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Influenza A infections: predictors of disease severity

  • Bacterial, Fungal and Virus Molecular Biology - Research Paper
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Abstract

Influenza affects approximately 10% of the world’s population annually. It is associated with high morbidity and mortality rates due to its propensity to progress to severe acute respiratory infection, leading to 10–40% of hospitalized patients needing intensive care. Characterizing the multifactorial predictors of poor prognosis is essential for developing strategies against this disease. This study aimed to identify predictors of disease severity in influenza A-infected (IFA-infected) patients and to propose a prognostic score. A retrospective cross-sectional study was conducted with 142 IFA-infected out- and inpatients treated at a tertiary hospital between 2010 and 2018. The viral subtypes, hemagglutinin mutations, viral load, IL-28B SNPs, and clinical risk factors were evaluated according to the patient’s ICU admission. Multivariate analysis identified the following risk factors for disease severity: neuromuscular diseases (OR = 7.02; 95% CI = 1.18–41.75; p = 0.032), cardiovascular diseases (OR = 5.47; 95% CI = 1.96–15.27; p = 0.001), subtype (H1N1) pdm09 infection (OR = 2.29; 95% CI = 1.02–5.15; p = 0.046), and viral load (OR = 1.43; 95% CI = 1.09–1.88; p = 0.009). The prognosis score for ICU admission is based on these predictors of severity presented and ROC curve AUC = 0.812 (p < 0.0001). Our results identified viral and host predictors of disease severity in IFA-infected patients, yielding a prognostic score that had a high performance in predicting the IFA patients’ ICU admission and better results than a viral load value alone. However, its implementation in health services needs to be validated in a broader population.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Funding

This work was supported by the Fundação Araucária. Project number: 059/2017.

Author information

Author notes

  1. L. A. Pereira and B. A. Lapinscki contributed equally to the manuscript.

Authors and Affiliations

  1. Graduate Program in Internal Medicine and Health Science, Federal University of Paraná, Curitiba, 82060-240, Brazil

    L. A. Pereira & B. A. Lapinscki

  2. Public Health Laboratory (LACEN-PR), Curitiba, Brazil

    J. S. Santos & M. C. Debur

  3. Medical School, Sector of Health Sciences, Federal University of Paraná, Curitiba, 82060-240, Brazil

    R. R. Petterle

  4. Clinical Analysis Department, Federal University of Parana, Curitiba, 82060-240, Brazil

    M. B. Nogueira

  5. Virology Laboratory, Federal University of Paraná, Curitiba, 82060-240, Brazil

    L. R. R. Vidal

  6. Virology Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, 82060-240, Brazil

    L. R. R. Vidal & S. M. Raboni

  7. Department of Medical Pathology, Federal University of Paraná, Curitiba, 82060-240, Brazil

    S. M. De Almeida

  8. Division of Infectious Diseases, Federal University of Paraná, Curitiba, 82060-240, Brazil

    S. M. Raboni

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  1. L. A. Pereira
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Contributions

Pereira LA: data collection, data analysis and interpretation, drafting the article, final approval. Lapinscki BA: data analysis and interpretation, drafting the article, critical revision, final approval. Santos JS: critical revision and final approval. Debur MC: critical revision, final approval. Petterle RR: data analysis. Nogueira MB: critical revision, final approval. Vidal LRR: data analysis and interpretation, critical revision, final approval. De Almeida SM: critical revision, final approval. Raboni SM: conception, data analysis and interpretation, drafting the article, critical revision, final approval, funding acquisition. All authors approved the final manuscript.

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Correspondence to S. M. Raboni.

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Pereira, L.A., Lapinscki, B.A., Santos, J.S. et al. Influenza A infections: predictors of disease severity. Braz J Microbiol 55, 75–86 (2024). https://doi.org/10.1007/s42770-023-01186-w

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