Clinical features and outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011 - 2015 Pubblico

Abstract

Background: Limited data on immunocompromised (IC) adults with influenza suggest they may present differently and have worse outcomes. Methods: We analyzed data on adults (>18 years of age) hospitalized with lab-confirmed influenza between 2011-2015 and reported to CDC's FluSurv-NET. IC patients had >1: HIV/AIDS, cancer, stem cell or organ transplant, non-steroid immunosuppressive therapy, immunoglobulin deficiency, asplenia, and other rare conditions. We compared IC and non-IC patients using descriptive statistics. Multivariable logistic regression was used to identify factors associated with mortality and Cox proportional hazards models determined whether length of hospital stay varied between the two groups. Results: Among 35,348 adults hospitalized over 4 seasons, 3633 (10%) were IC. The most common IC conditions were cancer (44%), non-steroid immunosuppressive therapy (44%), and HIV (17%). IC patients were younger than non-IC patients (median (IQR) 61.7 (55.0-74.0) vs. 70.2 (54.2-83.2) years; p<0.01). IC patients were more likely to have pre-existing renal disease (27% vs. 18%) and liver disease (7% vs. 3%) and less likely to have most other chronic pre-existing conditions including obesity (18% vs. 23%), cardiovascular disease (40% vs. 47%), and chronic lung disease (35% vs. 41%; p<0.01 for all). IC patients were more likely to have received influenza vaccination (53% vs. 46%; p<0.01) and antivirals (87% vs. 85%; p<0.01). Among cases with symptom data (2014-15), IC patients were more likely to present with fever (68% vs. 61%; p<0.01) but respiratory distress was similar (53% vs. 54%; p=0.3). IC patients were more likely to be diagnosed with pneumonia (34 vs. 31%; p<0.01). When controlling for confounders, IC patients 65-79 and >80 years of age were more likely to require intensive care than non-IC patients of those ages (aOR (95% CI): 1.20 (1.02-1.42) and 1.34 (1.05-1.71), respectively). In the multivariable analysis, IC adults had a longer length of stay (aHR of discharge (95% CI): 0.88 (0.85-0.90) and a higher odds of mortality than non-IC adults (aOR (95% CI): 1.48 (1.23-1.78)). Conclusions: Among adults hospitalized with influenza, IC patients had worse outcomes including a longer duration of hospitalization and increased all-cause mortality. Older IC adults had a higher odds of ICU admission.

Table of Contents

TABLE OF CONTENTS

INTRODUCTION

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1

BACKGROUND

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3

METHODS

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7

RESULTS

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13

DISCUSSION

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20

REFERENCES

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24

TABLES

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27

FIGURES

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35

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Parola chiave	Immunocompromised hosts Influenza Outcomes
Committee Chair / Thesis Advisor	Farley, Monica, Emory University
Committee Members	Anderson, Evan, Emory University Barry, Vaughn, Emory University Klein, Mitchel, Emory University

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