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    New prognostic laboratory parameters and use of intravenous immunglobulin G replacement for severe H1N1 infections
    (Medimond S R L, 2013) Gokturk, B.; Pekcan, S.; Emiroglu, Keser M.; Kirac, M.; Keles, S.; Guner, Sn; Artac, H.
    The appropriate treatment of severe pandemic H1N1 influenza, which was first identified in April 2009 in Mexico, is insufficient, especially in immunodeficient patients. We aimed to evaluate the features and prognostic factors of children with H1N1, and whether intravenous immunoglobulin G (IVIG) replacement can aid in facilitating a better outcome. Fifty-five hospitalized children with laboratory-confirmed H1N1 were evaluated retrospectively. The median age was 71 (1-216) months; and 65.4% had one or more underlying disorders. Thirty percent of the evaluated patients had one of the primary immunodeficiency disorders. Respiratory complications were seen in 72.7% of children. The mortality rate was 9%. Surprisingly, none of the six patients with primary immunodeficiency who were on regular IVIG replacement required intensive care unit admission or died. Eighty-three percent of patients who needed mechanical ventilation (p<0.001) and 27.7% of patients who needed oxygen support (p=0.002) died. The mortality rate of patients who admitted with neurological symptoms was higher (p=0.012, odds ratio: 17.25, confidence interval: 2.19-135.4). The mortality rate was significantly higher in patients with thrombocyte counts <165500/mm(3) (sensitivity: 79.6%, specificity: 83.3%) and with alanine aminotransferase (ALT) levels >50.5 U/L (sensitivity: 83.3%, specificity: 89.8%). Our study is important as it is the first to show the course in primary immunodeficient children with H1N1 infection who were on regular IVIG replacement. Thrombocytopenia, high ALT, neurologic symptoms, and hypoxia were detected as poor prognostic factors.