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Better Prediction Could Lead to Better Treatment
Better Prediction Could Lead to Better Treatment

October, 2012 – In a recent study published in the Pediatric Infectious Diseases Journal, CHORI Assistant Scientist A. Desiree LaBeaud, MD, and her colleagues report on the clinical and epidemiologic features found in pediatric patients admitted to Children’s Hospital Oakland with the novel influenza A virus, or H1N1, between April 2009 and February 2010. Identifying clear predictors for severe disease would potentially allow clinicians to know which patients are more likely than others to have a worse clinical course, and to treat them more aggressively from the outset.

"The only significant historical risk factor for severe disease that we found was for previous neuromuscular disorder," says Dr. LaBeaud. "Children who had neuromuscular disorders prior to contracting H1N1, such as cerebral palsy, were over three times more likely to have a severe clinical presentation of H1N1. Race was also a factor, with whites at 2 to 3 times the risk of severe disease than blacks or Hispanics."

“The only significant historical risk factor for severe disease that we found was for previous neuro-
muscular disorder.”



The H1N1 influenza outbreak was labeled a pandemic by the World Health Organization (WHO) and impacted millions of people worldwide. Pediatric populations were particularly vulnerable to the virus, with clinical presentations ranging from mild to fatal, yet very little data exists regarding what conditions might predict whether a given child has a more severe disease course.

"There was some evidence from previous studies suggesting that asthma, obesity and pre-existing high-risk medical conditions predicted more serious illness, but for the most part, there hasn't really been enough data for clinicians to say with clarity yes, having this condition or that condition meant having a worse H1N1 clinical presentation," explains Dr. LaBeaud.

"We had over a hundred children admitted to Children's with H1N1 during the peak of outbreak, so we wanted to see if we could retrospectively analyze the data from these pediatric patients to determine if there were certain factors that might contribute to the severity a patient's outcome."
“We wanted to see if we could retrospectively analyze the data from these pediatric patients to determine if there were certain factors that might contribute to the severity a patient's outcome.”
Overall, Dr. LaBeaud and her colleagues found that the most significant correlation with severe disease was previous neuromuscular disorder. This finding confirms data from the few prior studies that have been done on H1N1 predictors of severe disease, but the study did not confirm that obesity or asthma were predictors.

"We also found that the presence of low sodium, high platelets and high white blood cell count predicted severe disease," says Dr. LaBeaud.

"This is particularly important because simple lab tests can determinethese levels. This means that doctors may be able to use these labs to predict which patients may be headed for a worse course of the H1N1 infection and to treat those cases appropriately from the outset."
In addition, Dr. LaBeaud and her colleagues also investigated the accuracy of rapid influenza testing in this same group of pediatric patients.

"We found what many others have been finding as well that rapid testing for H1N1 resulted in both false-positives and false-negatives," says Dr. LaBeaud.

“This supports the accumulating evidence that clinicians should treat those patients at risk for H1N1 early, regardless of the results of rapid diagnostic testing.”

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