Analysis Of The Clinical Features And Risk Factors For Death Of 51 Patients With H7N9 Avian Influenza In Hunan Province

Objective: The epidemiological characteristics,clinical data and risk factors for death of 51 patients with H7N9 avian influenza in Hunan province from April 2013 to May 2017 were analyzed for the purpose of having new ideas of prognosis evaluation and the diagnosis,treatment of this disease.Methods: The epidemiological characteristics of 51 patients with H7N9 avian influenza in Hunan province from April 2013 to May 2017 were analyzed by describing the distributions of time,region and population,contact history of poultry and underlying disease.The clinical features of the disease were summarized by retrospectively analysing clinical manifestation,laboratory examination,imaging data and treatment of 51 patients with H7N9 avian influenza on admission.Single factor analysis and multifactor analysis were used to explain the risk factors for death of patients with H7N9 avian influenza.Results: 1.Fourteen patients died,in which 51(1)patients were infected with H7N9 avian influenza in Hunan province from April 2013 to May 2017.The mortality was 27.45%.The disease was epidemic in March to May and December to February of next year,with the typical characteristics of the high incidence of the epidemic in spring and winter.(2)Global autocorrelation analysis at the level of the city level showed that Moran's I value was 0.089(P>0.05).The cases were mainly male.(3)The average age of cases was(59.84±14.95)years.Farmers accounted for 68.63%.The patients with a history of poultry contact before the(4)onset of the disease accounted for 70.59%.(5)The patients with underlying diseases accounted for 60.78%.2.(1)The main clinical manifestations were fever(98.04%),cough(96.08%),expectoration(74.51%),dyspnea(54.90%),lassitude(70.59%),weak(78.43%)and anorexia(74.51%).Some of them also had systemic symptoms like chills(29.41%),hemoptysis(29.41%),pharyngalgia(23.53%),headache(11.76%),muscular soreness(27.45%),giddiness(11.76%),dizziness(7.84%),chest tightness(19.61%),diarrhea(7.84%),nausea(9.80%),vomiting(7.84%)and so on.The main clinical signs were rale shortness of breath,respiratory sound,heart rate faster,lip cyanosis,low respiratory sound,pharynx congestion,tonsillar enlargement,double lower limb edema;(2)Laboratory examination: The H7N9 case group showed that lymphocyte decreased;Procalcitonin and C-reactive protein increased;D-dimer increased.Activated partial prothrombin time extended.Alanine aminotransferase and aspartate aminotransferase increased;Urea nitrogen increased;Creatine kinase,creatine kinase MB isoenzyme and lactate dehydrogenase increased;The arterial partial pressure of oxygen and carbon dioxide decreased.(3)Imaging data: Computerized tomographic scanning showed ground glass opacity(78.43%),consolidation(100.00%),air bronchogram(88.24%),crazy-paving pattern(9.80%),interlobular septal thickening(79.61%),nodule(68.63%)and pleural effusion(47.06%).The distribution of the lesions was mainly under the distribution of the pleural and central type.The lesion mainly occurred in the double lower lung.The image was progressing rapidly in the early stage of the disease.After treatment,the lesions were gradually absorbed and some of fibrous cord was retained in the survival group.The lesions were progressing in the death group and some images showed improvement but the patients died eventually.(4)Treatment: The time from onset to medical treatment was(5.24±2.88)days in 51 patients with the H7N9 avian influenza patients.The time from onset to diagnose was(7.82±3.39)days.Fifty-one patients were treated with antiviral therapy.The time from the onset of symptoms to antiviral therapy was(6.65±2.64)days.The time of antiviral therapy was(9.71±5.15)days.Thirty-four patients were treated with glucocorticoid.The time from the onset of symptoms to glucocorticoid therapy was(7.09±3.37)days.The time with glucocorticoid therapy was(9.71±5.15)days.Fifty patients were treated with antibiotics.Fifty patients were treated with antibiotics.The time from the onset of symptoms to treated with antibiotics was(5.26±2.90)days.The day of antibiotic therapy was(12.22±8.41)days.Fifty patients were treated with oxygen therapy.Thirteen patients were treated with noninvasive ventilator assisted ventilation.Twenty-three patients received nasal or Oro tracheal intubation.Twelve patients were treated with tracheotomy assisted ventilation.Two patients were treated with ECMO support therapy.3.Results of single(1)factor analysis showed that age,diabetes,dyspnea,cyanosis,prothrombin time,fibrinogen,pH,pleural effusion showed in image,antiviral treatment course and assisted ventilation with nasal or oral trachea cannula were associated with the death of the disease.M(2)ultifactor COX regression analysis showed that dyspnea was the risk factors for death of patients with H7N9 avian influenza.Patients with dyspnea were 25.262 times more likely to die than the patients with no dyspnea.Conclusions: 1.H7N9 avian influenza is epidemic in winter and spring.The cases are distributed randomly.Middle aged and elderly patients,men,farmers,smokers,patients with a history of poultry contact and patients with underlying diseases may be the main susceptible population.2.The clinical,laboratory and imaging data of patients infected with H7N9 avian influenza had certain characteristics in the early stage,but lack specificity,which can assist diagnosticate H7N9 avian influenza.3.Dyspnea is an independent risk factor for death in patients with H7N9 avian influenza.