{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:20:43Z","timestamp":1787595643489,"version":"build-2736575974"},"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"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>Background<\/jats:title>\n                    <jats:p>The A(H1N1)pdm09 virus remains an important cause of severe influenza worldwide. This study examined the burden of ICU admission, mortality, and associated predictors among adults with A(H1N1)pdm09-related pneumonia treated at a leading infectious diseases hospital in Vietnam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Demographic, clinical, laboratory, treatment, and outcome data were retrospectively collected from the medical records of adults hospitalized with laboratory-confirmed A(H1N1)pdm09 infection between 2009 and 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 729 patients with laboratory-confirmed A(H1N1)pdm09 infection, 21.7% (158\/729) developed pneumonia. Among patients with pneumonia, 36.7% developed moderate-to-severe acute respiratory distress syndrome, 15.2% required invasive ventilation, 48.7% were admitted to the ICU, and 8.2% died. Independent predictors of ICU admission included age older than 60 years (AOR 18.91, 95% CI 3.60\u201399.24), the presence of comorbidities (AOR 9.39, 95% CI 2.75\u201332.06), and laboratory evidence of systemic inflammation, renal dysfunction, and hepatic involvement. Intensified antiviral therapy (AOR\u2009=\u20098.577, 95%CI 1.416\u201383.341, P\u2009=\u20090.020), and invasive ventilation (AOR 8.426, 95%CI 1.105\u2013141.366, P\u2009=\u20090.039) were independently associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mortality associated with A(H1N1)pdm09-related pneumonia remains substantial. Older patients, those with comorbidities, and those presenting with abnormal laboratory findings should be monitored closely for deterioration requiring intensive care. The study did not demonstrate improved outcomes with intensified antiviral regimens. Prospective studies are required before definitive treatment recommendations can be made.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348450","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:21:36Z","timestamp":1787592096000},"page":"e0348450","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["ICU admission and mortality in adult patients with influenza A(H1N1)pdm09-related pneumonia in Vietnam since the 2009 H1N1 pandemic: A 10-year cohort study"],"prefix":"10.1371","volume":"21","author":[{"given":"Quang Minh","family":"Ho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bich Thuy","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le Nhu 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Briand","year":"2011","journal-title":"Public Health"},{"issue":"1","key":"pone.0348450.ref020","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/23288604.2015.1123338","article-title":"Mapping Priority Setting in Health in 17 Countries Across Asia, Latin America, and sub-Saharan Africa","volume":"2","author":"R Li","year":"2016","journal-title":"Health Syst Reform"},{"key":"pone.0348450.ref021","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ijid.2022.05.032","article-title":"Global respiratory virus surveillance: strengths, gaps, and way forward","volume":"121","author":"S Gupta","year":"2022","journal-title":"Int J Infect Dis"},{"issue":"40","key":"pone.0348450.ref022","first-page":"4368","article-title":"National surveillance for influenza and influenza-like illness in Vietnam, 2006-2010","volume":"31","author":"YT Nguyen","year":"2013","journal-title":"Vaccine"},{"key":"pone.0348450.ref023","author":"Hospital for Tropical Disease"},{"key":"pone.0348450.ref024","unstructured":"Ministry of Health. Issuance of form of case report. Circular. 2001."},{"issue":"4","key":"pone.0348450.ref025","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e26179","article-title":"CRISPR\/Cas-based nucleic acid detection strategies: Trends and challenges","volume":"10","author":"J Zhou","year":"2024","journal-title":"Heliyon"},{"key":"pone.0348450.ref026"},{"key":"pone.0348450.ref027"},{"key":"pone.0348450.ref028"},{"key":"pone.0348450.ref029","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/1743-422X-5-77","article-title":"A broad spectrum, one-step reverse-transcription PCR amplification of the neuraminidase gene from multiple subtypes of influenza A virus","volume":"5","author":"AC Alvarez","year":"2008","journal-title":"Virol J"},{"key":"pone.0348450.ref030","unstructured":"Ministry of Health V. National guideline of diagnosis, treatment and prevention for A\/H1N1 influenza 2009. 2009."},{"issue":"3","key":"pone.0348450.ref031","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1007\/s00134-010-1759-y","article-title":"Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine\u2019s Task Force for intensive care unit triage during an influenza epidemic or mass disaster","volume":"36","author":"CL Sprung","year":"2010","journal-title":"Intensive Care Med"},{"issue":"23","key":"pone.0348450.ref032","first-page":"2526","article-title":"Acute respiratory distress syndrome: the Berlin Definition","volume":"307","author":"Force ARDS Definition Task","year":"2012","journal-title":"JAMA"},{"issue":"8","key":"pone.0348450.ref033","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus 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