{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T23:45:02Z","timestamp":1762299902077,"version":"3.40.5"},"reference-count":91,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Experimental studies have shown that vaccination can reduce viral replication to attenuate progression of influenza-associated lower respiratory tract illness (LRTI). However, clinical studies are conflicting, possibly due to use of non-specific outcomes reflecting a mix of large and small airway LRTI lacking specificity for acute lung or organ injury.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>We developed a global ordinal scale to differentiate large and small airway LRTI in hospitalized adults with influenza using physiologic features and interventions (PFIs): vital signs, laboratory and radiographic findings, and clinical interventions. We reviewed the literature to identify common PFIs across 9 existing scales of pneumonia and sepsis severity. To characterize patients using this scale, we applied the scale to an antiviral clinical trial dataset where these PFIs were measured through routine clinical care in adults hospitalized with influenza-associated LRTI during the 2010\u20132013 seasons.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>We evaluated 12 clinical parameters among 1020 adults; 210 (21%) had laboratory-confirmed influenza, with a median severity score of 4.5 (interquartile range, 2\u20138). Among influenza cases, median age was 63 years, 20% were hospitalized in the prior 90 days, 50% had chronic obstructive pulmonary disease, and 22% had congestive heart failure. Primary influencers of higher score included pulmonary infiltrates on imaging (48.1%), heart rate \u2265110 beats\/minute (41.4%), oxygen saturation &lt;93% (47.6%) and respiratory rate &gt;24 breaths\/minute (21.0%). Key PFIs distinguishing patients with severity &lt; or \u22658 (upper quartile) included infiltrates (27.1% vs 90.0%), temperature \u2265 39.1\u00b0C or &lt;36.0\u00b0C (7.1% vs 27.1%), respiratory rate &gt;24 breaths\/minute (7.9% vs 47.1%), heart rate \u2265110 beats\/minute (29.3% vs 65.7%), oxygen saturation &lt;90% (14.3% vs 31.4%), white blood cell count &gt;15,000 (5.0% vs 27.2%), and need for invasive or non-invasive mechanical ventilation (2.1% vs 15.7%).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>We developed a scale in adults hospitalized with influenza-associated LRTI demonstrating a broad distribution of physiologic severity which may be useful for future studies evaluating the disease attenuating effects of influenza vaccination or other therapeutics.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0258482","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T17:58:48Z","timestamp":1634839128000},"page":"e0258482","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Differentiating severe and non-severe lower respiratory tract illness in patients hospitalized with influenza: Development of the Influenza Disease Evaluation and Assessment of Severity (IDEAS) scale"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3349-9330","authenticated-orcid":true,"given":"Eric J.","family":"Chow","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8702-8393","authenticated-orcid":true,"given":"Mark W.","family":"Tenforde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa A.","family":"Rolfes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2394-8561","authenticated-orcid":true,"given":"Benjamin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shreya","family":"Chodisetty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio A.","family":"Ramirez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia M.","family":"Fry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8949-6548","authenticated-orcid":true,"given":"Manish M.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"issue":"1","key":"pone.0258482.ref001","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1186\/s13054-019-2491-9","article-title":"Influenza virus-related critical illness: prevention, diagnosis, treatment","volume":"23","author":"EJ Chow","year":"2019","journal-title":"Crit Care"},{"issue":"3","key":"pone.0258482.ref002","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1172\/JCI1355","article-title":"Local and systemic cytokine responses during experimental human influenza A virus infection. 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