Severity of Influenza A 2009 (H1N1) Pneumonia Is Underestimated by Routine Prediction Rules. Results from a Prospective, Population-Based Study 英文参考文献.docVIP

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Severity of Influenza A 2009 (H1N1) Pneumonia Is Underestimated by Routine Prediction Rules. Results from a Prospective, Population-Based Study 英文参考文献.doc

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Severity of Influenza A 2009 (H1N1) Pneumonia Is Underestimated by Routine Prediction Rules. Results from a Prospective, Population-Based Study 英文参考文献

SeverityofInfluenzaA2009(H1N1)PneumoniaIs UnderestimatedbyRoutinePredictionRules.Results fromaProspective,Population-BasedStudy AgnarBjarnason1,2,GudlaugThorleifsdottir1,3,ArthurLo¨ve1,3,JanusF.Gudnason4,HilmirAsgeirsson2, KristinnL.Hallgrimsson2,BerglindS.Kristjansdottir1,GunnsteinnHaraldsson5,OlafurBaldursson2, KarlG.Kristinsson1,5,MagnusGottfredsson1,2 * 1FacultyofMedicine,UniversityofIceland,Reykjavik,Iceland,2DepartmentofMedicine,LandspitaliUniversityHospital,Reykjavik,Iceland,3DepartmentofVirology, Landspitali University Hospital, Reykjavik, Iceland, 4Department of Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland, 5Department of Clinical Microbiology,LandspitaliUniversityHospital,Reykjavik,Iceland Abstract Background: Characteristics of patients with community-acquired pneumonia (CAP) due to pandemic influenza A 2009 (H1N1)havebeeninadequatelycomparedtoCAPcausedbyotherrespiratorypathogens.Theperformanceofprediction rulesforCAPduringanepidemicwithanewinfectiousagentareunknown. Methods: Prospective, population-based study from November 2008–November 2009, in centers representing 70% of hospital beds in Iceland. Patients admitted with CAP underwent evaluation and etiologic testing, including polymerase chain reaction (PCR) for influenza. Data on influenza-like illness in the community and overall hospital admissions were collected.Clinicalandlaboratorydata,includingpneumoniaseverityindex(PSI)andCURB-65ofpatientswithCAPdueto H1N1werecomparedtothosecausedbyotheragents. Results: Of 338consecutive andeligible patients 313 (93%) wereenrolled. Duringthe pandemic peak,influenza A2009 (H1N1) patients constituted 38% of admissions due to CAP. These patients were younger, more dyspnoeic and more frequently reported hemoptysis. They hadsignificantly lower severity scores thanother patients with CAP(1.23 vs. 1.61, P=.02 for CURB-65, 2.05 vs. 2.87for PSI, P,.001) and weremore likely torequire intensive care admission (41% vs. 5%, P,.001)andreceivemech