tetano
Editor, Senior Moderator
Eur Respir J. 2015 Jan 8. pii: ERJ-01697-2014. [Epub ahead of print]
[h=1]Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients.[/h] Lee N[SUP]1[/SUP], Leo YS[SUP]2[/SUP], Cao B[SUP]3[/SUP], Chan PK[SUP]4[/SUP], Kyaw WM[SUP]2[/SUP], Uyeki TM[SUP]5[/SUP], Tam WW[SUP]6[/SUP], Cheung CS[SUP]7[/SUP], Yung IM[SUP]7[/SUP], Li H[SUP]3[/SUP], Gu L[SUP]3[/SUP], Liu Y[SUP]3[/SUP], Liu Z[SUP]3[/SUP], Qu J[SUP]3[/SUP], Hui DS[SUP]8[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] We aimed to study factors influencing outcomes of adults hospitalised for seasonal and pandemic influenza. Individual-patient data from three Asian cohorts (Hong Kong, Singapore and Beijing; N=2649) were analysed. Adults hospitalised for laboratory-confirmed influenza (prospectively diagnosed) during 2008-2011 were studied. The primary outcome measure was 30-day survival. Multivariate Cox regression models (time-fixed and time-dependent) were used. Patients had high morbidity (respiratory/nonrespiratory complications in 68.4%, respiratory-failure in 48.6%, pneumonia in 40.8% and bacterial superinfections in 10.8%) and mortality (5.9% at 30 days and 6.9% at 60 days). 75.2% received neuraminidase inhibitors (NAI) (73.8% received oseltamivir and 1.4% received peramivir/zanamivir; 44.5% of patients received NAI ⩽2 days and 65.5% ⩽5 days after onset of illness); 23.1% received systemic corticosteroids. There were fewer deaths among NAI-treated patients (5.3% versus 7.6%; p=0.032). NAI treatment was independently associated with survival (adjusted hazard ratio (HR) 0.28, 95% CI 0.19-0.43), adjusted for treatment-propensity score and patient characteristics. Superinfections increased (adjusted HR 2.18, 95% CI 1.52-3.11) and chronic statin use decreased (adjusted HR 0.44, 95% CI 0.23-0.84) death risks. Best survival was shown when treatment started within ⩽2 days (adjusted HR 0.20, 95% CI 0.12-0.32), but there was benefit with treatment within 3-5 days (adjusted HR 0.35, 95% CI 0.21-0.58). Time-dependent analysis showed consistent results of NAI treatment (adjusted HR 0.39, 95% CI 0.27-0.57). Corticosteroids increased superinfection (9.7% versus 2.7%) and deaths when controlled for indications (adjusted HR 1.73, 95% CI 1.14-2.62). Early NAI treatment was associated with shorter length of stay in a subanalysis. NAI treatment may improve survival of hospitalised influenza patients; benefit is greatest from, but not limited to, treatment started within 2 days of illness. Superinfections and corticosteroids increase mortality. Antiviral and non-antiviral management strategies should be considered.
Copyright ?ERS 2014.
PMID: 25573405 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25573405
[h=1]Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients.[/h] Lee N[SUP]1[/SUP], Leo YS[SUP]2[/SUP], Cao B[SUP]3[/SUP], Chan PK[SUP]4[/SUP], Kyaw WM[SUP]2[/SUP], Uyeki TM[SUP]5[/SUP], Tam WW[SUP]6[/SUP], Cheung CS[SUP]7[/SUP], Yung IM[SUP]7[/SUP], Li H[SUP]3[/SUP], Gu L[SUP]3[/SUP], Liu Y[SUP]3[/SUP], Liu Z[SUP]3[/SUP], Qu J[SUP]3[/SUP], Hui DS[SUP]8[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] We aimed to study factors influencing outcomes of adults hospitalised for seasonal and pandemic influenza. Individual-patient data from three Asian cohorts (Hong Kong, Singapore and Beijing; N=2649) were analysed. Adults hospitalised for laboratory-confirmed influenza (prospectively diagnosed) during 2008-2011 were studied. The primary outcome measure was 30-day survival. Multivariate Cox regression models (time-fixed and time-dependent) were used. Patients had high morbidity (respiratory/nonrespiratory complications in 68.4%, respiratory-failure in 48.6%, pneumonia in 40.8% and bacterial superinfections in 10.8%) and mortality (5.9% at 30 days and 6.9% at 60 days). 75.2% received neuraminidase inhibitors (NAI) (73.8% received oseltamivir and 1.4% received peramivir/zanamivir; 44.5% of patients received NAI ⩽2 days and 65.5% ⩽5 days after onset of illness); 23.1% received systemic corticosteroids. There were fewer deaths among NAI-treated patients (5.3% versus 7.6%; p=0.032). NAI treatment was independently associated with survival (adjusted hazard ratio (HR) 0.28, 95% CI 0.19-0.43), adjusted for treatment-propensity score and patient characteristics. Superinfections increased (adjusted HR 2.18, 95% CI 1.52-3.11) and chronic statin use decreased (adjusted HR 0.44, 95% CI 0.23-0.84) death risks. Best survival was shown when treatment started within ⩽2 days (adjusted HR 0.20, 95% CI 0.12-0.32), but there was benefit with treatment within 3-5 days (adjusted HR 0.35, 95% CI 0.21-0.58). Time-dependent analysis showed consistent results of NAI treatment (adjusted HR 0.39, 95% CI 0.27-0.57). Corticosteroids increased superinfection (9.7% versus 2.7%) and deaths when controlled for indications (adjusted HR 1.73, 95% CI 1.14-2.62). Early NAI treatment was associated with shorter length of stay in a subanalysis. NAI treatment may improve survival of hospitalised influenza patients; benefit is greatest from, but not limited to, treatment started within 2 days of illness. Superinfections and corticosteroids increase mortality. Antiviral and non-antiviral management strategies should be considered.
Copyright ?ERS 2014.
PMID: 25573405 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25573405