Clinical risk scores as predictors of severe outcome in hospitalized
influenza patients: an observational cohort study from Norway 2014-2018
Abstract
Background Seasonal influenza causes substantial numbers of
hospitalizations annually, and there is a need to identify prognostic
markers of clinical outcomes in hospitalized influenza patients. Methods
Patients hospitalized with influenza were included during four influenza
seasons (2014-2018). On admission, patients were assessed by the CRB65,
CRB, SIRS and qSOFA risk scores. “Severe outcome” was defined as
treatment in intensive care unit and/or all of the following three
clinical parameters: pneumonia, O2 supplementation and hospital stay ≥
5days. Regression analyses were used to study effects of scores,
influenza (sub)types and age on outcomes and treatment. Results A total
of 156 patients with median age of 70 years were included. Patients with
influenza A(H3N2) were older than those with B and A(H1N1). Older age
was associated with fewer symptoms. Severe outcome was observed in 22%
of the cases. High CRB, CRB65, SIRS and qSOFA scores at admission was
observed in 60%, 46%, 40% and 29% of patients with severe outcome,
respectively. Influenza (sub)types were not associated with severe
outcome. Antiviral treatment was given to 37% of the patients, while
78% received antibiotics. The use of antiviral treatment increased
during the study period. Patients with influenza B received less
antiviral treatment. Conclusion This is the first study describing adult
patients hospitalized with seasonal influenza in Norway. Risk scores,
and particularly CRB, may be useful to predict severe outcome in
influenza disease. More patients might have profited from antiviral
therapy; including patients with influenza B infection.