{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T07:43:14Z","timestamp":1781854994939,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Mol. Biosci."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Influenza virus is a common pathogen causing community-acquired pneumonia. After H1N1 infection, some patients present with rapid disease progression and various respiratory complications, especially immunocompromised patients and pregnant women. However, most patients have a favorable prognosis. Influenza viruses infect respiratory epithelial cells, leading to diffuse alveolar damage (DAD), which could induce secondary bacterial or fungal infections that could lead to serious complications, such as acute respiratory failure, severe pneumonia, pneumothorax, mediastinal emphysema, acute respiratory distress syndrome (ARDS) and post-ARDS fibrosis.<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> The short-term mortality rate of ARDS is decreasing, and understanding survivors\u2019 posthospitalization outcomes is very important. Our aim was to evaluate the outcomes of 69 patients who survived H1N1 pneumonia with severe respiratory complications and abnormal CT findings and developed post-ARDS pulmonary fibrosis.<\/jats:p><jats:p><jats:bold>Materials and methods:<\/jats:bold> The 280 inpatients included in this trial had been diagnosed with H1N1 infection that was confirmed by pharyngeal sputum or swab tests. The data were collected from January 2018 to January 2020 in the First Affiliated Hospital of Zhengzhou University and the Sixth People's Hospital of Zhengzhou. Of these patients, 232 had CT findings indicating pulmonary fibrosis after H1N1 infection, and 69 survived and consented to participate in this study. 6\u00b0months after diagnosis, the 69 surviving patients were interviewed and underwent physical examinations, CT scans, 6\u00b0min walk tests, and quality-of-life evaluations (SF-36). We analyzed the baseline variables and six-month outcomes of post-ARDS pulmonary fibrosis in patients with H1N1 pneumonia.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Of the 69 surviving patients with post-ARDS pulmonary fibrosis, there were 24 females and 45 males, with a mean age of 53.7 \u00b1 16.8\u00b0years; 18 patients (26%) had no underlying disease, and 14 (20%) patients had more than one underlying disease. The distance walked in 6\u00b0min increased from an average of 451.9\u00b0m at 3\u00b0months to 575.4\u00b0m at 6\u00b0months; the mean 36-Item Short Form Survey (SF-36) physical function score increased from an average of 75.3 at 3\u00b0months to 77.5 at 6\u00b0months; and the average CT score decreased from 31.3 at 3\u00b0months to 14.8 at 6\u00b0months. Treatment with systemic corticosteroids and the presence of an underlying disease were related to the CT score and the distance walked in 6\u00b0min.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Among the survivors with pulmonary fibrosis after H1N1 influenza, the 6\u00b0min walk test and CT scores continued to be affected after 6\u00b0months. The 6\u00b0min walk distance and imaging findings improved during the first 6\u00b0months. The health-related QoL (HRQoL) scores of H1N1 pneumonia survivors were lower than those of sex- and age-matched controls.<\/jats:p>","DOI":"10.3389\/fmolb.2021.640763","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T04:43:35Z","timestamp":1623127415000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Six-Month Outcomes of Post-ARDS Pulmonary Fibrosis in Patients With H1N1 Pneumonia"],"prefix":"10.3389","volume":"8","author":[{"given":"Jing","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weili","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junlu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunling","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengying","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuejie","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1007\/s00134-017-4919-5","article-title":"Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017","volume":"43","author":"Annane","year":"2017","journal-title":"Intensive Care Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1097\/01.ccm.0000194723.78632.62","article-title":"Effect of Low Doses of Corticosteroids in Septic Shock Patients with or without Early Acute Respiratory Distress Syndrome*","volume":"34","author":"Annane","year":"2006","journal-title":"Crit. Care Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.1001\/jama.2012.5669","article-title":"Acute Respiratory Distress Syndrome: the Berlin Definition","volume":"307","author":"Ranieri","year":"2012","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1378\/chest.10-1036","article-title":"Clinical Features of Pneumonia Caused by 2009 Influenza A(H1N1) Virus in Beijing, China","volume":"139","author":"Bai","year":"2011","journal-title":"Chest"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1056\/NEJMra1000449","article-title":"Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection","volume":"362","author":"Bautista","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1136\/thoraxjnl-2016-209400","article-title":"Are Physical Measures Related to Patient-Centred Outcomes in ARDS Survivors?","volume":"72","author":"Chan","year":"2017","journal-title":"Thorax"},{"key":"B7","doi-asserted-by":"publisher","first-page":"17275","DOI":"10.1038\/s41598-017-17497-6","article-title":"Long Term Outcomes in Survivors of Epidemic Influenza A (H7N9) Virus Infection","volume":"7","author":"Chen","year":"2017","journal-title":"Sci. Rep."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1007\/s00134-006-0217-3","article-title":"Quality of Life after Acute Respiratory Distress Syndrome: a Meta-Analysis","volume":"32","author":"Dowdy","year":"2006","journal-title":"Intensive Care Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"R100","DOI":"10.1186\/cc12745","article-title":"An Exploration of Social and Economic Outcome and Associated Health-Related Quality of Life after Critical Illness in General Intensive Care Unit Survivors: a 12-month Follow-Up Study","volume":"17","author":"Griffiths","year":"2013","journal-title":"Crit. Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1056\/NEJMoa022450","article-title":"One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome","volume":"348","author":"Herridge","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1056\/NEJMoa1011802","article-title":"Functional Disability 5 Years after Acute Respiratory Distress Syndrome","volume":"364","author":"Herridge","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1378\/chest.09-2344","article-title":"Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection","volume":"137","author":"Hui","year":"2010","journal-title":"Chest"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1164\/rccm.2106157","article-title":"Acute Interstitial Pneumonia","volume":"165","author":"Ichikado","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1148\/radiol.2373041515","article-title":"Prediction of Prognosis for Acute Respiratory Distress Syndrome with Thin-Section CT: Validation in 44 Cases","volume":"238","author":"Ichikado","year":"2006","journal-title":"Radiology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.annfar.2009.12.026","article-title":"Grippe A (H1N1) et SDRA : caract\u00e9ristiques des patients admis en r\u00e9animation et prise en charge. Revue de la litt\u00e9rature","volume":"29","author":"Jaber","year":"2010","journal-title":"Ann. Fran\u00e7aises d'Anesth\u00e9sie de R\u00e9animation"},{"key":"B16","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S2213-2600(18)30098-5","article-title":"Prediction of ARDS Outcome: what Tool Should I Use?","volume":"6","author":"Kacmarek","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1136\/thoraxjnl-2017-210775","article-title":"Prediction of Long-Term Outcome Subtypes in ARDS: First Steps towards Personalised Medicine in Critical Care","volume":"72","author":"Latronico","year":"2017","journal-title":"Thorax"},{"key":"B18","doi-asserted-by":"publisher","first-page":"205031211667172","DOI":"10.1177\/2050312116671725","article-title":"SF-36 Total Score as a Single Measure of Health-Related Quality of Life: Scoping Review","volume":"4","author":"Lins","year":"2016","journal-title":"SAGE Open Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1378\/chest.11-2196","article-title":"Long-term Outcomes of Pandemic 2009 Influenza A(H1N1)-associated Severe ARDS","volume":"142","author":"Luyt","year":"2012","journal-title":"Chest"},{"key":"B20","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1378\/chest.06-2100","article-title":"Methylprednisolone Infusion in Early Severe ARDS","volume":"131","author":"Meduri","year":"2007","journal-title":"Chest"},{"key":"B21","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1001\/jama.280.2.159","article-title":"Effect of Prolonged Methylprednisolone Therapy in Unresolving Acute Respiratory Distress Syndrome","volume":"280","author":"Meduri","year":"1998","journal-title":"JAMA"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1164\/rccm.201111-2025OC","article-title":"The Adult Respiratory Distress Syndrome Cognitive Outcomes Study","volume":"185","author":"Mikkelsen","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1309\/ajcpxy17sulqkswk","article-title":"Pathologic Findings in Novel Influenza A (H1N1) Virus (\"Swine Flu\") Infection","volume":"133","author":"Mukhopadhyay","year":"2010","journal-title":"Am. J. Clin. Pathol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1056\/NEJMoa0904252","article-title":"Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico","volume":"361","author":"Perez-Padilla","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1097\/MCC.0b013e3283427259","article-title":"H1N1: Viral Pneumonia as a Cause of Acute Respiratory Distress Syndrome","volume":"17","author":"Ramsey","year":"2011","journal-title":"Curr. Opin. Crit. Care"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1056\/NEJMra050541","article-title":"Antiinflammatory Action of Glucocorticoids - New Mechanisms for Old Drugs","volume":"353","author":"Rhen","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1164\/rccm.201708-1761OC","article-title":"Six-Month Outcome of Immunocompromised Patients with Severe Acute Respiratory Distress Syndrome Rescued by Extracorporeal Membrane Oxygenation. An International Multicenter Retrospective Study","volume":"197","author":"Schmidt","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1056\/NEJMoa051693","article-title":"Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome","volume":"354","author":"Steinberg","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s10156-010-0187-9","article-title":"Clinical Features of the 2009 Swine-Origin Influenza A (H1N1) Outbreak in Japan","volume":"17","author":"Takayama","year":"2011","journal-title":"J. Infect. Chemother."},{"key":"B30","doi-asserted-by":"publisher","first-page":"R143","DOI":"10.1186\/cc10266","article-title":"Critical Care Services and the H1N1 (2009) Influenza Epidemic in Australia and New Zealand in 2010: the Impact of the Second winter Epidemic","volume":"15","author":"Webb","year":"2011","journal-title":"Crit. Care"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1164\/ajrccm.156.4.9611047","article-title":"Health-related Quality of Life after Acute Lung Injury","volume":"156","author":"Weinert","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."}],"container-title":["Frontiers in Molecular Biosciences"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmolb.2021.640763\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T04:43:37Z","timestamp":1623127417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmolb.2021.640763\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,8]]},"references-count":31,"alternative-id":["10.3389\/fmolb.2021.640763"],"URL":"https:\/\/doi.org\/10.3389\/fmolb.2021.640763","relation":{},"ISSN":["2296-889X"],"issn-type":[{"value":"2296-889X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,8]]},"article-number":"640763"}}