tetano
Editor, Senior Moderator
Chest. 2011 Mar 17. [Epub ahead of print]
Timing of Oseltamivir Administration and Outcomes in Hospitalized Adults with Pandemic 2009 Influenza A (H1N1) Virus Infection.
Viasus D, Pa?o-Pardo JR, Pach?n J, Riera M, L?pez-Medrano F, Payeras A, Fari?as MC, Moreno A, Rodr?guez-Ba?o J, Oteo JA, Ortega L, Torre-Cisneros J, Segura F, Carratal? J; for the Novel Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI).
Departments of Infectious Diseases from the Hospital Universitari de Bellvitge - IDIBELL, University of Barcelona, Barcelona (Drs. Viasus, Carratal?), Hospital Universitario La Paz - IDIPAZ, Madrid (Dr. Pa?o-Pardo), Hospital Universitario Virgen del Roc?o, Sevilla (Dr. Pach?n), Hospital Universitario Son Dureta, Palma de Mallorca (Dr. Riera), Hospital Universitario 12 de Octubre, Madrid (Dr. L?pez-Medrano), Hospital Son Ll?tzer, Palma de Mallorca (Dr. Payeras), Hospital Universitario Marqu?s de Valdecilla, Santander (Dr. Fari?as), Hospital Universitario Clinic, Barcelona (Dr. Moreno), Hospital Universitario Virgen Macarena, Sevilla (Dr. Rodr?guez-Ba?o), Hospital San Pedro - CIBIR, Logro?o (Dr. Oteo), SCIAS - Hospital de Barcelona, Barcelona (Dr. Ortega), Hospital Universitario Reina Sof?a - IMIBIC, University of C?rdoba, C?rdoba (Dr. Torre-Cisneros), Hospital Parc Tauli, Sabadell (Dr. Segura), Spain.
Abstract
ABSTRACT
BACKGROUND: Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A (H1N1) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with pandemic (H1N1) 2009.
METHODS: Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed pandemic (H1N1) 2009 at thirteen Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, length of hospital stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes.
RESULTS: Five hundred thirty-eight hospitalized patients with pandemic (H1N1) 2009 were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR] 2-5 days). Regarding outcomes, the median duration of fever was 2 days (IQR 1-3), the median LOS was 5 days (IQR 3-8), 49 (9.1%) patients underwent mechanical ventilation, and 11 (2%) patients died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (chi-square test for trend P=.001, P=<.001, P=.008 and P=.001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+1 day increase) was associated with a prolonged duration of fever (odd ratio [OR] 1.10, 95% confidence interval [CI] 1.02-1.19), prolonged LOS (OR 1.07, 95% CI 1.00-1.15) and higher mortality (OR 1.20, 95% CI 1.06-1.35).
CONCLUSIONS: Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with pandemic (H1N1) 2009, even in those who are admitted beyond 48 hours after onset of symptoms.
PMID: 21415133 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21415133
Timing of Oseltamivir Administration and Outcomes in Hospitalized Adults with Pandemic 2009 Influenza A (H1N1) Virus Infection.
Viasus D, Pa?o-Pardo JR, Pach?n J, Riera M, L?pez-Medrano F, Payeras A, Fari?as MC, Moreno A, Rodr?guez-Ba?o J, Oteo JA, Ortega L, Torre-Cisneros J, Segura F, Carratal? J; for the Novel Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI).
Departments of Infectious Diseases from the Hospital Universitari de Bellvitge - IDIBELL, University of Barcelona, Barcelona (Drs. Viasus, Carratal?), Hospital Universitario La Paz - IDIPAZ, Madrid (Dr. Pa?o-Pardo), Hospital Universitario Virgen del Roc?o, Sevilla (Dr. Pach?n), Hospital Universitario Son Dureta, Palma de Mallorca (Dr. Riera), Hospital Universitario 12 de Octubre, Madrid (Dr. L?pez-Medrano), Hospital Son Ll?tzer, Palma de Mallorca (Dr. Payeras), Hospital Universitario Marqu?s de Valdecilla, Santander (Dr. Fari?as), Hospital Universitario Clinic, Barcelona (Dr. Moreno), Hospital Universitario Virgen Macarena, Sevilla (Dr. Rodr?guez-Ba?o), Hospital San Pedro - CIBIR, Logro?o (Dr. Oteo), SCIAS - Hospital de Barcelona, Barcelona (Dr. Ortega), Hospital Universitario Reina Sof?a - IMIBIC, University of C?rdoba, C?rdoba (Dr. Torre-Cisneros), Hospital Parc Tauli, Sabadell (Dr. Segura), Spain.
Abstract
ABSTRACT
BACKGROUND: Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A (H1N1) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with pandemic (H1N1) 2009.
METHODS: Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed pandemic (H1N1) 2009 at thirteen Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, length of hospital stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes.
RESULTS: Five hundred thirty-eight hospitalized patients with pandemic (H1N1) 2009 were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR] 2-5 days). Regarding outcomes, the median duration of fever was 2 days (IQR 1-3), the median LOS was 5 days (IQR 3-8), 49 (9.1%) patients underwent mechanical ventilation, and 11 (2%) patients died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (chi-square test for trend P=.001, P=<.001, P=.008 and P=.001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+1 day increase) was associated with a prolonged duration of fever (odd ratio [OR] 1.10, 95% confidence interval [CI] 1.02-1.19), prolonged LOS (OR 1.07, 95% CI 1.00-1.15) and higher mortality (OR 1.20, 95% CI 1.06-1.35).
CONCLUSIONS: Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with pandemic (H1N1) 2009, even in those who are admitted beyond 48 hours after onset of symptoms.
PMID: 21415133 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21415133