Prognosis of 18 H7N9 avian influenza patients in Shanghai

Shuihua Lu; Tao Li; Xiuhong Xi; Qingguo Chen; Xuhui Liu; Binxing Zhang; Jiaxian Ou; Jie Liu; Qin Wang; Biao Zhu; Xinian Liu; Chunxue Bai; Jieming Qu; Hongzhou Lu; Zhiyong Zhang; Yuanlin Song

doi:10.1371/journal.pone.0088728

Prognosis of 18 H7N9 avian influenza patients in Shanghai

PLoS One. 2014 Apr 2;9(4):e88728. doi: 10.1371/journal.pone.0088728. eCollection 2014.

Authors

Shuihua Lu¹, Tao Li¹, Xiuhong Xi¹, Qingguo Chen¹, Xuhui Liu¹, Binxing Zhang¹, Jiaxian Ou², Jie Liu², Qin Wang², Biao Zhu³, Xinian Liu¹, Chunxue Bai², Jieming Qu⁴, Hongzhou Lu¹, Zhiyong Zhang¹, Yuanlin Song⁵

Affiliations

¹ Department of Tuberculosis, Shanghai Public Health Clinical Center, Shanghai, China.
² Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Department of Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Pulmonary Medicine, Huadong Hospital, Fudan University, Shanghai, China.
⁵ Department of Tuberculosis, Shanghai Public Health Clinical Center, Shanghai, China; Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Pulmonary Medicine, Zhongshan Hospital, Qingpu Branch, Shanghai, China.

Abstract

Purpose: To provide prognosis of an 18 patient cohort who were confirmed to have H7N9 lung infection in Shanghai.

Methods: Patients' history, clinical manifestation, laboratory test, treatment strategy and mortality were followed and recorded for data analysis.

Results: A total of 18 patients had been admitted into Shanghai Public Health Clinical Center from April 8th to July 29, 2013. 22.2% of the patients were found to have live poultry contact history and 80% were aged male patients with multiple co-morbidities including diabetes, hypertension and/or chronic obstructive pulmonary disease (COPD). This group of patients was admitted to the clinical center around 10 days after disease onset. According to laboratory examinations, increased C reactive protein (CRP), Procalcitonin (PCT), Plasma thromboplastin antecedent (PTA) and virus positive time (days) were indicative of patients' mortality. After multivariate analysis, only CRP level showed significant prediction of mortality (P = 0.013) while results of prothrombin time (PT) analysis almost reached statistical significance (P = 0.056).

Conclusions: H7N9 infection induced pneumonia of different severity ranging from mild to severe pneumonia or acute lung injury/acute respiratory distress syndrome to multiple organ failure. Certain laboratory parameters such as plasma CRP, PCT, PTA and virus positive days predicted mortality of H7N9 infection and plasma CRP is an independent predictor of mortality in these patients.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
C-Reactive Protein / metabolism*
Calcitonin / blood*
Calcitonin Gene-Related Peptide
China / epidemiology
Disease-Free Survival
Factor XI / metabolism*
Female
Follow-Up Studies
Humans
Influenza A Virus, H7N9 Subtype*
Influenza, Human / blood*
Influenza, Human / mortality*
Influenza, Human / therapy
Male
Middle Aged
Protein Precursors / blood*
Prothrombin Time
Survival Rate

Substances

CALCA protein, human
Protein Precursors
Calcitonin
C-Reactive Protein
Factor XI
Calcitonin Gene-Related Peptide

Grants and funding

This research was supported by Shanghai Leading Academic Discipline Project (B115), and National Natural Science Foundation of China (30930090, 81100046, 81170056). Dr. Yuanlin Song was supported by the Program for Professor of Special Appointment (Eastern Scholar) at Shanghai Institutions of Higher Learning and Key Medical grant from Shanghai Science and Technology Committee (11411951102, 12JC1402300). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.