Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.

<h4>Background</h4>Little is known about risk factors for severe outcomes in patients infected with H5N1 and no systematic review has been conducted. Understanding risk factors is an important step for prioritizing prophylaxis or treatment in the event of a pandemic.<h4>Objectives&...

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Main Authors: Dominik Mertz, Tae Hyong Kim, Jennie Johnstone, Po-Po Lam, Michelle Science, Stefan P Kuster, Shaza A Fadel, Dat Tran, Eduardo Fernandez, Neera Bhatnagar, Mark Loeb
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2014-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0089697
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author Dominik Mertz
Tae Hyong Kim
Jennie Johnstone
Po-Po Lam
Michelle Science
Stefan P Kuster
Shaza A Fadel
Dat Tran
Eduardo Fernandez
Neera Bhatnagar
Mark Loeb
author_facet Dominik Mertz
Tae Hyong Kim
Jennie Johnstone
Po-Po Lam
Michelle Science
Stefan P Kuster
Shaza A Fadel
Dat Tran
Eduardo Fernandez
Neera Bhatnagar
Mark Loeb
author_sort Dominik Mertz
collection DOAJ
description <h4>Background</h4>Little is known about risk factors for severe outcomes in patients infected with H5N1 and no systematic review has been conducted. Understanding risk factors is an important step for prioritizing prophylaxis or treatment in the event of a pandemic.<h4>Objectives</h4>To systematically evaluate risk factors for severe outcomes in patients with avian influenza H5N1 infection.<h4>Data sources</h4>MEDLINE, EMBASE, CINAHL, GlobalHealth, and CENTRAL through March 2011.<h4>Eligibility criteria for selecting studies</h4>Observational studies of any design published in English, French, Spanish, German or Korean that reported on risk factor-outcome combinations of interest in participants with confirmed H5N1 infections. Outcomes considered included death, ventilator support, hospital and ICU admission, pneumonia, and composite outcomes.<h4>Study appraisal</h4>Risk of bias was assessed using the Newcastle-Ottawa scale (NOS).<h4>Results</h4>We identified 20 studies reporting on 999 patients infected with H5N1. The majority of studies (n = 14, 70%) were at intermediate risk of bias, i.e. 4-6 points on the NOS. Females were at increased risk of death (OR 1.75, 95% CI 1.27-2.44), while young age, in particular <5 years of age (OR 0.44, 95% CI 0.25-0.79 for death), was protective. Data on traditional risk factors was scarce and requires further studies. Another major limitation in the published literature was lack of adjustment for confounders.<h4>Interpretation</h4>Females were at increased risk for complications following H5N1 infection while young age protected against severe outcomes. Research on traditional risk factors was limited and is required.
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spelling doaj-art-9ed0e70e61024ae397b602e7b07d9fa42025-08-20T03:56:09ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0193e8969710.1371/journal.pone.0089697Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.Dominik MertzTae Hyong KimJennie JohnstonePo-Po LamMichelle ScienceStefan P KusterShaza A FadelDat TranEduardo FernandezNeera BhatnagarMark Loeb<h4>Background</h4>Little is known about risk factors for severe outcomes in patients infected with H5N1 and no systematic review has been conducted. Understanding risk factors is an important step for prioritizing prophylaxis or treatment in the event of a pandemic.<h4>Objectives</h4>To systematically evaluate risk factors for severe outcomes in patients with avian influenza H5N1 infection.<h4>Data sources</h4>MEDLINE, EMBASE, CINAHL, GlobalHealth, and CENTRAL through March 2011.<h4>Eligibility criteria for selecting studies</h4>Observational studies of any design published in English, French, Spanish, German or Korean that reported on risk factor-outcome combinations of interest in participants with confirmed H5N1 infections. Outcomes considered included death, ventilator support, hospital and ICU admission, pneumonia, and composite outcomes.<h4>Study appraisal</h4>Risk of bias was assessed using the Newcastle-Ottawa scale (NOS).<h4>Results</h4>We identified 20 studies reporting on 999 patients infected with H5N1. The majority of studies (n = 14, 70%) were at intermediate risk of bias, i.e. 4-6 points on the NOS. Females were at increased risk of death (OR 1.75, 95% CI 1.27-2.44), while young age, in particular <5 years of age (OR 0.44, 95% CI 0.25-0.79 for death), was protective. Data on traditional risk factors was scarce and requires further studies. Another major limitation in the published literature was lack of adjustment for confounders.<h4>Interpretation</h4>Females were at increased risk for complications following H5N1 infection while young age protected against severe outcomes. Research on traditional risk factors was limited and is required.https://doi.org/10.1371/journal.pone.0089697
spellingShingle Dominik Mertz
Tae Hyong Kim
Jennie Johnstone
Po-Po Lam
Michelle Science
Stefan P Kuster
Shaza A Fadel
Dat Tran
Eduardo Fernandez
Neera Bhatnagar
Mark Loeb
Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.
PLoS ONE
title Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.
title_full Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.
title_fullStr Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.
title_full_unstemmed Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.
title_short Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis.
title_sort populations at risk for severe or complicated avian influenza h5n1 a systematic review and meta analysis
url https://doi.org/10.1371/journal.pone.0089697
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