients with H1N1 infection, the patients who do require ICU care have a rapidly progressive course with high disease severity. Unlike typical influenza, where the extremes of age (i.e. elderly and very young) and those with underlying cardiopulmonary comorbidities are at increased risk of developing severe and potentially fatal infections, young otherwise healthy patients (including children of all ages), obese patients, and pregnant females appear to be at an increased risk for severe disease from the novel influenza A (H1N1) virus.

Participants

The study data consists of 892 adult subjects and 838 pediatric subjects who were admitted to an intensive care unit at a participating site with confirmed or suspected Novel H1N1 Influenza infection. Subjects with influenza-like illness due to non-influenza disease and negative testing for influenza were excluded.

Design

Patients were enrolled on the day of ICU admission and baseline demographics collected from the medical record. The presenting clinical features and lab values for organ function were also collected. APACHE III (or PRISM for children) and Sepsis-related Organ Failure Assessment (SOFA) scores were calculated for data present in the medical record on enrollment. Crude outcomes were collected weekly in order to have a real-time picture of the clinical course. At ICU discharge, death or day 28, more in-depth outcomes were collected. 60-day followup was collected for patients who remained hospitalized beyond day 28. In children remaining hospitalized beyond day 60, this information was collected at day 90. Cause of death was requested.

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