.jpg "Carla Rosenzvit, MD, photo")
.jpg "Michelle Gong, MD, MS photo")
Michelle Gong, MD, MS
Chief of Critical Care Medicine
Montefiore Medical Center
New York, NY
Disclosure information not submitted.
Tina Chen, MD
Physician
Albert Einstein College of Medicine
Bronx, United States
Disclosure information not submitted.
Title: Acute Respiratory Failure from Influenza is Associated with Longer ICU Stay.
Introduction: Acute respiratory failure (ARF) from influenza pneumonia carries high morbidity and mortality. However, no direct comparison between influenza and other causes of ARF exist. We compare the characteristics of ARF from influenza versus other causes and the association between influenza status and clinical outcomes.
Methods: We performed retrospective chart review study using electronic health record and data abstraction software Clinical Looking Glass. We included adult patients admitted to the intensive care units with ARF requiring mechanical ventilation in 3 hospitals in The Bronx, New York, during the two influenza seasons in 2017 and 2018. Influenza status (FLU+ or -) was determined by PCR test 72 hours peri-intubation. We used Chi-Square and Mann Whitney U tests for bivariate analysis and logistic regression and linear regression for multivariate adjusted analysis. We included a priori variables: age, race, gender, APACHE II, Charlson comorbidity index, presence of ARDS and shock as confounders in adjusted models. Additional subgroup analysis of ARF from pneumonia was performed.
Results: A total of 668 patients were included with 76 (11.4%) FLU+ patients and 592 (88.6%) FLU-. There were no significant differences between groups in terms of age, race, gender or APACE II score. Sepsis was more likely in the FLU+ (n= 62 (81%) versus FLU- n= 408(70%), p=0.04). Unadjusted In hospital mortality for FLU+ was 23 (30.3%) and 170 (28.7%) for FLU- (p=0.78). Median ICU LOS for FLU+ group was 9.04 days (IQR 5.2,16.5) and 6.65 (IQR 3.5, 12.2) for FLU- group(p< 0.05). After adjustment for confounders, there was no significant difference in in-hospital mortality (adjusted odds ratio 0.97 (CI 0.53; 1.77)). FLU+ had an increase in both ICU LOS by 1.48 days (CI 1.2;1.83), and hospital LOS by 1.3 days (CI 1.06, 1.6), there were no differences in VFD at 28 days between groups. In the subgroup of ARF from pneumonia, FLU+ had an increase in ICU LOS by 1.4 days (CI 1.1;1.7) and in hospital LOS by 1.2 days (CI 1.01; 1.5).
Conclusions: Influenza ARF patients were similar in baseline characteristics with those without influenza. We did not find significant differences in mortality among FLU+ ARF versus other causes of ARF. FLU+ ARF is associated with increased ICU LOS and hospital LOS when compared to FLU- ARF.