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Volume 23, Number 4—April 2017

Dispatch

Markers of Disease Severity in Patients with Spanish Influenza in the Japanese Armed Forces, 1919–1920

Koichiro KudoComments to Author , Toshie Manabe, Shinyu Izumi, Jin Takasaki, Yuji Fujikura, Akihiko Kawana, and Kenji Yamamoto
Author affiliations: Koto Hospital, Tokyo, Japan (K. Kudo); Waseda University Organization for Regional and Inter-regional Studies, Tokyo (K. Kudo, T. Manabe); Teikyo University School of Medicine, Tokyo (T. Manabe); Tsukuba University Graduate School of Comprehensive Human Sciences, Ibaraki, Japan (T. Manabe); National Center for Global Health and Medicine, Tokyo (S. Izumi, J. Takasaki, K. Yamamoto); National Defence Medical College, Saitama, Japan (Y. Fujikura, A. Kawana); So-Yu Medical Foundation Institute of Medicine, Tokyo (K. Yamamoto)

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Table 1

General characteristics and clinical findings of patients with Spanish influenza during hospitalization, Japan, 1919–1920*

Characteristic/clinical feature
Nonsurvivors, n = 8
Survivors, by hospitalization length, n = 462
<10 d, n = 131
11–20 d, n = 161
>21 d, n = 170
p value†
Median age, y (IQR) 22 (21–23) 22 (21–28) 21 (20– 27) 21 (20–22) <0.001‡
Time from onset to first visit, median d (IQR) 2 (1 – 3) 1 (1–1) 1 (0 – 1) 1 (1–2) 0.081‡
Hospitalization, median d (IQR)
7 (6 −14)
8 (6–9)
15 (13 – 17)
32 (25–40)
<0.001‡
Duration of high fever from admission, median d (IQR) 7 (5–14) 3 (2–4) 7 (5 – 8) 10 (7–18) <0.001‡
   >6 d, no. (%)
6 (75.0)
12 (9.2)
91 (56.5)
123 (72.8)
<0.001§
Maximum respiration rate during hospitalization, median (IQR) 53 (45–60) 24 (21–26) 25 (24–30) 29 (25–33) <0.001‡
   ≥26 breaths/min., no. (%)
8 (100.0)
10 (16.4)
34 (39.5)
74 (65.5)
<0.001§
Diphasic fever, no. (%)
0
12 (9.2)
51 (31.7)
111 (65.7)
<0.001§
Adventitious lung sounds, no. (%)
Discontinuous 8 (100.0) 45 (34.4) 96 (59.6) 141 (82.9) <0.001§
Continuous 8 (100.0) 75 (57.3) 121 (75.2) 144 (84.7) <0.001§
Bronchial sounds on chest wall 5 (62.5) 7 (5.3) 13 (8.1) 27 (15.9) 0.002¶
Friction rub
2 (25.0)
2 (1.5)
6 (3.7)
21 (12.4)
<0.001¶
Clinical symptoms, no. (%)
Upper respiratory tract# 7 (87.5) 126 (96.2) 155 (96.3) 157 (92.4) 0.071§
Dyspnea/tachypnea 8 (100.0) 108 (82.4) 144 (89.4) 159 (93.5) 0.003§
Gastric intestinal 5 (62.5) 26 (19.8) 41 (25.5) 61 (35.9) 0.001§
Psycho/mental**
7 (87.5)
121 (92.4)
150 (93.2)
153 (90.0)
0.273§
*High fever, body temperature of >38°C; diphasic fever, body temperature >38°C at a time after the initial fever had decreased to <37.5°C. IQR, interquartile range;
†p values were calculated for the 3 groups on days of hospitalization of survivors (<10 d, vs 11 – 20, vs >21 d). 
‡By Kruskal-Wallis test.
§By χ2 test.
¶By Fisher exact test.
#Upper respiratory tract symptoms were cough, sputum, and wheezing. 
**Psycho/mental denotes psychological and mental disturbances, including anxiety, irritation, delirium, and confusion.

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