Extreme influenza epidemics and out-of-hospital cardiac arrest
Extreme influenza epidemics and out-of-hospital cardiac arrest
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DOI：
10.1016/j.ijcard.2018.02.028
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发表时间：
2018-07-15
影响因子：
3.5
通讯作者：
Hagihara, Akihito
中科院分区：
文献类型：
--
作者：
Onozuka, Daisuke;Hagihara, Akihito
引言：有令人信服的证据表明流感流行与主要不良心血管事件之间存在关联。然而，极端流感流行作为院外心脏骤停（OHCA）的触发因素的作用尚不清楚。因此，我们评估了极端流感流行和OHCA.Methods发病率之间的潜在关联：我们使用了准实验设计与时间序列分析的国家登记数据的情况下，OHCA从所有47个县的日本在2005年和2014年之间的流感季节。泊松回归时间序列模型与分布滞后非线性模型被用来估计特定的州流感流行对OHCA的影响。结果：在研究期间，共报告了481,516例推定为心源性的OHCA。最低发病率百分位数（MMP）估计为流感发病率的第0百分位数。极端流感流行（流感发病率的第99百分位数）的总体累积相对风险与MMP相比为1.25（95%置信区间，1.16-1.34）。极端流感流行的影响在1.5-7.1天和17.9-21天的滞后期内是显著的。多因素随机效应Meta分析结果显示，各地市间存在显著的空间异质性（Cochran Q检验，p = 0.011; I-2 = 23.2%）。我们的研究结果表明，应实施几周的极端流感感染预防，以降低OHCA的风险。(C)2018爱思唯尔B. V.保留所有权利。
Introduction: There is compelling evidence for an association between influenza epidemics and major adverse cardiovascular events. However, the role of extreme influenza epidemics as a trigger of out-of-hospital cardiac arrest (OHCA) is unclear. Thus, we evaluated the potential association between extreme influenza epidemics and incidence of OHCA.Methods: We used a quasi-experimental design with time-series analysis of national registry data for cases of OHCA from all 47 prefectures of Japan during influenza seasons between 2005 and 2014. A Poisson regression time-series model with a distributed lag non-linear model was used to estimate prefecture-specific effects of influenza epidemics on OHCA. A multivariate meta-analysis was conducted for nationally pooled estimates.Results: In total,481,516 OHCAs of presumed cardiac origin were reported during the study period. The minimum morbidity percentile (MMP) was estimated as the 0th percentile for influenza incidence. The overall cumulative relative risk versus the MMP was 1.25 (95% confidence interval, 1.16-1.34) for extreme influenza epidemics (at the 99th percentile of influenza incidence). The effect of extreme influenza epidemics was significant for lag periods of 1.5-7.1 and 17.9-21 days. Multivariate random-effects meta-analysis indicated significant spatial heterogeneity among prefectures (Cochran Q test, p = 0.011; I-2 = 23.2%).Conclusion: Extreme influenza epidemics are associated with higher risk of OHCA. Our findings suggest that several weeks' prevention for extreme influenza infections should be implemented to reduce the risk of OHCA. (C) 2018 Elsevier B.V. All rights reserved.