Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults
Authors: Eric J. Chow, Melissa A. Rolfes, Alissa O’Halloran, Nisha B. Alden, Evan J. Anderson, Nancy M. Bennett, Laurie Billing, Elizabeth Dufort, Pam D. Kirley, Andrea George, Lourdes Irizarry, Sue Kim, Ruth Lynfield, Patricia Ryan, William Schaffner, H. Keipp Talbot, Ann Thomas, Kimberly Yousey-Hindes, Carrie Reed, Shikha Garg
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Seasonal influenza virus infection is a major cause of morbidity and mortality and may be associated with respiratory and nonrespiratory diagnoses. <h3>Objective</h3> To examine the respiratory and nonrespiratory diagnoses reported for adults hospitalized with laboratory-confirmed influenza between 2010 and 2018 in the United States. <h3>Design, Setting, and Participants</h3> This cross-sectional study used data from the US Influenza Hospitalization Surveillance Network (FluSurv-NET) from October 1 through April 30 of the 2010-2011 through 2017-2018 influenza seasons. FluSurv-NET is a population-based, multicenter surveillance network with a catchment area that represents approximately 9% of the US population. Patients are identified by practitioner-ordered influenza testing. Adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza were included in the study. <h3>Exposures</h3> FluSurv-NET defines laboratory-confirmed influenza as a positive influenza test result by rapid antigen assay, reverse transcription–polymerase chain reaction, direct or indirect fluorescent staining, or viral culture. <h3>Main Outcomes and Measures</h3> Acute respiratory or nonrespiratory diagnoses were defined using<i>International Classification of Diseases, Ninth Revision, Clinical Modification</i>(<i>ICD-9-CM</i>) and<i>International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10)</i>discharge diagnosis codes. The analysis included calculation of the frequency of acute respiratory and nonrespiratory diagnoses with a descriptive analysis of patient demographic characteristics, underlying medical conditions, and in-hospital outcomes by respiratory and nonrespiratory diagnoses. <h3>Results</h3> Of 89 999 adult patients hospitalized with laboratory-confirmed influenza, 76 649 (median age, 69 years; interquartile range, 55-82 years; 55% female) had full medical record abstraction and at least 1<i>ICD</i>code for an acute diagnosis. In this study, 94.9% of patients had a respiratory diagnosis and 46.5% had a nonrespiratory diagnosis, including 5.1% with only nonrespiratory diagnoses. Pneumonia (36.3%), sepsis (23.3%), and acute kidney injury (20.2%) were the most common acute diagnoses. Fewer patients with only nonrespiratory diagnoses received antiviral therapy for influenza compared with those with respiratory diagnoses (81.4% vs 88.9%;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> Nonrespiratory diagnoses occurred frequently among adults hospitalized with influenza, further contributing to the burden of infection in the United States. The findings suggest that during the influenza season, practitioners should consider influenza in their differential diagnosis for patients who present to the hospital with less frequently recognized manifestations and initiate early antiviral treatment for patients with suspected or confirmed infection.