Infect Chemother.  2016 Dec;48(4):294-301. 10.3947/ic.2016.48.4.294.

Analysis of Risk Factors for Severe Acute Respiratory Infection and Pneumonia and among Adult Patients with Acute Respiratory Illness during 2011-2014 Influenza Seasons in Korea

Affiliations
  • 1Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
  • 2Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea. wjkim@korea.ac.kr
  • 3Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
  • 5Department of Internal Medicine, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea.
  • 6Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 7Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 8Department of Internal Medicine, Chonnam National University School of Medicine, Kwangju, Korea.
  • 9Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 10Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 11Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
  • 12Transgovernmental Enterprise for Pandemic Influenza in Korea, Seoul, Korea.

Abstract

BACKGROUND
The World Health Organization recommends the surveillance of influenza-like illness (ILI) and severe acute respiratory infection (SARI) to respond effectively to both seasonal influenza epidemics and pandemics. In Korea, the "Hospital-based Influenza Morbidity and Mortality (HIMM)" surveillance system has been operated to monitor ILI and SARI occurrences.
MATERIALS AND METHODS
A multi-center prospective observational study was conducted. Adult patients with acute respiratory infection (ARI) were enrolled during the 2011-12, 2012-2013, and 2013-2014 influenza seasons at the 10 university hospitals using the HIMM surveillance system. With respect to SARI and pneumonia development, risk profiles were analyzed in patients with ARI in Korea.
RESULTS
A total of 5,459 cases were eligible for this analysis. Among 5,459 cases with ARI, 2,887 cases (52.9%) were identified that they had influenza infection. Among enrolled cases, 750 cases belonged to the SARI group, while 4,709 cases belonged to the non-SARI group. With respect to pneumonia development, 317 cases were accompanied by pneumonia, and 5,142 cases were not. Multivariate analyses revealed that the following factors were associated with an increased risk of SARI: Old age (≥65 years) (odds ratio [OR] 2.69, 95% confidence interval [CI] 2.2-3.32), chronic heart disease (CHD) (OR 2.24, 95% CI 1.68-2.98), cerebrovascular disease (CVD) (OR 1.49, 95% CI 1.05-2.10), chronic obstructive pulmonary disease (COPD) (OR 2.34, 95% CI 1.48-3.69), asthma (OR 2.33, 95% CI 1.62-3.36), chronic kidney disease (CKD) (OR 2.62, 95% CI 1.73-3.99), chronic liver disease (OR 1.71, 95% CI 1.04-2.81), and autoimmune diseases (OR 2.53, 1.57-4.08). Multivariate analyses revealed that the following factors were independent risk factors for pneumonia development: Old age (≥65 years) (OR 5.71, 95% CI 4.10-7.94), CHD (OR 1.54, 95% CI 1.07-2.22), COPD (OR 2.34, 95% CI 1.48-3.69), asthma (OR 2.33, 95% CI 1.62-3.36), CKD (OR 2.62, 95% CI 1.73-3.99), immunocompromised conditions (OR 3.12, 95% CI 1.47-6.62), and autoimmune diseases (OR 3.35, 95% CI 1.79-6.27). The risk of SARI and pneumonia was increased by the number of concurrent chronic medical conditions.
CONCLUSION
The risk of SARI and pneumonia development among adult patient with ARI was significantly increased by the presence or number of concurrent chronic medical conditions in Korea.

Keyword

Influenza; Complication; Hospitalization; Pneumonia; Risk factors

MeSH Terms

Adult*
Asthma
Autoimmune Diseases
Cerebrovascular Disorders
Heart Diseases
Hospitalization
Hospitals, University
Humans
Influenza, Human*
Korea*
Liver Diseases
Mortality
Multivariate Analysis
Observational Study
Pandemics
Pneumonia*
Prospective Studies
Pulmonary Disease, Chronic Obstructive
Renal Insufficiency, Chronic
Risk Factors*
Seasons*
World Health Organization

Figure

  • Figure 1 Study flow ILI, influenza-like illness; m-SARI, modified severe acute respiratory infection; flu, influenza; OPD, out-patient department; TIA, transient ischemic attack; SDH, subdural hematoma; AMI, acute myocardial infarction; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; CHD, chronic heart disease.

  • Figure 2 Risk of SARI and pneumonia following acute respiratory illness in adult cases with multiple risk factors (A) The risk ratio of modified SARI increases about 9.5 times as the number of SARI risk factors increases from zero to four. (B) The risk ratio of pneumonia increases about 16 times as the number of pneumonia risk factors increases from zero to four. SARI, severe acute respiratory infection.


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Sang-Ho Choi
Infect Chemother. 2016;48(4):344-346.    doi: 10.3947/ic.2016.48.4.344.

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