Determinants of poor clinical outcome in patients with influenza pneumonia: a systematic review and meta-analysis
Abstract
BACKGROUND
The clinical burden of influenza is increasing globally. Aging, immunosuppression, and underlying respiratory illness are determinants of poor clinical outcomes, including greater mortality. Bacterial infections seem to be the main reason. Updated information on the role of bacterial infection as the cause of complications would be of value in improving the prognosis of influenza patients.
METHODS
A systematic review and meta-analysis were performed by using the Pubmed repository using keywords like: Influenza, H1N1, Streptococcus pneumoniae, bacterial coinfection, secondary coinfection, bacterial complications in pneumonia, and seasonal influenza. Only articles written in English were only included on publications from 2010 to 2020. Analyses were conducted following PRISMA guidelines. The results were independently validated using a TrinetX database cohort of roughly 4 million patients.
RESULTS
We included 136 studies that contained data from 48,259 influenza-hospitalized patients of any age. Bacterial infections were diagnosed in 5,391 (11.2%). Streptococcus pneumoniae (30.7%) and Staphylococcus aureus (30.4%) were the most frequent microorganisms, followed by Haemophilus influenzae (7.1%) and Pseudomonas aeruginosa (5.9%). The random effects model of the meta-analysis indicated that bacterial infections posed a 3.4-fold increased risk of death compared to influenza infection alone. Unexpectedly, asthma was protective (odds ratio 0.8).
CONCLUSION
Bacterial…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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