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. 2024 Jul 6;14(1):15563.
doi: 10.1038/s41598-024-66550-8.

Age, comorbidity burden and late presentation are significant predictors of hospitalization length and acute respiratory failure in patients with influenza

Victor Daniel Miron  1   2 , Oana Săndulescu  3   4 , Anca Streinu-Cercel  1   2 , Dragoș Florea  1   2 , Simona Paraschiv  1   2 , Leontina Bănică  2 , Ovidiu Vlaicu  2 , Dan Oțelea  2 , Anuța Bilașco  1   2 , Daniela Pițigoi  1   2 , Adrian Streinu-Cercel #  1   2 , Anca Cristina Drăgănescu #  1   2
Affiliations

Age, comorbidity burden and late presentation are significant predictors of hospitalization length and acute respiratory failure in patients with influenza

Victor Daniel Miron et al. Sci Rep. .

Abstract

Influenza viruses are responsible for a high number of infections and hospitalizations every year. In this study, we aimed to identify clinical and host-specific factors that influence the duration of hospitalization and the progression to acute respiratory failure (ARF) in influenza. We performed an analysis of data from a prospective active influenza surveillance study that was conducted over five seasons (2018/19 to 2022/23). A total of 1402 patients with influenza were included in the analysis, the majority of which (64.5%) were children (under 18 years), and 9.1% were elderly. At least one chronic condition was present in 29.2% of patients, and 9.9% of patients developed ARF. The median hospital stay was 4 days (IQR: 3, 6 days). The most important predictors of prolonged hospital stay and development of ARF were extremes of age (infants and elderly), presence of chronic diseases, particularly the cumulus of at least 3 chronic diseases, and late presentation to hospital. Among the chronic diseases, chronic obstructive pulmonary disease, cardiovascular disease, cancer, diabetes, obesity, and chronic kidney disease were strongly associated with a longer duration of hospitalization and occurrence of ARF. In this context, interventions aimed at chronic disease management, promoting influenza vaccination, and improving awareness and access to health services may contribute to reducing the impact of influenza not only in Romania but globally. In addition, continued monitoring of the circulation of influenza viruses is essential to limit their spread among vulnerable populations.

Keywords: Acute respiratory failure; Adults; Children; Elderly; Hospitalization; Influenza.

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Conflict of interest statement

All authors declare that they were members of the research team of the GIHSN project co-funded by Foundation for Influenza Epidemiology, and members of the research team of the DRIVE study, that has received support from the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking (DRIVE, Grant No. 777363), within the scope of the submitted work.

Figures

Figure 1
Figure 1
Study chart with distribution of cases by seasons.
Figure 2
Figure 2
Distribution of the median length of hospitalization by age group. Infants: 0–11 months; toddlers: 1–2 years; preschoolers: 3–4 years; schoolers: 5–13 years; teenagers: 14–17 years; adults: 18–64 years; elderly: 65 years and over.
Figure 3
Figure 3
Probability of predicting progression to acute respiratory failure based on symptoms at hospital admission.
Figure 4
Figure 4
Probability of predicting progression to acute respiratory failure based on chronic conditions. COPD—chronic obstructive pulmonary disease.
Figure 5
Figure 5
Probability of predicting progression to acute respiratory failure according to type of influenza virus and co-infections. RSV—respiratory syncytial virus; SARS-CoV-2—severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

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