Yoğun bakım ünitesinde influenza ve diğer solunum yolu viral enfeksiyonlarının klinik özellikleri: Bir yıllık tek merkezli retrospektif çalışma
Abstract
Amaç: Bu çalışmanın amacı, yoğun bakım hastalarında saptanan solunum yolu viral enfeksiyonlarının klinik özelliklerini ve mortalite ile ilişkili prognostik faktörleri değerlendirmektir.
Yöntem: Bu retrospektif, tek merkezli çalışmaya, Mart 2024 – Mart 2025 tarihleri arasında Kocaeli Üniversitesi Tıp Fakültesi yoğun bakım ünitesine kabul edilen ve BioFire® Respiratory 2.1 Plus Panel testi ile solunum yolu viral etkeni saptanan ≥18 yaş erişkin hastalar dahil edildi. Demografik veriler, klinik ve pnömoni skorlama sistemleri (APACHE II, SOFA, PSI, CURB-65), laboratuvar parametreleri ve hasta prognozu (yaşam/exitus) analiz edildi.
Bulgular: Toplam 2719 yoğun bakım hastasından 547’sine solunum paneli uygulanmış, bunların 95’inde (%17,4) en az bir viral etken saptanmıştır. En sık tespit edilen virüsler rhinovirüs/enterovirüs (n=22), SARS-CoV-2 (n=15) ve influenza A-H3 (n=23) olmuştur. Viral pozitif hastalarda yoğun bakım mortalite oranı %54,3 bulunmuştur. Ölen hastalarda APACHE II, SOFA, PSI ve CURB-65 skorlarının yanı sıra üre ve prokalsitonin düzeylerinin anlamlı derecede yüksek olduğu görülmüştür (p<0,05). Alt gruplara göre viral etkenlere bağlı mortalite oranları farklılık gösterse de bu fark istatistiksel olarak anlamlı bulunmamıştır (p=0,215).
Sonuç: Yoğun bakım hastalarında görülen solunum yolu viral enfeksiyonları, özellikle klinik şiddet skorları ve bazı laboratuvar parametreleri yüksek olan bireylerde mortalite ile ilişkilidir. Daha geniş örneklemli, çok merkezli, prospektif çalışmalar ile bu bulguların doğrulanması gerekmektedir.
References
- Fragkou PC, Moschopoulos CD, Karofylakis E, Kelesidis T, Tsiodras S. Update in viral infections in the intensive care unit. Front Med (Lausanne). 2021;8:575580. doi:10.3389/fmed.2021.575580
- Xu JQ, Zhang WY, Fu JJ, et al. Viral sepsis: diagnosis, clinical features, pathogenesis, and clinical considerations. Mil Med Res. 2024;11:78. doi:10.1186/s40779-024-00581-0
- Kelesidis T, Mastoris I, Metsini A, Tsiodras S. How to approach and treat viral infections in ICU patients. BMC Infect Dis. 2014;14:321. doi:10.1186/1471-2334-14-321
- Lin GL, McGinley JP, Drysdale SB, Pollard AJ. Epidemiology and immune pathogenesis of viral sepsis. Front Immunol. 2018;9:2147. doi:10.3389/fimmu.2018.02147
- Hong HL, Hong SB, Ko GB, et al. Viral Infection is not uncommon in adult patients with severe hospital-acquired pneumonia. PLoS One. 2014;9(4):e95865. doi:10.1371/journal.pone.0095865
- Piralla A, Rovida F, Girello A, et al. Frequency of respiratory virus infections and next-generation analysis of influenza A/H1N1pdm09 dynamics in the lower respiratory tract of patients admitted to the ICU. PLoS One. 2017;12(6):e0178926. doi:10.1371/journal.pone.0178926
- Olsen SJ, Winn AK, Budd AP, et al. Changes in influenza and other respiratory virus activity during the COVID-19 Pandemic-United States, 2020-2021. MMWR Morb Mortal Wkly Rep. 2021;70(29):1013-1019. doi:10.15585/mmwr.mm7029a1. PMID: 34292924
- Telenti A, Arvin A, Corey L, et al. After the pandemic: perspectives on the future trajectory of COVID-19. Nature. 2021;596(7873):495-504. doi:10.1038/s41586-021-03792-w
- Al-Dorzi HM, Alsafwani ZA, Alsalahi E, et al. Patients with influenza admitted to a tertiary-care hospital in Riyadh between 2018 and 2022: characteristics, outcomes and factors associated with ICU admission and mortality. BMC Pulm Med. 2024;24(1):464. doi:10.1186/s12890-024-03281-6
- Verdier V, Lilienthal F, Desvergez A, Gazaille V, Winer A, Paganin F. Severe forms of influenza infections admitted in intensive care units: Analysis of mortality factors. Influenza Other Respir Viruses. 2023;17(7):e13168. doi:10.1111/irv.13168
- Naquin A, O’Halloran A, Ujamaa D, et al. Laboratory-confirmed influenza-associated hospitalizations among children and adults-influenza hospitalization surveillance network, United States, 2010-2023. MMWR Surveill Summ. 2024;73(6):1-18. doi:10.15585/mmwr.ss7706a1
- O’Halloran AC, Holstein R, Cummings C, et al. Rates of influenza-associated hospitalization, intensive care unit admission, and in-hospital death by race and ethnicity in the United States from 2009 to 2019. JAMA Netw Open. 2021;4(8):e2121880. doi:10.1001/jamanetworkopen.2021.21880
- Cancella De Abreu M, Ropers J, Oueidat N, et al. Biomarkers of COVID-19 short-term worsening: a multiparameter analysis within the prospective multicenter COVIDeF cohort. European Journal of Emergency Medicine. 2024;31(6):429-437. doi:10.1097/MEJ.0000000000001175
- Ambrosch A, Luber D, Klawonn F, Kabesch M. Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: Risk factors, symptomatology and clinical course compared to influenza A / B and the original SARS-CoV-2 strain. J Clin Virol. 2023;161:105399. doi:10.1016/j.jcv.2023.105399
- Surie D, Yuengling KA, DeCuir J, et al. Severity of respiratory syncytial virus vs COVID-19 and influenza among hospitalized US adults. JAMA Network Open. 2024;7(4):e244954. doi:10.1001/jamanetworkopen.2024.4954
The clinical characteristics of influenza and other viral respiratory infections in the intensive care unit: A one-year single-center retrospective study
Abstract
Objective: The aim of this study was to evaluate the clinical features and prognostic factors associated with mortality in respiratory viral infections in intensive care unit patients.
Methods: This retrospective, single-centre study included adult patients aged ≥18 years who were admitted to the intensive care unit of Kocaeli University Faculty of Medicine between March 2024 and March 2025 and whose respiratory viral agent was detected by BioFire® Respiratory 2.1 Plus Panel test. Demographic data, clinical and pneumonia scoring systems (APACHE II, SOFA, PSI, CURB-65), laboratory parameters and patient prognosis (survived/non survived) were analysed.
Results: A total of 547 out of 2719 intensive care unit patients underwent respiratory panel, and at least one viral agent was detected in 95 (17.4%) of them. The most frequently detected viruses were rhinovirus/enterovirus (n=22), SARS-CoV-2 (n=15) and influenza A-H3 (n=23). The intensive care unit mortality rate was 54.3% in viral positive patients. APACHE II, SOFA, PSI and CURB-65 scores as well as urea and procalcitonin levels were found to be significantly higher in patients with non-survived (p<0.05). Although mortality rates due to viral agents differed according to subgroups, this difference was not statistically significant (p=0.215).
Conclusion: Respiratory viral infections in intensive care unit patients are associated with mortality, especially in individuals with high clinical severity scores and some laboratory parameters. These findings need to be confirmed with larger sample, multicentre, prospective studies.
Ethical Statement
Approval for the study was granted by the Kocaeli University Non-Interventional Clinical Research Ethics Committee (Approval number: GOKAEK-2025/05/33).
Supporting Institution
None
Thanks
We would like to thank Assoc. Prof. Sibel Balcı for her valuable contributions to the statistical analysis of the study
References
- Fragkou PC, Moschopoulos CD, Karofylakis E, Kelesidis T, Tsiodras S. Update in viral infections in the intensive care unit. Front Med (Lausanne). 2021;8:575580. doi:10.3389/fmed.2021.575580
- Xu JQ, Zhang WY, Fu JJ, et al. Viral sepsis: diagnosis, clinical features, pathogenesis, and clinical considerations. Mil Med Res. 2024;11:78. doi:10.1186/s40779-024-00581-0
- Kelesidis T, Mastoris I, Metsini A, Tsiodras S. How to approach and treat viral infections in ICU patients. BMC Infect Dis. 2014;14:321. doi:10.1186/1471-2334-14-321
- Lin GL, McGinley JP, Drysdale SB, Pollard AJ. Epidemiology and immune pathogenesis of viral sepsis. Front Immunol. 2018;9:2147. doi:10.3389/fimmu.2018.02147
- Hong HL, Hong SB, Ko GB, et al. Viral Infection is not uncommon in adult patients with severe hospital-acquired pneumonia. PLoS One. 2014;9(4):e95865. doi:10.1371/journal.pone.0095865
- Piralla A, Rovida F, Girello A, et al. Frequency of respiratory virus infections and next-generation analysis of influenza A/H1N1pdm09 dynamics in the lower respiratory tract of patients admitted to the ICU. PLoS One. 2017;12(6):e0178926. doi:10.1371/journal.pone.0178926
- Olsen SJ, Winn AK, Budd AP, et al. Changes in influenza and other respiratory virus activity during the COVID-19 Pandemic-United States, 2020-2021. MMWR Morb Mortal Wkly Rep. 2021;70(29):1013-1019. doi:10.15585/mmwr.mm7029a1. PMID: 34292924
- Telenti A, Arvin A, Corey L, et al. After the pandemic: perspectives on the future trajectory of COVID-19. Nature. 2021;596(7873):495-504. doi:10.1038/s41586-021-03792-w
- Al-Dorzi HM, Alsafwani ZA, Alsalahi E, et al. Patients with influenza admitted to a tertiary-care hospital in Riyadh between 2018 and 2022: characteristics, outcomes and factors associated with ICU admission and mortality. BMC Pulm Med. 2024;24(1):464. doi:10.1186/s12890-024-03281-6
- Verdier V, Lilienthal F, Desvergez A, Gazaille V, Winer A, Paganin F. Severe forms of influenza infections admitted in intensive care units: Analysis of mortality factors. Influenza Other Respir Viruses. 2023;17(7):e13168. doi:10.1111/irv.13168
- Naquin A, O’Halloran A, Ujamaa D, et al. Laboratory-confirmed influenza-associated hospitalizations among children and adults-influenza hospitalization surveillance network, United States, 2010-2023. MMWR Surveill Summ. 2024;73(6):1-18. doi:10.15585/mmwr.ss7706a1
- O’Halloran AC, Holstein R, Cummings C, et al. Rates of influenza-associated hospitalization, intensive care unit admission, and in-hospital death by race and ethnicity in the United States from 2009 to 2019. JAMA Netw Open. 2021;4(8):e2121880. doi:10.1001/jamanetworkopen.2021.21880
- Cancella De Abreu M, Ropers J, Oueidat N, et al. Biomarkers of COVID-19 short-term worsening: a multiparameter analysis within the prospective multicenter COVIDeF cohort. European Journal of Emergency Medicine. 2024;31(6):429-437. doi:10.1097/MEJ.0000000000001175
- Ambrosch A, Luber D, Klawonn F, Kabesch M. Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: Risk factors, symptomatology and clinical course compared to influenza A / B and the original SARS-CoV-2 strain. J Clin Virol. 2023;161:105399. doi:10.1016/j.jcv.2023.105399
- Surie D, Yuengling KA, DeCuir J, et al. Severity of respiratory syncytial virus vs COVID-19 and influenza among hospitalized US adults. JAMA Network Open. 2024;7(4):e244954. doi:10.1001/jamanetworkopen.2024.4954
Details
| Primary Language | English |
|---|---|
| Subjects | Intensive Care |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 30, 2025 |
| Submission Date | June 2, 2025 |
| Acceptance Date | June 26, 2025 |
| Published in Issue | Year 2025 Volume: 8 Issue: 2 |
Cite
The articles in the Journal of "Acta Medica Nicomedia" are open access articles licensed under a Creative Commons Attribution-ShareAlike 4.0 International License at the web address https://dergipark.org.tr/tr/pub/actamednicomedia