2014-2015年北京市流行性感冒流行季严重急性呼吸道感染病例的临床特征及发生不良结局的危险因素分析

目的 描述北京市2014-2015年流行性感冒(流感)流行季监测到的严重急性呼吸道感染(SARI)病例的人口统计学及临床特征,并对患者出现不良结局的危险因素进行分析。方法 对2014年9月至2015年4月北京市SARI监测哨点医院纳入的SARI病例进行临床信息的收集,并采集SARI病例的呼吸道标本进行流感病毒核酸检测。以临床过程中出现重症监护(intensive care unit, ICU)治疗和死亡作为不良结局。分别以全部SARI病例和流感感染的SARI病例作为对象,分析相应患者出现不良结局的危险因素。结果 10家哨点医院共监测到4230例SARI病例,对其中1480例患者开展了临床资料收集和实验室检测,对1315例患者的数据进行了分析。患者以5岁(33.76%)和 60岁(31.86%)为主。平均住院时间为8 d。实验室确诊的流感病毒感染者为294例,占22.36%。对于全部SARI病例,出现不良结局的危险因素主要为患有心血管疾病、免疫系统疾病、肾病、糖尿病等基础病。与年龄60岁者相比,年龄 60岁的SARI患者出现不良结局的风险更高。对于流感感染的SARI病例,患有免疫系统疾病(OR=6.97, 95%CI:1.12~43.28)和肾脏疾病(OR=8.92,95%CI:1.36~58.43)为其出现不良结局的危险因素。结论 患有慢性基础性疾病和高龄是呼吸道感染的住院患者出现不良结局的主要危险因素。

Clinical characteristics of severe acute respiratory infection and risk factors associated with adverse outcomes in Beijing,2014-2015 influenza season

Objective To understand the clinical characteristics of severe acute respiratory infection(SARI) and the risk factors associated with adverse outcome in SARI cases in Beijing. Methods Epidemiologic and clinical information of the SARI cases were collected from 10 sentinel hospitals in Beijing from September 2014 to April 2015,and respiratory tract specimens were collected from them for influenza virus RNA detection. Receiving ICU treatment and death were considered as adverse outcomes. Logistic regression analysis was conducted to identify the risk factors associated with adverse outcomes of the SARI cases and influenza positive SARI cases respectively. Results A total of 4230 SARI cases were found in the 10 sentinel hospitals, in which 1480 were surveyed. The data of 1315 were analyzed. The cases aged5 years and 60 years accounted for 33.76% and 31.86% of the total respectively. The median length of hospitalization of the SARI cases was 8 days. Influenza was confirmed in about 22.36%(n=294) of the SARI cases. For all the SARI cases, the risk factors associated with adverse outcomes included underlying diseases(cardiovascular disease, immune system diseases, kidney disease, diabetes). Compared with cases aged60 years,the cases aged 60 years had higher risk for adverse outcome. For the influenza cases, immune system diseases(OR=6.97, 95% CI:1.12-43.28) and kidney disease were the risk factors(OR=8.92,95% CI: 1.36-58.43) for adverse outcome. Conclusion Underlying disease and advanced age were the risk factors associated with adverse outcome in inpatients with respiratory infection.