Impacts of Age and Gender at the Risk of Underlying Medical Conditions and Death in Patients with Avian Influenza A (H7N9): a Meta-analysis Study

Overview

Journal Ther Clin Risk Manag

Publisher Dove Medical Press

Date 2018 Sep 21

PMID 30233197

Authors

Qinglin Cheng

Gang Zhao

Li Xie

Xuchu Wang

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of our study was to conduct a series of analyses that examined the impacts of age and gender at the risk of underlying medical conditions (UMCs) and death in patients with influenza A (H7N9).

Methods: We began by searching for potentially relevant articles in English or Chinese before February 28, 2018. Additionally, we reviewed our own files and reference lists of articles identified by this search.

Results: The association between death and UMCs was significant in H7N9 patients, with an OR of 1.49 (95% CI: 1.24-1.78). Subgroup analyses showed that having two or more UMCs of any type (OR: 2.24; =0.044), chronic respiratory diseases (OR: 1.81; =0.032), and chronic cardiovascular disease (OR: 1.63; =0.013) had an association with increased fatality in H7N9 patients. Age (60 years or older) [adjusted OR (AOR): 1.86; =0.032] and gender (male: AOR: 1.68, =0.006; female: AOR: 1.88, =0.044) were significantly associated with death in H7N9 patients with UMCs compared to H7N9 patients without any UMC. Stratification analyses found statistically significant increased death in H7N9 patients with UMCs who were 60 years of age and older (AOR: 2.72; <0.001) and gender (male; AOR=1.64; =0.033), compared to H7N9 patients without these respective conditions.

Conclusion: Impacts of age are substantial and significant at the risk of UMCs and death in H7N9 patients. This analysis did not find a significant difference in gender comparisons. Efforts should particularly focus on reducing fatality rates in patients with combined risks from UMCs and other significant impact factor such as age (60 years or older).

References

Bermejo-Martin J, Almansa R, Ortiz de Lejarazu R . Weakened immunity in aged hosts with comorbidities as a risk factor for the emergence of influenza A H7N9 mutants. J Infect Dev Ctries. 2013; 7(6):497-8. DOI: 10.3855/jidc.3810. View

Feng F, Jiang Y, Yuan M, Shen J, Yin H, Geng D . Association of radiologic findings with mortality in patients with avian influenza H7N9 pneumonia. PLoS One. 2014; 9(4):e93885. PMC: 3976364. DOI: 10.1371/journal.pone.0093885. View

Wu Z, Zhang Y, Zhao N, Yu Z, Pan H, Chan T . Comparative Epidemiology of Human Fatal Infections with Novel, High (H5N6 and H5N1) and Low (H7N9 and H9N2) Pathogenicity Avian Influenza A Viruses. Int J Environ Res Public Health. 2017; 14(3). PMC: 5369099. DOI: 10.3390/ijerph14030263. View

Arima Y, Vong S . Human infections with avian influenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution. Western Pac Surveill Response J. 2013; 4(2):1-3. PMC: 3762971. DOI: 10.5365/WPSAR.2013.4.2.005. View

Guan Y, Farooqui A, Zhu H, Dong W, Wang J, Kelvin D . H7N9 Incident, immune status, the elderly and a warning of an influenza pandemic. J Infect Dev Ctries. 2013; 7(4):302-7. DOI: 10.3855/jidc.3675. View

Ma W, Huang H, Chen J, Xu K, Dai Q, Yu H . Predictors for fatal human infections with avian H7N9 influenza, evidence from four epidemic waves in Jiangsu Province, Eastern China, 2013-2016. Influenza Other Respir Viruses. 2017; 11(5):418-424. PMC: 5596522. DOI: 10.1111/irv.12461. View

Cheng Q, Ding H, Sun Z, Kao Q, Yang X, Huang R . Retrospective study of risk factors for mortality in human avian influenza A(H7N9) cases in Zhejiang Province, China, March 2013 to June 2014. Int J Infect Dis. 2015; 39:95-101. DOI: 10.1016/j.ijid.2015.09.008. View

Virlogeux V, Yang J, Fang V, Feng L, Tsang T, Jiang H . Association between the Severity of Influenza A(H7N9) Virus Infections and Length of the Incubation Period. PLoS One. 2016; 11(2):e0148506. PMC: 4757028. DOI: 10.1371/journal.pone.0148506. View

Cho H, Kim H, Na D, Kim S, Jo D, Lee D . Meta-analysis method for discovering reliable biomarkers by integrating statistical and biological approaches: An application to liver toxicity. Biochem Biophys Res Commun. 2016; 471(2):274-81. DOI: 10.1016/j.bbrc.2016.01.082. View

10.

Gao H, Lu H, Cao B, Du B, Shang H, Gan J . Clinical findings in 111 cases of influenza A (H7N9) virus infection. N Engl J Med. 2013; 368(24):2277-85. DOI: 10.1056/NEJMoa1305584. View

11.

Qiu C, Fratiglioni L . A major role for cardiovascular burden in age-related cognitive decline. Nat Rev Cardiol. 2015; 12(5):267-77. DOI: 10.1038/nrcardio.2014.223. View

12.

Dudley J, Mackay I . Age-specific and sex-specific morbidity and mortality from avian influenza A(H7N9). J Clin Virol. 2013; 58(3):568-70. PMC: 7108379. DOI: 10.1016/j.jcv.2013.09.004. View

13.

Ji H, Gu Q, Chen L, Xu K, Ling X, Bao C . Epidemiological and clinical characteristics and risk factors for death of patients with avian influenza A H7N9 virus infection from Jiangsu Province, Eastern China. PLoS One. 2014; 9(3):e89581. PMC: 3942409. DOI: 10.1371/journal.pone.0089581. View

14.

Chen Y, Li X, Tian L, Zheng S, Yang S, Dong Y . Dynamic behavior of lymphocyte subgroups correlates with clinical outcomes in human H7N9 infection. J Infect. 2014; 69(4):358-65. DOI: 10.1016/j.jinf.2014.05.006. View

15.

Simonsen L, Taylor R, Young-Xu Y, Haber M, May L, Klugman K . Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States. mBio. 2011; 2(1):e00309-10. PMC: 3025524. DOI: 10.1128/mBio.00309-10. View

16.

Hennessy T, Bruden D, Castrodale L, Komatsu K, Erhart L, Thompson D . A case-control study of risk factors for death from 2009 pandemic influenza A(H1N1): is American Indian racial status an independent risk factor?. Epidemiol Infect. 2015; 144(2):315-24. PMC: 5222627. DOI: 10.1017/S0950268815001211. View

17.

Wu P, Peng Z, Fang V, Feng L, Tsang T, Jiang H . Human Infection with Influenza A(H7N9) Virus during 3 Major Epidemic Waves, China, 2013-2015. Emerg Infect Dis. 2016; 22(6):964-72. PMC: 4880089. DOI: 10.3201/eid2206.151752. View

18.

Ribeiro A, Pellini A, Kitagawa B, Marques D, Madalosso G, de Cassia Nogueira Figueira G . Risk factors for death from Influenza A(H1N1)pdm09, State of São Paulo, Brazil, 2009. PLoS One. 2015; 10(3):e0118772. PMC: 4361171. DOI: 10.1371/journal.pone.0118772. View

19.

Liu X, Zhang Y, Xu X, Du W, Su K, Zhu C . Evaluation of plasma exchange and continuous veno-venous hemofiltration for the treatment of severe avian influenza A (H7N9): a cohort study. Ther Apher Dial. 2014; 19(2):178-84. DOI: 10.1111/1744-9987.12240. View

20.

Chai C, Chen E, Chen Z, Gong Z, Lu H, Cai J . [Clinical and epidemiological characteristics of the 6 confirmed human cases with novel influenza A (H7N9) virus infection in Zhejiang]. Zhonghua Liu Xing Bing Xue Za Zhi. 2013; 34(5):443-5. View