International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Dual-subtype positivity of influenza A(H1N1) and A(H3N2) is associated with worse hypoxemia, fungal co-detection, and adverse short-term outcomes in adults with influenza-associated community-acquired pneumonia.
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Li Qianni, Li Hongyan, Fan Lingxiang, Chen Xu-Ping, Liu Wanxun, Zhao Jian, Zhou Qi
Аннотация
OBJECTIVES: Dual-subtype influenza A positivity is poorly characterized. We evaluated whether detection of A(H1N1) and A(H3N2) during the same admission identifies a high-risk phenotype in adults hospitalized with influenza-associated community-acquired pneumonia.
METHODS: This retrospective single-center study linked clinical and bronchoalveolar lavage fluid pathogen-spectrum records. Influenza A was detected by RT-PCR and BALF pathogens by targeted next-generation sequencing. The primary endpoint was composite adverse hospital disposition (in-hospital death or discharge against medical advice [DAMA]); components were reported separately. Associations were estimated with binomial generalized linear models and Firth sensitivity analyses.
RESULTS: Among 97 adults (51 H1N1 mono-positive; 46 dual-positive), dual positivity was associated with lower PaO2/FiO2 (244.17 vs 293.94; P = 0.018), higher CRP and IL-6, more invasive ventilation (23.9% vs 7.8%; P = 0.047), and more fungal co-detection (47.8% vs 25.5%; P = 0.034). Composite adverse disposition occurred in 26.1% vs 3.9% (OR: 8.65; P = 0.003); the age- and sex-adjusted OR was 8.24 (P = 0.010) and attenuated after PaO2/FiO2 adjustment (OR: 4.38; P = 0.147). In-hospital death was 15.2% vs 3.9% (P = 0.081).
CONCLUSION: Dual positivity identified a severe hypoxemic phenotype with greater fungal co-detection. Oxygenation was the principal clinical correlate of excess risk.
METHODS: This retrospective single-center study linked clinical and bronchoalveolar lavage fluid pathogen-spectrum records. Influenza A was detected by RT-PCR and BALF pathogens by targeted next-generation sequencing. The primary endpoint was composite adverse hospital disposition (in-hospital death or discharge against medical advice [DAMA]); components were reported separately. Associations were estimated with binomial generalized linear models and Firth sensitivity analyses.
RESULTS: Among 97 adults (51 H1N1 mono-positive; 46 dual-positive), dual positivity was associated with lower PaO2/FiO2 (244.17 vs 293.94; P = 0.018), higher CRP and IL-6, more invasive ventilation (23.9% vs 7.8%; P = 0.047), and more fungal co-detection (47.8% vs 25.5%; P = 0.034). Composite adverse disposition occurred in 26.1% vs 3.9% (OR: 8.65; P = 0.003); the age- and sex-adjusted OR was 8.24 (P = 0.010) and attenuated after PaO2/FiO2 adjustment (OR: 4.38; P = 0.147). In-hospital death was 15.2% vs 3.9% (P = 0.081).
CONCLUSION: Dual positivity identified a severe hypoxemic phenotype with greater fungal co-detection. Oxygenation was the principal clinical correlate of excess risk.