Complicated hospitalization due to influenza: results from the Global Hospital Influenza Network for the 2017–2018 season
Authors: Lina Bruno , Georges Alexandre , Burtseva Elena , Nunes Marta C. , Andrew Melissa K. , McNeil Shelly A. , Ruiz-Palacios Guillermo M. , Feng Luzhao , Kyncl Jan , Vanhems Philippe , Ortiz Justin R. , Paget John , Reiner Robert C. ,   on behalf of the GIHSN 2017–2018 study collaborators, Amour Sélilah , N’Gattia Coulibaly Anderson , Moreno Victor Baselga , Baumeister Elsa , Khelil Jalila Ben , Danilenko Daria , Diez-Domingo Javier , Drăgănescu Anca Cristina , Emukule Gideon O. , Gauhar Zhetpisbayeva , Guerrero M. Lourdes , Mira-Iglesias Ainara , Kisteneva Lidija , Koul Parvaiz A. , Kuatbaeva Ainagul , Torres Victor Alberto Laguna , Launay Odile , Lenzi Nezha , Madhi Shabir , Mandakova Zdenka , Medić Snežana , Ristić Mioljub , Mir Hyder , Nitsch-Osuch Aneta , Otieno Nancy , Pițigoi Daniela , Pontoriero Andrea , Ramirez Estela , Salah Ben , Sandulescu Oana , Serafin Natali , Shan Wei , Sominina Anna , Trushakova Svetlana , Zalewski Andrzej , Zhang Tao 
Published: July 2020

Abstract
Background
Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017–2018 season and examine factors associated with complicated hospitalization among patients admitted with laboratory-confirmed influenza illness.

Methods
The study enrolled patients who were hospitalized in a GIHSN hospital in the previous 48 h with acute respiratory symptoms and who had symptoms consistent with influenza within the 7 days before admission. Enrolled patients were tested by reverse transcription-polymerase chain reaction to confirm influenza virus infection. “Complicated hospitalization” was defined as a need for mechanical ventilation, admission to an intensive care unit, or in-hospital death. In each of four age strata (< 15, 15–< 50, 50–< 65, and ≥ 65 years), factors associated with complicated hospitalization in influenza-positive patients were identified by mixed effects logistic regression and those associated with length of hospital stay using a linear mixed-effects regression model.

Results
The study included 12,803 hospitalized patients at 14 coordinating sites in 13 countries, of which 4306 (34%) tested positive for influenza. Influenza viruses B/Yamagata, A/H3N2, and A/H1N1pdm09 strains dominated and cocirculated, although the dominant strains varied between sites. Complicated hospitalization occurred in 10.6% of influenza-positive patients. Factors associated with complicated hospitalization in influenza-positive patients included chronic obstructive pulmonary disease (15–< 50 years and ≥ 65 years), diabetes (15–< 50 years), male sex (50–< 65 years), hospitalization during the last 12 months (50–< 65 years), and current smoking (≥65 years). Chronic obstructive pulmonary disease (50–< 65 years), other chronic conditions (15–< 50 years), influenza A (50–< 65 years), and hospitalization during the last 12 months (< 15 years) were associated with a longer hospital stay. The proportion of patients with complicated influenza did not differ between influenza A and B.

Conclusions
Complicated hospitalizations occurred in over 10% of patients hospitalized with influenza virus infection. Factors commonly associated with complicated or longer hospitalization differed by age group but commonly included chronic obstructive pulmonary disease, diabetes, and hospitalization during the last 12 months.