Clinical analysis of early predictors of patients with 2009 H1N1 pneumonia / 中华急诊医学杂志

ABSTRACT

Objective To explore the early predictors of patients with 2009 H1N1 pneumonia by analyzing the clinical features.Methods The 2009 H1 N1 pneumonia patients,admitted to our emergency intensive care unit (EICU) from October 2009 to January 2010,were retrospectively analyzed. The 86patients were divided into died and survival groups. The chi-square test and T test were used to examine the difference between groups.Results Of the 86 patients we studied,15 ( 17.4％ ) cases died and 12 cases received mechanical ventilation. All patients underwent chest radiography on admission and the findings were consistent with pneumonia in all cases.The median duration of symptoms before admission was 3.2 days.The first laboratory test results indicated the average total number of white blood cell (WBC) was (6358 ±483) /mm3.Of the 86 patients,47 (54.7％ ) showed a reduction in WBC.Of the 71 patients who survived,35 (49.3％) had leucopenia and12 (80％) in died group (x2 =4.71,P ＜ 0.05).In survival group,39 (54.9％) had lymphopenia and 13 (86.7％) in died group (x2 =5.22,P ＜0.05).Of 72 patients had T-lymphocyte subsets results,CD4 + T cell counts on average was (424.8 ±231.6 ) /mm3 in57 survival cases and (242.5 ±99.1) /mm3 in 15 died cases (t=2.14,P ＜ 0.05).On admission,serum creatine kinase (CK) in died group was (794.5 ± 85.1 ) U/L,higher than (632.3 ±47.9) U/L in survival group (t =2.25,P ＜ 0.05).Elevated CK was found in 14 (93.3％)of 15 died cases and 50 (70.4％) in survival group (x2 =5.87,P ＜ 0.05). Serum lactate dehydrogenase (LDH) in died group was (1028.6 ± 97.3) U/L,higher than (832.3 ± 56.1 ) U/L in survival group (t =2.31,P ＜ 0.05). According to the criterion of body mass index (BMI) ≥25 kg/m2,33 (38.4％) cases were obesity,in which 13 (86.7％ ) in died group and 20 (28.2％) in survival group ( x2 =17.92,P ＜ 0.01 ),The mortality was increasing along with the BMI was increasing ( r =0.37,P =0.048). Conclusions SOFA,MEDS,CURB-65 score used in emergency room as the risk stratification methods can not effectively predict the 2009 H1N1 pneumonia patients. Peripheral blood lymphocyte counts,serum creatine kinase and lactate dehydrogenase,body mass index in the early course may be factors associated with outcomes of 2009 H1N1 pneumonia patients.