Risk factors for hospital-acquired influenza A and patient characteristics: a matched case-control study
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RESEARCH ARTICLE
Open Access
Risk factors for hospital-acquired influenza A and patient characteristics: a matched case-control study Kui Yang1†, Ni Zhang2†, Chunchen Gao3, Hongyan Qin3, Anhui Wang4 and Liqiang Song1*
Abstract Background: While hospital-acquired influenza A results in an additional cost burden and considerable mortality in patients, its risk factors are unknown. We aimed to describe the characteristics of patients vulnerable to hospitalacquired influenza A and to identify its risk factors to assist clinicians control hospital-acquired infections and reduce the burden of treatment. Methods: A case-control study was conducted among hospitalized patients aged ≥18 years at a tertiary level teaching hospital during the 2018–2019 influenza A season. Patient data were retrieved from hospital-based electronic medical records. Hospital-acquired influenza A was defined as a case of influenza A diagnosed 7 days or more after admission, in a patient with no evidence of influenza A infection on admission. The controls without influenza A were selected among patients exposed to the same setting and time period. We identified risk factors using conditional logistic regression and described the characteristics of hospital-acquired influenza A by comparing the clinical data of infected patients and the controls. Results: Of the 412 hospitalized patients with influenza A from all the departments in the study hospital, 93 (22.6%) cases were classified as hospital-acquired. The most common comorbidities of the 93 cases were hypertension (41.9%), coronary heart disease (21.5%), and cerebrovascular disease (20.4%). Before the onset of hospital-acquired influenza A, patients presented more lymphocytopenia (51.6% vs 35.5%, P = 0.027), hypoalbuminemia (78.5% vs 57.0%, P = 0.002), and pleural effusion (26.9% vs 9.7%, P = 0.002) than the matched controls. Infected patients also had longer hospital stays (18 days vs 14 days, P = 0.002), and higher mortality rates (10.8% vs 2.2%, P = 0.017) than the matched controls. Lymphocytopenia (odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.24–7.80; P = 0.016), hypoalbuminemia (OR: 2.24; 95% CI: 1.10–4.57; P = 0.027), and pleural effusion (OR: 3.09; 95% CI: 1.26–7.58; P = 0.014) were independently associated with hospital-acquired influenza A. Conclusions: Lymphocytopenia, hypoalbuminemia and pleural effusion are independent risk factors that can help identify patients at high risk of hospital-acquired influenza A, which can extend hospital stay and is associated with a high mortality. Keywords: Influenza, human, Nosocomial infection, Hospital-acquired influenza a, Risk factors
* Correspondence: [email protected] † Kui Yang and Ni Zhang contributed equally to this work. 1 Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No.127, Changle West Road, Xincheng District, Xi’an 710032, Shaanxi Province, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article i
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