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dc.contributor.authorvan Asten, Liselotte
dc.contributor.authorLuna Pinzon, Angie
dc.contributor.authorde Lange, Dylan W
dc.contributor.authorde Jonge, Evert
dc.contributor.authorDijkstra, Frederika
dc.contributor.authorMarbus, Sierk
dc.contributor.authorDonker, Gé A
dc.contributor.authorvan der Hoek, Wim
dc.contributor.authorde Keizer, Nicolette F
dc.date.accessioned2019-02-26T13:41:29Z
dc.date.available2019-02-26T13:41:29Z
dc.date.issued2018-12-19
dc.identifier.issn1466-609X
dc.identifier.pmid30567568
dc.identifier.doi10.1186/s13054-018-2274-8
dc.identifier.urihttp://hdl.handle.net/10029/622859
dc.description.abstractWhile influenza-like-illness (ILI) surveillance is well-organized at primary care level in Europe, few data are available on more severe cases. With retrospective data from intensive care units (ICU) we aim to fill this current knowledge gap. Using multiple parameters proposed by the World Health Organization we estimate the burden of severe acute respiratory infections (SARI) in the ICU and how this varies between influenza epidemics. We analyzed weekly ICU admissions in the Netherlands (2007-2016) from the National Intensive Care Evaluation (NICE) quality registry (100% coverage of adult ICUs in 2016; population size 14 million) to calculate SARI incidence, SARI peak levels, ICU SARI mortality, SARI mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score, and the ICU SARI/ILI ratio. These parameters were calculated both yearly and per separate influenza epidemic (defined epidemic weeks). A SARI syndrome was defined as admission diagnosis being any of six pneumonia or pulmonary sepsis codes in the APACHE IV prognostic model. Influenza epidemic periods were retrieved from primary care sentinel influenza surveillance data. Annually, an average of 13% of medical admissions to adult ICUs were for a SARI but varied widely between weeks (minimum 5% to maximum 25% per week). Admissions for bacterial pneumonia (59%) and pulmonary sepsis (25%) contributed most to ICU SARI. Between the eight different influenza epidemics under study, the value of each of the severity parameters varied. Per parameter the minimum and maximum of those eight values were as follows: ICU SARI incidence 558-2400 cumulated admissions nationwide, rate 0.40-1.71/10,000 inhabitants; average APACHE score 71-78; ICU SARI mortality 13-20%; ICU SARI/ILI ratio 8-17 cases per 1000 expected medically attended ILI in primary care); peak-incidence 101-188 ICU SARI admissions in highest-incidence week, rate 0.07-0.13/10,000 population). In the ICU there is great variation between the yearly influenza epidemic periods in terms of different influenza severity parameters. The parameters also complement each other by reflecting different aspects of severity. Prospective syndromic ICU SARI surveillance, as proposed by the World Health Organization, thereby would provide insight into the severity of ongoing influenza epidemics, which differ from season to season.en_US
dc.language.isoenen_US
dc.subjectBurdenen_US
dc.subjectInfluenzaen_US
dc.subjectIntensive careen_US
dc.subjectPneumoniaen_US
dc.subjectSARIen_US
dc.subjectSevere acute respiratory infectionsen_US
dc.subjectSeverityen_US
dc.titleEstimating severity of influenza epidemics from severe acute respiratory infections (SARI) in intensive care units.en_US
dc.typeArticleen_US
dc.identifier.journalCrit Care 2018; 22(1):351en_US
dc.source.journaltitleCritical care (London, England)


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