Details:

Alternative Title:
PLoS One
Publisher's site:
http://dx.doi.org/10.1371/journal.pone.0091630
Personal Author:
Patel, Rita B. ; Mathur, Maya B. ; Gould, Michael ; Uyeki, Timothy M. ; Bhattacharya, Jay ; ... More +
Patel, Rita B. ; Mathur, Maya B. ; Gould, Michael ; Uyeki, Timothy M. ; Bhattacharya, Jay ; Xiao, Yang ; Khazeni, Nayer Less -
Description:
Background

Human infections with highly pathogenic avian influenza (HPAI) A (H5N1) viruses have occurred in 15 countries, with high mortality to date. Determining risk factors for morbidity and mortality from HPAI H5N1 can inform preventive and therapeutic interventions.

Methods

We included all cases of human HPAI H5N1 reported in World Health Organization Global Alert and Response updates and those identified through a systematic search of multiple databases (PubMed, Scopus, and Google Scholar), including articles in all languages. We abstracted predefined clinical and demographic predictors and mortality and used bivariate logistic regression analyses to examine the relationship of each candidate predictor with mortality. We developed and pruned a decision tree using nonparametric Classification and Regression Tree methods to create risk strata for mortality.

Findings

We identified 617 human cases of HPAI H5N1 occurring between December 1997 and April 2013. The median age of subjects was 18 years (interquartile range 6–29 years) and 54% were female. HPAI H5N1 case-fatality proportion was 59%. The final decision tree for mortality included age, country, per capita government health expenditure, and delay from symptom onset to hospitalization, with an area under the receiver operator characteristic (ROC) curve of 0.81 (95% CI: 0.76–0.86).

Interpretation

A model defined by four clinical and demographic predictors successfully estimated the probability of mortality from HPAI H5N1 illness. These parameters highlight the importance of early diagnosis and treatment and may enable early, targeted pharmaceutical therapy and supportive care for symptomatic patients with HPAI H5N1 virus infection.


Subject:
[+]
Adolescent
Adult
Child
Child, Preschool
Demography
Female
Follow-Up Studies
Health Expenditures
Hospitalization
Humans
Infant
Infant, Newborn
Influenza, Human
Influenza A Virus, H5N1 Subtype
International Agencies
Male
Models, Statistical
Prognosis
Risk Factors
ROC Curve
Survival Rate
Young Adult

Source:
PLoS One. 2014; 9(3).
Document Type:
Journal Article
Funding:
1 K08 HS019816/HS/AHRQ HHS/United States ; K08 HS019816/HS/AHRQ HHS/United States
1 K08 HS019816/HS/AHRQ HHS/United States ; K08 HS019816/HS/AHRQ HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:f9a0181364b8479f51488065b5829e87ef94f0bd89dfb8d585b6fb06f5e4852c
File Type:

Supporting Files

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