Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients.
Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients.
复制标题
DOI：
10.1183/09031936.00169714
复制
发表时间：
2015-06
期刊：
影响因子：
--
通讯作者：
Hui DS
中科院分区：
文献类型：
--
作者：
Lee N;Leo YS;Cao B;Chan PK;Kyaw WM;Uyeki TM;Tam WW;Cheung CS;Yung IM;Li H;Gu L;Liu Y;Liu Z;Qu J;Hui DS
我们的目的是研究影响因季节性流感和大流行性流感住院的成人预后的因素。分析了3个亚洲队列（中国香港、新加坡和北京; N=2649）的个体患者数据。对2008- 2011年期间因实验室确诊流感（前瞻性诊断）住院的成人进行了研究。主要结果指标为30天生存率。使用多变量考克斯回归模型（时间固定和时间依赖）。患者的发病率（68.4%的呼吸/非呼吸系统并发症，48.6%的呼吸衰竭，40.8%的肺炎和10.8%的细菌双重感染）和死亡率（30天和60天时分别为5.9%和6.9%）较高。75.2%的患者接受神经氨酸酶抑制剂（NAI）治疗（73.8%的患者接受奥司他韦治疗，1.4%的患者接受帕拉米韦/扎那米韦治疗; 44.5%的患者在发病后2天内接受NAI治疗，65.5%的患者在发病后5天内接受NAI治疗）; 23.1%的患者接受全身性皮质类固醇治疗。NAI治疗患者的死亡率更低（5.3% vs 7.6%; p=0.032）。NAI治疗与生存率独立相关（校正的风险比（HR）0.28，95%CI 0.19-0.43），校正了治疗倾向评分和患者特征。重复感染增加（校正HR 2.18，95% CI 1.52-3.11），长期使用他汀类药物降低（校正HR 0.44，95% CI 0.23-0.84）死亡风险。当治疗在12天内开始时显示最佳生存率（校正HR 0.20，95% CI 0.12-0.32），但在3-5天内治疗有获益（校正HR 0.35，95% CI 0.21-0.58）。时间依赖性分析显示NAI治疗的结果一致（校正HR 0.39，95% CI 0.27-0.57）。当控制适应症时，皮质类固醇增加了二重感染（9.7% vs 2.7%）和死亡（校正HR 1.73，95% CI 1.14-2.62）。在亚组分析中，早期NAI治疗与较短的住院时间相关。NAI治疗可以改善住院流感患者的生存率;受益最大的是，但不限于，在患病后2天内开始治疗。重叠感染和皮质类固醇增加死亡率。应考虑抗病毒和非抗病毒管理策略。
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 HR0.35, 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.
登录
查看更多内容
影响因子：
3.7
作者：
Higuera Iglesias AL;Kudo K;Manabe T;Corcho Berdugo AE;Corrales Baeza A;Alfaro Ramos L;Guevara Gutiérrez R;Manjarrez Zavala ME;Takasaki J;Izumi S;Bautista E;Perez Padilla JR
通讯作者：
Perez Padilla JR
影响因子：
11.8
作者：
Han, Ke;Ma, Huilai;Zeng, Guang
通讯作者：
Zeng, Guang
DOI：
10.1164/rccm.201209-1718oc
发表时间：
2013-04-01
影响因子：
24.7
作者：
Kruger, Peter;Bailey, Michael;Venkatesh, Bala
通讯作者：
Venkatesh, Bala
DOI：
10.1164/rccm.201101-0110oc
发表时间：
2011-05-01
影响因子：
24.7
作者：
Kim, Sung-Han;Hong, Sang-Bum;Koh, Younsuck
通讯作者：
Koh, Younsuck
影响因子：
6.4
作者：
Chan, Paul K. S.;Lee, Nelson;Dreyer, Nancy A.
通讯作者：
Dreyer, Nancy A.