{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:55:31Z","timestamp":1776092131871,"version":"3.50.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>It was a single-center study, including all hospitalized patients in intensive care, between November 1<jats:sup>st<\/jats:sup>, 2009 and October 31<jats:sup>st<\/jats:sup>, 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H<jats:sub>1<\/jats:sub>N<jats:sub>1<\/jats:sub> pdm09 (84.2%) and H<jats:sub>3<\/jats:sub>N<jats:sub>2<\/jats:sub> (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25\u201313] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC<jats:sub>95%<\/jats:sub> [1.474\u201337.317]; p = 0.015), PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> \u2264 95 mmHg (OR = 9.078; IC<jats:sub>95%<\/jats:sub> [1.636\u201350.363]; p = 0.012) and lymphocytes count \u2264 1.325 10<jats:sup>9<\/jats:sup>\/L (OR = 10.199; IC<jats:sub>95%<\/jats:sub> [1.550\u201367.101]; p = 0.016).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Influenza A in ICU is not uncommon, even in A(H1N1) dominant seasons; its management is highly demanding. It is responsible for considerable morbi-mortality especially in elderly patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0270814","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T17:30:56Z","timestamp":1657128656000},"page":"e0270814","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5183-9672","authenticated-orcid":true,"given":"Amira","family":"Jamoussi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samia","family":"Ayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takoua","family":"Merhabene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamdi","family":"Doghri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jalila","family":"Ben Khelil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Besbes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,7,6]]},"reference":[{"key":"pone.0270814.ref001","unstructured":"Asia S. Up to 650 000 people die of respiratory diseases linked to seasonal flu each year. WHO 2017."},{"issue":"9","key":"pone.0270814.ref002","doi-asserted-by":"crossref","first-page":"e74064","DOI":"10.1371\/journal.pone.0074064","article-title":"Virological surveillance of influenza viruses during the 2008\u201309, 2009\u201310 and 2010\u201311 seasons in Tunisia","volume":"8","author":"A El Moussi","year":"2013","journal-title":"PloS one"},{"issue":"7","key":"pone.0270814.ref003","doi-asserted-by":"crossref","first-page":"459","DOI":"10.26719\/2016.22.7.459","article-title":"Modelling of seasonal influenza and estimation of the burden in Tunisia","volume":"22","author":"S Chlif","year":"2016","journal-title":"EMHJ-Eastern Mediterranean Health Journal"},{"issue":"1","key":"pone.0270814.ref004","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1186\/s12889-019-7035-3","article-title":"Evaluation of the influenza-like illness surveillance system in Tunisia, 2012\u20132015","volume":"19","author":"R Yazidi","year":"2019","journal-title":"BMC public health"},{"issue":"1","key":"pone.0270814.ref005","first-page":"1","article-title":"Characteristics and outcome of ill critical patients with influenza A infection","volume":"29","author":"R Bouneb","year":"2018","journal-title":"Pan African Medical Journal"},{"key":"pone.0270814.ref006","unstructured":"Guide de Surveillance de la Grippe en Tunisie 1\u00e8re Edition. 2016."},{"key":"pone.0270814.ref007","unstructured":"OMS, Organisation Mondiale de la Sant\u00e9. WHO Global Epidemiological Surveillance Standards for Influenza. 2013."},{"issue":"1","key":"pone.0270814.ref008","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1183\/09031936.01.00213501","article-title":"Imaging of pneumonia: trends and algorithms","volume":"18","author":"T. Franquet","year":"2001","journal-title":"European Respiratory Journal"},{"issue":"23","key":"pone.0270814.ref009","first-page":"2526","article-title":"Acute respiratory distress syndrome","volume":"307","author":"ADT Force","year":"2012","journal-title":"Jama"},{"issue":"1","key":"pone.0270814.ref010","first-page":"1","article-title":"Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury","volume":"2","author":"JA Kellum","year":"2012","journal-title":"Kidney international supplements"},{"key":"pone.0270814.ref011","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.ajic.2004.10.001","article-title":"National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004","volume":"32","author":"System NNIS","year":"2004","journal-title":"Am J Infect Control"},{"issue":"4","key":"pone.0270814.ref012","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.jcrc.2013.03.001","article-title":"Low\u2013tidal volume mechanical ventilation in patients with acute respiratory distress syndrome caused by pandemic influenza A\/H1N1 infection","volume":"28","author":"DK Oh","year":"2013","journal-title":"Journal of critical care"},{"key":"pone.0270814.ref013","first-page":"13788","article-title":"Thrombocytopenia as a mortality risk factor in acute respiratory failure in H1N1 influenza","volume":"143","author":"JC Lopez-Delgado","year":"2013","journal-title":"Swiss Med Wkly"},{"issue":"3","key":"pone.0270814.ref014","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/jgs.12152","article-title":"Epidemiology, Clinical Features, and Prognosis of Elderly Adults with Severe Forms of Influenza A (H 1 N 1)","volume":"61","author":"J Garnacho\u2010Montero","year":"2013","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"pone.0270814.ref015","first-page":"235","article-title":"Acute respiratory distress syndrome secondary to influenza A (H1N1) pdm09: clinical characteristics and mortality predictors","volume":"68","author":"C Hern\u00e1ndez-C\u00e1rdenas","year":"2016","journal-title":"Revista de Investigaci\u00f3n Cl\u00ednica"},{"issue":"3","key":"pone.0270814.ref016","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/crj.12346","article-title":"Mortality prediction to hospitalized patients with influenza pneumonia: PO2\/FiO2 combined lymphocyte count is the answer","volume":"11","author":"SJ Shi","year":"2017","journal-title":"Clin Respir J"},{"issue":"1","key":"pone.0270814.ref017","doi-asserted-by":"crossref","first-page":"e0210353","DOI":"10.1371\/journal.pone.0210353","article-title":"Risk factors associated with severe outcomes in adult hospitalized patients according to influenza type and subtype","volume":"14","author":"A Mart\u00ednez","year":"2019","journal-title":"PloS one"},{"issue":"12","key":"pone.0270814.ref018","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1016\/j.vaccine.2019.02.001","article-title":"Seasonal influenza vaccination policies in the eastern Mediterranean region: current status and the way forward","volume":"37","author":"A Abubakar","year":"2019","journal-title":"Vaccine"},{"issue":"4","key":"pone.0270814.ref019","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.4314\/ahs.v20i4.5","article-title":"The epidemiology of seasonal influenza after the 2009 influenza pandemic in Africa: a systematic review","volume":"20","author":"A Lagare","year":"2020","journal-title":"Afri Health Sci"},{"issue":"1","key":"pone.0270814.ref020","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1186\/s12889-021-10970-y","article-title":"Knowledge, attitudes and uptake related to influenza vaccine among healthcare workers during the 2018\u20132019 influenza season in Tunisia","volume":"21","author":"I Cherif","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0270814.ref021","first-page":"1","article-title":"Epidemiology and Public Health 2020: Reasons Leading to Influenza Vaccine Acceptance and Decline among Tunisian Healthcare Workers","volume":"11","author":"G Kharroubi","year":"2020","journal-title":"Journal of Vaccines and Vaccination"},{"issue":"4","key":"pone.0270814.ref022","doi-asserted-by":"crossref","first-page":"e0123755","DOI":"10.1371\/journal.pone.0123755","article-title":"Influenza and other respiratory viruses detected by influenza-like illness surveillance in Leyte Island, the Philippines, 2010\u20132013","volume":"10","author":"H Otomaru","year":"2015","journal-title":"PloS ONE"},{"issue":"19","key":"pone.0270814.ref023","doi-asserted-by":"crossref","first-page":"23379","DOI":"10.1007\/s11356-018-3922-x","article-title":"Temporal and climate characteristics of respiratory syncytial virus bronchiolitis in neonates and children in Sousse, Tunisia, during a 13-year surveillance","volume":"27","author":"I Brini","year":"2020","journal-title":"Environ Sci Pollut Res Int"},{"issue":"1","key":"pone.0270814.ref024","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1186\/s12879-020-05167-4","article-title":"Complicated hospitalization due to influenza: results from the Global Hospital Influenza Network for the 2017\u20132018 season","volume":"20","author":"B Lina","year":"2020","journal-title":"BMC Infect Dis"},{"issue":"3","key":"pone.0270814.ref025","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s15010-020-01569-3","article-title":"Comparative virulence of seasonal viruses responsible for lower respiratory tract infections: a southern European multi-centre cohort study of hospital admissions","volume":"49","author":"A Almeida","year":"2021","journal-title":"Infection"},{"key":"pone.0270814.ref026","unstructured":"Organization WH. WHO interim protocol: rapid operations to contain the initial emergence of pandemic influenza. Geneva: World Health Organization. 2007."},{"issue":"4","key":"pone.0270814.ref027","article-title":"Neuraminidase inhibitors for preventing and treating influenza in adults and children","author":"T Jefferson","year":"2014","journal-title":"Cochrane database of systematic reviews"},{"issue":"5","key":"pone.0270814.ref028","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S2213-2600(14)70041-4","article-title":"Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data","volume":"2","author":"SG Muthuri","year":"2014","journal-title":"Lancet Respir Med"},{"issue":"5","key":"pone.0270814.ref029","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1093\/jac\/dkq511","article-title":"Impact of early oseltamivir treatment on outcome in critically ill patients with 2009 pandemic influenza A","volume":"66","author":"A Rodr\u00edguez","year":"2011","journal-title":"J Antimicrob Chemother"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0270814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T17:31:22Z","timestamp":1657128682000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0270814"}},"subtitle":[],"editor":[{"given":"Robert Jeenchen","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,7,6]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7,6]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0270814","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,6]]}}}