[The analysis of the clinical features between survivors and non-survivors with the severe form of new influenza A (H1N1) viral infection].

OBJECTIVE: To understand the clinical features of critically ill patients with pandemic 2009 influenza A (H1N1) and investigate the risk factors associated with death cases. METHODS: The clinical features of 55 critically ill patients with pandemic 2009 influenza A (H1N1) viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15, 2009 were retrospectively analyzed, and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. RESULTS: There were 31 males and 24 females. The age ranged from 10 months to 84 year old, and the mean (SD) was 38 (20) year old. The critically ill cases were more in patients under age 65 (48/55), with obesity (33/49), with underlying diseases (26/49), and pregnancy (6/24). Both the survivors and non-survivors of patients had high fever, cough, sputum (some sputum with blood), dyspnea, räles of both lungs fields, and all further developed severe pneumonia. The patients also showed respiratory failure (54/55) and ARDS (26/55). All of them received oseltamivir therapy, and 38 patients received mechanical ventilation and 30 were given steroid therapy. Secondary infection occurred in 27 cases, and ventilator-associated pneumonia happened in 10 patients. In the early stage of onset, C-reactive protein (CRP) increased [(131 ± 130) mg/L] and low counts of T lymphocytes were present [CD(4)(+), CD(8)(+) T was (217 ± 139)/µl and (162 ± 82)/µl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P < 0.05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks (OR was 6.512, 19.631 respectively, both of P value was low than 0.05). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. CONCLUSIONS: Critical illness in pandemic 2009 influenza A (H1N1) was associated with patients under age 65, with obesity, underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.

[The clinical characteristics and staging of severe acute respiratory syndrome].

OBJECTIVE: To investigate the clinical characteristics and to initiate a clinical staging of severe acute respiratory syndrome (SARS). METHODS: Retrospective analysis was conducted in the clinical symptoms, physical signs and the results of laboratory examinations from 1170 cases with SARS in Beijing, and the clinical characteristics in different stages of the disease were compared. RESULTS: The initial symptom of SARS was pyrexia and the temperature was > 38 degrees C. The natural course of fever was about 14 days. In almost all cases, the respiratory symptoms and systemic toxic manifestations were observed. They came to a climax at the second week and then decreased or nearly disappeared after the third week. The physical signs of SARS were not obvious. The moist rales were observed in 43.3% of patients. Hypoxemia was a common characteristic in SARS. The decrease in partial pressure of oxygen in artery and oxygen saturation in pulse oximeter with normal partial pressure of carbon dioxide was found in most patients at the second week. Abnormal chest X-ray including infiltration and consolidation shadows were seen in 100% of patients. The abnormal images could be found at the first day, enlarged during the second week (to a climax at the 8th or 9th day), and then recovered from the 2 week. The amounts of CD(4)(+), CD(8)(+), and CD(3)(+) of peripheral blood were decreased at the early stage and recovered after 2 or 3 weeks. Some patients suffered from temporary multiple organ dysfunctions (mainly impairments of liver and myocardium). CONCLUSION: The main clinical manifestations of SARS included respiratory and systemic toxic symptoms. The typical course of the disease was about 4 weeks. The first week could be considered as early stage, the second week as fastigium stage, and from the next two weeks as recovery stage.