Clinical characteristics and analysis of prognostic factors of influenza in pregnant women in Beijing

doi:10.3877/cma.j.issn.1674-1358.2021.06.001

Abstract

Abstract:

Objective

To investigate the demographic characteristics, etiological characteristics and clinical prognosis of pregnant women with severe influenza, and to explore the influencing factors associated with clinical severity.

Methods

The epidemiological and clinical information of pregnant women with influenza who were confirmed by laboratory tests in Beijing Ditan Hospital, Capital Medical University from August 2013 to May 2020 were analyzed, retrospectively. Descriptive statistics were performed on general condition, epidemiology, clinical manifestations and signs of the patients, and clinical outcomes were observed: critical illness, hospitalized duration and fetal prognosis. According to the progress after hospitalization, patients were divided into severe group (72 cases) and critical group (7 cases).

Results

Total of 79 pregnant women were diagnosed with severe influenza. The age of 79 cases ranged from 20 to 40 years old, with a median age of 31 years old. None of the patients was vaccinated. Influenza virus infection occurred in all trimesters, but the majority of hospitalized patients were in the third trimester (64/79, 82.29%). Pregnancy stage (P = 0.023), auscultation with dry and wet pulmonary rale on admission (P = 0.019) of pregnant women in severe and critically ill groups were significantly different (Fisher’s exact test). Older age (Z =-3.096, P = 0.002) and critical illness (Z =-2.64, P = 0.008) were both influencing factors for the hospitalized duration of pregnant women with influenza. Total of 45 cases remained pregnant, 7 cases miscarried, 6 babies delivered preterm, and 21 babies delivered to term. Univariable Logistic regression analysis showed that the risk of dry/wet rales of cases with critically illness increased compared with that of severe cases (OR = 7.69, 95%CI: 1.19-49.85, P = 0.019).

Conclusions

Among the hospitalized maternal patients with influenza infection, the third trimester is the most common. For pregnant women with influenza, early hospitalization yields good results. The adverse effects of influenza for pregnant women during the first and second trimesters on fetuses and newborns are more obvious.

Key words: Influenza, Pregnant women, Risk factors, Treatment, Prognosis

Xue Zhao, Fang Qian, Meihua Song, Bing Han, Meiling Chen, Beibei Wang, Rui Song. Clinical characteristics and analysis of prognostic factors of influenza in pregnant women in Beijing[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(06): 361-367.

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References 25

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		危重症组（7例）	重症组（72例）	χ²值	P值
年龄				0.459	0.863^a
	高龄（> 35岁）	4（5.06）	11（13.92）
	非高龄（≤ 35岁）	3（3.80）	61（77.22）
孕期				25.233	< 0.001^c
	早期妊娠	0（0.00）	6（8.33）
	中期妊娠	3（42.86）	5（6.94）
	晚期妊娠	3（42.86）	61（86.11）
	产褥期	1（14.29）	0（0.00）
基础疾病		4（57.14）	19（26.39）	—	0.171^b
	慢性呼吸系统疾病	1（14.29）	2（2.78）
	心血管疾病	1（14.29）	2（2.78）
	肝脏疾病	1（14.29）	1（1.39）
	内分泌疾病	1（14.29）	14（19.44）
病原学				2.068	0.630^a
	乙型病毒	2（28.57）	10（13.89）
	甲型病毒	5（71.43）	62（86.11）

		危重症组（7例）	重症组（72例）	χ²值	P值
年龄				0.459	0.863^a
	高龄（> 35岁）	4（5.06）	11（13.92）
	非高龄（≤ 35岁）	3（3.80）	61（77.22）
孕期				25.233	< 0.001^c
	早期妊娠	0（0.00）	6（8.33）
	中期妊娠	3（42.86）	5（6.94）
	晚期妊娠	3（42.86）	61（86.11）
	产褥期	1（14.29）	0（0.00）
基础疾病		4（57.14）	19（26.39）	—	0.171^b
	慢性呼吸系统疾病	1（14.29）	2（2.78）
	心血管疾病	1（14.29）	2（2.78）
	肝脏疾病	1（14.29）	1（1.39）
	内分泌疾病	1（14.29）	14（19.44）
病原学				2.068	0.630^a
	乙型病毒	2（28.57）	10（13.89）
	甲型病毒	5（71.43）	62（86.11）

		危重症组（7例）	重症组（72例）	χ²值	P值
入院病程> 5 d				5.365	0.081^a
	是	4（57.14）	8（11.11）
	否	3（42.86）	64（88.89）
临床表现与体征
	卡他症状	7（100.00）	48（66.67）	3.352	0.070^a
	发热	7（100.00）	72（100.00）	—	—
发热持续时间				2.601	0.237^a
	> 3 d	4（57.14）	20（27.78）
	≤ 3 d	3（42.86）	52（72.22）
咳嗽		5（71.43）	45（62.5）	0.219	0.954^a
咯痰		3（42.68）	28（38.89）	0.042	1.000^a
头痛		1（14.29）	13（18.06）	0.062	1.000^a
喘息		2（28.57）	7（9.72）	—	0.381^b
呼吸困难		1（14.29）	3（4.17）	—	0.793^b
乏力		2（28.57）	16（22.22）	0.146	1.000^a
肌肉疼痛		2（28.57）	19（26.39）	0.016	1.000^a
纳差		3（42.68）	17（23.61）	1.250	0.508^a
咽痛		2（28.57）	33（45.83）	0.380	0.632^a
可闻及干/湿啰音		3（42.68）	5（6.94）	—	0.019^b
与确诊或疑似流感接触史		3（42.68）	11（15.28）	3.328	0.192^a
入院前后抗病毒药物治疗		7（100.00）	67（93.06）	—	0.621^b
	奥司他韦	3（42.68）	43（64.18）
	帕拉米韦	3（42.68）	13（19.40）
	奥司他韦+帕拉米韦序贯治疗	1（14.29）	11（16.42）

		危重症组（7例）	重症组（72例）	χ²值	P值
入院病程> 5 d				5.365	0.081^a
	是	4（57.14）	8（11.11）
	否	3（42.86）	64（88.89）
临床表现与体征
	卡他症状	7（100.00）	48（66.67）	3.352	0.070^a
	发热	7（100.00）	72（100.00）	—	—
发热持续时间				2.601	0.237^a
	> 3 d	4（57.14）	20（27.78）
	≤ 3 d	3（42.86）	52（72.22）
咳嗽		5（71.43）	45（62.5）	0.219	0.954^a
咯痰		3（42.68）	28（38.89）	0.042	1.000^a
头痛		1（14.29）	13（18.06）	0.062	1.000^a
喘息		2（28.57）	7（9.72）	—	0.381^b
呼吸困难		1（14.29）	3（4.17）	—	0.793^b
乏力		2（28.57）	16（22.22）	0.146	1.000^a
肌肉疼痛		2（28.57）	19（26.39）	0.016	1.000^a
纳差		3（42.68）	17（23.61）	1.250	0.508^a
咽痛		2（28.57）	33（45.83）	0.380	0.632^a
可闻及干/湿啰音		3（42.68）	5（6.94）	—	0.019^b
与确诊或疑似流感接触史		3（42.68）	11（15.28）	3.328	0.192^a
入院前后抗病毒药物治疗		7（100.00）	67（93.06）	—	0.621^b
	奥司他韦	3（42.68）	43（64.18）
	帕拉米韦	3（42.68）	13（19.40）
	奥司他韦+帕拉米韦序贯治疗	1（14.29）	11（16.42）

		例数	住院时间[M（P25，P75），d]	统计量	P值
孕期				H = 4.587	0.101
	早期妊娠	6	4（2，8.5）
	中期妊娠	8	11.5（4.75，15.75）
	晚期妊娠	64	6（4.75，8）
年龄				Z =-3.096	0.002
	高龄	15	8（6，13）
	非高龄	64	5（4，7）
是否危重症				Z =-2.64	0.008
	是	7	10（7，21）
	否	72	6（4，8）
使用抗病毒药物^a				Z =-0.314	0.754
	≤ 3 d	50	6（4，8）
	> 3 d	24	6（5，9）

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