V1. Studies of the epidemiology of viral infections
Oral Abstract Submission
Joshua Doyle, MD, PhD
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Decatur, GA
Disclosure: Nothing to disclose
Lauren Beacham, MA
Statistician
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Rachel Herlihy, MD. MPH
State Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: Nothing to disclose
Kim Yousey-Hindes, MPH, CPH
Epidemiologist 3
Connecticut Emerging Infections Program
New Haven, Connecticut
Disclosure: Nothing to disclose
Evan J. Anderson, MD
Infectious Diseases Physician
Emory University, Atlanta VA Medical Center
Atlanta, Georgia
Disclosure: AbbVie: Consultant
MedImmune: Scientific Research Study Investigator
Merck: Scientific Research Study Investigator
Micron Biomedical: Scientific Research Study Investigator
Novavax: Grant/Research Support
PaxVax: Scientific Research Study Investigator
Pfizer: Grant/Research Support, Advisor or Review Panel member
Regeneron: Scientific Research Study Investigator
Sanofi Pasteur: Scientific Research Study Investigator
Maya Monroe, MPH
Epidemiologist
Maryland Department of Health and Mental Hygiene
Baltimore, Maryland
Disclosure: Nothing to disclose
Sue Kim, MPH
Epidemiologist
Michigan Department of Health and Human Services
Lansing, Michigan
Disclosure: Nothing to disclose
Ruth Lynfield, MD
State Epidemiologist
Minnesota Department of Health
St. Paul, Minnesota
Disclosure: Nothing to disclose
Lourdes Irizarry, MD
Infectious Diseases Physician
New Mexico Department of Health
Santa Fe, NM
Disclosure: Nothing to disclose
Nancy Spina, MPH
Epidemiologist
New York State Department of Health
Albany, NY
Disclosure: Nothing to disclose
Nancy M. Bennett, MD
Professor of Medicine and Public Health Sciences
University of Rochester School of Medicine and Dentistry
Rochester, NY
Disclosure: Nothing to disclose
Mary Hill, MPH
Epidemiology Supervisor
Salt Lake County Health Department
Salt Lake City, UT
Disclosure: Nothing to disclose
William Schaffner, MD
Director of Preventive Medicine
Vanderbilt University Medical Center
Nashville, Tennessee
Disclosure: Nothing to disclose
Keipp Talbot, MD, MPH
Infectious Diseases Physician
Vanderbilt University Medical Center
Nashville, TN
Disclosure: Sanofi Pasteur: Grant/Research Support
Sequirus: Advisor or Review Panel member
Wesley Self, MD, MPH
Associate Professor of Emergency Medicine
Vanderbilt University Medical Center
Nashville, TN
Disclosure: Nothing to disclose
Derek Williams, MD, MPH
Associate Professor of Pediatrics
Vanderbilt University Medical Center
Nashville, TN
Disclosure: Nothing to disclose
Background : Influenza can lead to severe outcomes among adults hospitalized with influenza, and causes substantial annual morbidity and mortality. We evaluated the performance of validated pneumonia severity indices in predicting severe influenza-associated outcomes.
Methods : We conducted a multicenter study within CDC’s Influenza Hospitalization Surveillance Network (FluSurv-NET) which included adults (≥ 18 years) hospitalized with laboratory-confirmed influenza during the 2017–18 influenza season. Medical charts were abstracted to obtain data on vital signs and laboratory values at admission on a stratified random sample of cases at a subset of hospitals at 11 network sites. Estimates were weighted to reflect the probability of selection. Cases were assigned to low- and high-risk groups based on the CURB-65 (‘Confusion, Urea, Respiratory rate, Blood pressure, Age ≥65’) index (high-risk cutoff = score ≥ 3), and the Pneumonia Severity Index (PSI) (high-risk cutoff = category V). We calculated area under receiver operating characteristic curves (AUROC), sensitivity, and specificity to estimate the performance of each index in predicting severe outcome categories: 1) intensive care unit (ICU) admission, 2) non-invasive mechanical ventilation (NIMV), 3) mechanical ventilation (MV), vasopressors, extracorporeal membrane oxygenation (ECMO) and 4) death.
Results : Among 27,523 adults hospitalized with influenza, 8665 (31%) were sampled for inclusion in this analysis; median age was 70 years and 92% had ≥ 1 chronic condition. A total of 1,366 (16%) were classified as high-risk by CURB-65 and 1,249 (14%) by PSI. Both indices had low discrimination for severe outcomes; the AUROC for CURB-65 ranged from 0.55 for ICU admission to 0.65 for death, and for PSI ranged from 0.58 for ICU admission to 0.73 for death. Risk status by CURB-65 was less sensitive than PSI in predicting MV, vasopressor, or ECMO usage as well as death (Figure). The specificity of CURB-65 and PSI was similar against all outcomes (Figure).
Conclusion : The CURB-65 and PSI indices performed poorly in predicting severe outcomes other than death; PSI had the best discrimination overall. Alternative approaches are needed to predict severe influenza-related outcomes and optimize clinical care.
