A clinical prediction rule for diagnosing human infections with avian influenza A(H7N9) in a hospital emergency department setting

BMC Medicine

Benjamin J Cowling¹  Hongjie Yu²  Gabriel M Leung⁵  Luzhao Feng²  Eric H Y Lau¹  Yang Huai³  Peng Wu¹  Zhibin Peng²  Jiandong Zheng²  Fengfeng Liu²  Hui Jiang²  Bin Cao⁴  Tim K Tsang¹  Dennis K M Ip⁵  Qiaohong Liao² 

[1] Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China;Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, 155# Changbai Road, Beijing 102206, P.R. China;China-US Collaborative Program on Emerging and Re-emerging Infection Disease, US Centers for Disease Control and Prevention, Beijing, China;Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China;Division of Community Medicine and Public Health Practice, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China

关键词: Hospital emergency setting;    Clinical diagnosis;    Clinical prediction rule;    Avian influenza A(H7N9);   

Others  :  1121569
DOI  :  10.1186/s12916-014-0127-0

 received in 2014-02-20, accepted in 2014-07-10,  发布年份 2014

【 摘 要 】

Background

Human infections with avian influenza A(H7N9) virus are associated with severe illness and high mortality. To better inform triage decisions of hospitalization and management, we developed a clinical prediction rule for diagnosing patients with A(H7N9) and determined its predictive performance.

Methods

Clinical details on presentation of adult patients hospitalized with either A(H7N9)(n = 121) in China from March to May 2013 or other causes of acute respiratory infections (n = 2,603) in Jingzhou City, China from January 2010 through September 2012 were analyzed. A clinical prediction rule was developed using a two-step coefficient-based multivariable logistic regression scoring method and evaluated with internal validation by bootstrapping.

Results

In step 1, predictors for A(H7N9) included male sex, poultry exposure history, and fever, haemoptysis, or shortness of breath on history and physical examination. In step 2, haziness or pneumonic consolidation on chest radiographs and leukopenia were also associated with a higher probability of A(H7N9). The observed risk of A(H7N9) was 0.3% for those assigned to the low-risk group and 2.5%, 4.3%, and 44.0% for tertiles 1 through 3, respectively, in the high-risk group. This prediction rule achieved good model performance, with an optimism-corrected sensitivity of 0.93, a specificity of 0.80, and an area under the receiver-operating characteristic curve of 0.96.

Conclusions

A simple decision rule based on data readily obtainable in the setting of patients’ first clinical presentations from the first wave of the A/H7N9 epidemic in China has been developed. This prediction rule has achieved good model performance in predicting their risk of A(H7N9) infection and should be useful in guiding important clinical and public health decisions in a timely and objective manner. Data to be gathered with its use in the current evolving second wave of the A/H7N9 epidemic in China will help to inform its performance in the field and contribute to its further refinement.

【 授权许可】

   
2014 Liao et al.; licensee BioMed Central Ltd

【 图 表 】

Figure 1.

Figure 2.

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