tetano
Editor, Senior Moderator
Oxford Journals
Medicine
Clinical Infectious Diseases
Volume53, Issue4
Pp. 326-333
Early Use of Glucocorticoids Was a Risk Factor for Critical Disease and Death From pH1N1 Infection
Ke Han1,2,a,
Huilai Ma2,a,
Xiangdong An3,a,
Yang Su2,
Jing Chen2,
Zhiyong Lian3,
JinHui Zhao2,
Bao-Ping Zhu2,
Robert E. Fontaine4,
Zijian Feng5, and
Guang Zeng2
+ Author Affiliations
1Institute of Immunization Program, Guangdong Center for Disease Control and Prevention, Guangdong, China
2Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China
3Office for Disease Control and Emergency Response, Shenyang Center for Disease Control and Prevention, Liaoning, China
4US Centers for Disease Control and Prevention, Atlanta, Georgia
5Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing, China
Correspondence: Guang Zeng, MS, Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China (guangzeng4605@sohu.com).
Abstract
Background. Glucocorticoids increase the risk of developing critical disease from viral infections. However, primary care practitioners in China use them as antipyretics, potentially exposing hundreds of millions to this risk.
Methods. We enrolled all patients with confirmed pandemic influenza A (pH1N1) virus infection aged ≥3 years with available medical records at 4 Shenyang City hospitals from 20 October to 30 November 2009. A critical patient was any confirmed, hospitalized pH1N1 patient who developed ≥1 of the following: death, respiratory failure, septic shock, failure or insufficiency of ≥2 nonpulmonary organs, mechanical ventilation, or ICU admission. In a retrospective cohort study, we evaluated the risk of developing critical illness in relation to early (≤72 hours of influenza-like illness [ILI] onset) glucocorticoids treatment.
Results. Of the 83 hospitalized case-patients, 46% developed critical illness, 17% died, and 37% recovered and were discharged. Critically ill and other patients did not differ by underlying conditions and severity, median temperature at first clinic visit, and other measured risk factors. Of 17 patients who received early glucocorticoid treatment, 71% subsequently developed critical disease compared with 39% of 66 patients who received late (>72 hours) or no glucocorticoid treatment (RRM-H = 1.8, 95% CI = 1.2?2.8, after adjusting for 2 summary variables; ie, presence of underlying diseases and presence of underlying risk factors). Proportional hazards modeling showed that use of glucocorticoids tripled the hazard of developing critical disease (hazard ratio
= 2.9, 95% CI = 1.3?6.2, after adjusting for the same summary variables).
Conclusions. Early use of parenteral glucocorticoids therapy for fever reduction and pneumonia prevention increases the risk for critical disease or death from pH1N1 infection. We recommend that guidelines on glucocorticoid use be established and enforced.
http://cid.oxfordjournals.org/content/53/4/326.short?rss=1
Medicine
Clinical Infectious Diseases
Volume53, Issue4
Pp. 326-333
Early Use of Glucocorticoids Was a Risk Factor for Critical Disease and Death From pH1N1 Infection
Ke Han1,2,a,
Huilai Ma2,a,
Xiangdong An3,a,
Yang Su2,
Jing Chen2,
Zhiyong Lian3,
JinHui Zhao2,
Bao-Ping Zhu2,
Robert E. Fontaine4,
Zijian Feng5, and
Guang Zeng2
+ Author Affiliations
1Institute of Immunization Program, Guangdong Center for Disease Control and Prevention, Guangdong, China
2Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China
3Office for Disease Control and Emergency Response, Shenyang Center for Disease Control and Prevention, Liaoning, China
4US Centers for Disease Control and Prevention, Atlanta, Georgia
5Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing, China
Correspondence: Guang Zeng, MS, Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China (guangzeng4605@sohu.com).
Abstract
Background. Glucocorticoids increase the risk of developing critical disease from viral infections. However, primary care practitioners in China use them as antipyretics, potentially exposing hundreds of millions to this risk.
Methods. We enrolled all patients with confirmed pandemic influenza A (pH1N1) virus infection aged ≥3 years with available medical records at 4 Shenyang City hospitals from 20 October to 30 November 2009. A critical patient was any confirmed, hospitalized pH1N1 patient who developed ≥1 of the following: death, respiratory failure, septic shock, failure or insufficiency of ≥2 nonpulmonary organs, mechanical ventilation, or ICU admission. In a retrospective cohort study, we evaluated the risk of developing critical illness in relation to early (≤72 hours of influenza-like illness [ILI] onset) glucocorticoids treatment.
Results. Of the 83 hospitalized case-patients, 46% developed critical illness, 17% died, and 37% recovered and were discharged. Critically ill and other patients did not differ by underlying conditions and severity, median temperature at first clinic visit, and other measured risk factors. Of 17 patients who received early glucocorticoid treatment, 71% subsequently developed critical disease compared with 39% of 66 patients who received late (>72 hours) or no glucocorticoid treatment (RRM-H = 1.8, 95% CI = 1.2?2.8, after adjusting for 2 summary variables; ie, presence of underlying diseases and presence of underlying risk factors). Proportional hazards modeling showed that use of glucocorticoids tripled the hazard of developing critical disease (hazard ratio
= 2.9, 95% CI = 1.3?6.2, after adjusting for the same summary variables).
Conclusions. Early use of parenteral glucocorticoids therapy for fever reduction and pneumonia prevention increases the risk for critical disease or death from pH1N1 infection. We recommend that guidelines on glucocorticoid use be established and enforced.
http://cid.oxfordjournals.org/content/53/4/326.short?rss=1