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Oxygen exchange and C-reactive protein predict safe discharge in patients with H1N1 influenza

Morton, Ben ORCID:, Nweze, K., O'Connor, J., Turton, P,, Joekes, E., Blakey, John and Welters, I. D. (2017) 'Oxygen exchange and C-reactive protein predict safe discharge in patients with H1N1 influenza'. QJM: An International Journal of Medicine, Vol 110, Issue 4, pp. 227-232.

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Pandemic influenza has potential to overwhelm healthcare resources. There is uncertainty over performance of existing triage tools for hospital admission and discharge decisions.
Our aim was to identify clinical criteria that predict safe discharge from hospital and develop a pragmatic triage tool to guide physician decision-making.
We retrospectively examined an existing database of patients who presented to the Royal Liverpool University Hospital during the 2010-2011 influenza pandemic.
Inclusion criteria: patients ≥18 years, with PCR confirmed H1N1 influenza. Exclusion criteria: died in the emergency department or case notes unavailable. Successful discharge was defined as discharge within 24 hours of presentation and no readmission within seven days.
Eighty-six patients were included and 16 were successfully discharged. Estimated P/F ratio and C-reactive protein predicted safe discharge in a multivariable logistic regression model (AUC 0.883). A composite univariate predictor (estimated P/F minus C-reactive protein, AUC 0.877) was created to calculate specific cut off points for sensitivity and specificity. A pragmatic decision tool was created to incorporate these thresholds and relevant guidelines. Discharge: SpO2 (in air) ≥ 94% and CRP <50. Observe: SpO2 ≥ 94% and CRP >50 or SpO2 ≤ 93% and CRP <50. Admit: SpO2 ≤ 93% and CRP >50.
We identified that oxygen exchange and CRP, a marker of acute inflammation, were the most important predictors of safe discharge. Our proposed simple triage model requires validation but has the potential to aid clinical decisions in the event of a future pandemic, and potentially for seasonal influenza.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in QJM: An International Journal of Medicine following peer review. The version of record B. Morton, K. Nweze, J. O’Connor, P. Turton, E. Joekes, J.D. Blakey, I.D. Welters; Oxygen exchange and C-reactive protein predict safe discharge in patients with H1N1 influenza. QJM 2017; 110 (4): 227-232 is available online at:
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 105 Epidemiology
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 515 Human influenza
WX Hospitals and Other Health Facilities > Clinical Departments and Units > WX 215 Emergency service. Ambulance service
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Martin Chapman
Date Deposited: 18 Oct 2016 10:28
Last Modified: 18 Oct 2017 01:02


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