Clinical experience with severe 2009 H1N1 influenza in the intensive care unit at King Saud Medical City, Saudi Arabia

SummaryPurposeThe objective of this study was to describe the epidemiological characteristics, clinical features, treatment, and outcome of 2009 H1N1-infected patients who were admitted to the intensive care unit (ICU) at King Saud Medical City (KSMC) in Riyadh, Kingdom of Saudi Arabia.MethodsRetrospectively, we collected demographic data as well as data on the clinical presentation and risk factors for 86 patients who were admitted to the ICU with H1N1 influenza A. The APACHE IV System was used to assess the severity of the illness. The overall hospital mortality was calculated and correlated with the use of steroids and the time of oseltamivir administration.ResultsThe mean age of the patients was 40.8 years. Mortality increased steadily with increasing APACHE IV score. Patients who received steroids had a mortality rate of 47% compared with 23% for patients who were not treated with steroids; this difference was significant, with a P value of <0.01.The late administration of oseltamivir was associated with a mortality rate of 82% compared with 28% in the context of early oseltamivir administration; this difference was significant, with a P value of <0.01.ConclusionsPatients who were admitted to the ICU with severe 2009 H1N1 infection were young and had a relatively high severity-of-illness score. The late administration of oseltamivir was associated with a 12-fold increase in mortality. Steroid use was associated with a 3-fold increase in mortality.

► We collected data about patients who were admitted to KSMC ICU with 2009 H1N1 influenza A.
► The mortality rate increased steadily with increasing severity of illness.
► The overall hospital mortality was 35%.
► The late administration of oseltamivir was associated with a 12-fold increase in mortality.
► Steroid use was associated with a 3-fold increase in mortality.