A case-control study on risk factors associated with death in pregnant women with severe pandemic H1N1 infection

Acute Infectious Disease Prevention and Control, Anhui Provincial CDC, Hefei, Anhui, China.
BMJ Open (Impact Factor: 2.27). 07/2012; 2(4). DOI: 10.1136/bmjopen-2012-000827
Source: PubMed


To describe the risk factors associated with death in pregnant women with severe pandemic H1N1 infection.
Case-control study.
Anhui, China.
A total of 46 pregnant women with severe pandemic H1N1 infection were studied during June 2009-April 2011. PRIMARY AND SECONDARY OUTCOME MEASURES: All the cases were confirmed by the clinicians and epidemiologists together based on the positive laboratory result.
Of the seven pregnant women who died of the pandemic H1N1 infection, five (70%) cases were in their third trimester. Twenty-nine (63%) cases from the surviving group were admitted to hospital within 3 days after the onset of symptoms, while only one (2%) case from the death group took the earliest admission 2 days after the onset. There was a significant difference on how soon to be admitted between the death and the surviving groups (OR 0.09, 95% CI 0.01 to 0.68). The median time of administrating corticosteroids was 5 days after the onset in the death group and 3 days in the surviving group showing no significant difference between them (p=0.056).
For the pregnant women with severe p(H1N1) infection, the risk factors associated with death were as follows: the delay of antiviral treatment and being in the third trimester. The corticosteroids therapy appeared to have no effects on preventing the cases from death.

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Available from: Furong Li, Nov 25, 2015
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    ABSTRACT: Background: Most studies have reported that corticosteroid therapy adversely influences influenza-related outcomes. Methods: Electronic databases were searched from inception to March 2013 for experimental and observational studies investigating systemic corticosteroid therapy for presumed influenza-associated complications. Meta-analysis of Observational Studies in Epidemiology guidelines were adopted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects models, and heterogeneity was assessed using the I(2) statistic. Quality of evidence was assessed using the Grading Assessment, Development, and Evaluation system. Results: We identified 16 eligible studies (3039 individuals), all of which were observational; 10 (1497 individuals) were included in the meta-analysis of mortality, of which 9 studied patients with 2009 pandemic influenza A virus subtype H1N1. Risk of bias was greatest in the comparability domain of the Newcastle-Ottawa scale, consistent with potential confounding by indication, and data specific to mortality were of low quality. Meta-analysis found an increased odds of mortality (OR, 2.12; 95% CI, 1.36-3.29) associated with corticosteroid therapy. Subgroup analysis of adjusted estimates from 4 studies with very low statistical heterogeneity found a similar association (OR, 2.58; 95% CI, 1.39-4.79). Conclusions: No completed clinical trials were identified. Evidence from observational studies, with important limitations, suggests that corticosteroid therapy for presumed influenza-associated complications is associated with increased mortality.
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