Clinical features and risk factors for severe and critical pregnant women with 2009 pandemic H1N1 influenza infection in China

BMC Infectious Diseases

Chen Wang⁷  Lan-juan Li²  Jing-xiao Zhang⁴  Wei Chen⁵  Wen-bao Huang^1,10  Xi-xin Yan¹  Hong-yuan Zhang⁶  Ke Hu³  Zhen Xu⁸  Li Gu⁹  Li-rong Liang⁹  Shi-gui Yang²  Bin Cao⁹  Xiao-li Li⁹  Peng-jun Zhang⁹ 

[1] Department of Respiratory, Second Hospital of Hebei Medical University, Shi Jiazhuang, China;State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Key Laboratory of Infectious Diseases Key Laboratory of Infectious Diseases, Zhejiang University, Hangzhou, China;Renmin Hospital of Wuhan University, Wuhan, China;the Second Affiliated Hospital, Nanchang University, Changchun, China;Shengjing Hospital of China Medical University, Shenyang, China;The First Affiliated Hospital of Anhui medical university, Hefei, China;Department of Respiratory Medicine, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Hospital, Ministry of Heath, Beijing, China;Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China;Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Respiratory Medicine, Capital Medical University, Beijing, China;Hang zhou No.1 People's hospital, Hangzhou, China

关键词: Non-invasive ventilation;    Mortality;    Pandemic H1N1 influenza;    Neonate;    Pregnant women;   

Others  :  1175461
DOI  :  10.1186/1471-2334-12-29

 received in 2011-08-12, accepted in 2012-02-01,  发布年份 2012

【 摘 要 】

Background

2009 pandemic H1N1 (pH1N1) influenza posed an increased risk of severe illness among pregnant women. Data on risk factors associated with death of pregnant women and neonates with pH1N1 infections are limited outside of developed countries.

Methods

Retrospective observational study in 394 severe or critical pregnant women admitted to a hospital with pH1N1 influenza from Sep. 1, 2009 to Dec. 31, 2009. rRT-PCR testing was used to confirm infection. In-hospital mortality was the primary endpoint of this study. Univariable logistic analysis and multivariate logistic regression analysis were used to investigate the potential factors on admission that might be associated with the maternal and neonatal mortality.

Results

394 pregnant women were included, 286 were infected with pH1N1 in the third trimester. 351 had pneumonia, and 77 died. A PaO₂/FiO₂ ≤ 200 (odds ratio (OR), 27.16; 95% confidence interval (CI), 2.64-279.70) and higher BMI (i.e. ≥ 30) on admission (OR, 1.26; 95% CI, 1.09 to 1.47) were independent risk factors for maternal death. Of 211 deliveries, 146 neonates survived. Premature delivery (OR, 4.17; 95% CI, 1.19-14.56) was associated neonatal mortality. Among 186 patients who received mechanical ventilation, 83 patients were treated with non-invasive ventilation (NIV) and 38 were successful with NIV. The death rate was lower among patients who initially received NIV than those who were initially intubated (24/83, 28.9% vs 43/87, 49.4%; p = 0.006). Septic shock was an independent risk factor for failure of NIV.

Conclusions

Severe hypoxemia and higher BMI on admission were associated with adverse outcomes for pregnant women. Preterm delivery was a risk factor for neonatal death among pregnant women with pH1N1 influenza infection. NIV may be useful in selected pregnant women without septic shock.

【 授权许可】

   
2012 Zhang et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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