Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis.
Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis.
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DOI：
10.1111/irv.12363
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发表时间：
2016-05
影响因子：
4.4
通讯作者：
Nguyen-Van-Tam JS
中科院分区：
文献类型：
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作者：
Muthuri SG;Venkatesan S;Myles PR;Leonardi-Bee J;Lim WS;Al Mamun A;Anovadiya AP;Araújo WN;Azziz-Baumgartner E;Báez C;Bantar C;Barhoush MM;Bassetti M;Beovic B;Bingisser R;Bonmarin I;Borja-Aburto VH;Cao B;Carratala J;Cuezzo MR;Denholm JT;Dominguez SR;Duarte PA;Dubnov-Raz G;Echavarria M;Fanella S;Fraser J;Gao Z;Gérardin P;Giannella M;Gubbels S;Herberg J;Higuera Iglesias AL;Hoeger PH;Hoffmann M;Hu X;Islam QT;Jiménez MF;Kandeel A;Keijzers G;Khalili H;Khandaker G;Knight M;Kusznierz G;Kuzman I;Kwan AM;Lahlou Amine I;Langenegger E;Lankarani KB;Leo YS;Linko R;Liu P;Madanat F;Manabe T;Mayo-Montero E;McGeer A;Memish ZA;Metan G;Mikić D;Mohn KG;Moradi A;Nymadawa P;Ozbay B;Ozkan M;Parekh D;Paul M;Poeppl W;Polack FP;Rath BA;Rodríguez AH;Siqueira MM;Skręt-Magierło J;Talarek E;Tang JW;Torres A;Törün SH;Tran D;Uyeki TM;van Zwol A;Vaudry W;Velyvyte D;Vidmar T;Zarogoulidis P;PRIDE Consortium Investigators;Nguyen-Van-Tam JS
神经氨酸酶抑制剂（NAIs）对流感相关肺炎（IRP）的影响尚未确定。我们的目的是调查 A(H1N1)pdm09 病毒感染住院患者的 NAI 治疗与 IRP 发生率和结局之间的关联。对 20 634 名实验室确诊的 A(H1N1)pdm09 (n = 20 021) 或临床诊断 (n = 613)“大流行性流感”住院患者的个体参与者数据进行的全球荟萃分析。主要结果是放射学证实的 IRP。使用广义线性混合模型估计优势比 (OR)，并根据 NAI 治疗倾向、抗生素和皮质类固醇进行调整。在 20 634 名参与者中，5978 名 (29·0%) 有 IRP；相反，3349 名 (16·2%) 确认不存在放射学肺炎（对照）。早期 NAI 治疗（症状出现 2 天内）与不接受 NAI 治疗相比，与 IRP 没有显着相关性。或 0·83（95% CI 0·64–1·06；P = 0·136）]。在 5978 名 IRP 患者中，早期 NAI 治疗与不接受 NAI 治疗相比，对死亡率没有影响。 OR = 0·72 (0·44–1·17; P = 0·180)] 或需要通气支持的可能性 [adj. OR = 1·17 (0·71–1·92; P = 0·537)]，但早期治疗与后期治疗相比死亡率显着降低[调整。 OR = 0·70 (0·55–0·88; P = 0·003)] 和需要通气支持的可能性 [调整。 OR = 0·68 (0·54–0·85; P = 0·001)]。与不治疗相比，对 A(H1N1)pdm09 病毒感染住院患者进行早期 NAI 治疗并没有降低 IRP 的可能性。然而，对于发生 IRP 的患者，早期 NAI 治疗与后期治疗相比，可降低死亡率和需要通气支持的可能性。
The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.