Early Use of Glucocorticoids Was a Risk Factor for Critical Disease and Death From pH1N1 Infection
Early Use of Glucocorticoids Was a Risk Factor for Critical Disease and Death From pH1N1 Infection
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DOI：
10.1093/cid/cir398
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发表时间：
2011-08-15
影响因子：
11.8
通讯作者：
Zeng, Guang
中科院分区：
文献类型：
--
作者：
Han, Ke;Ma, Huilai;Zeng, Guang
背景糖皮质激素会增加病毒感染导致危重疾病的风险。然而，在中国的初级保健从业者使用它们作为退烧药，潜在地暴露数亿人的这种风险。我们招募了2009年10月20日至11月30日期间在沈阳市4家医院确诊为甲型pH 1 N1流感病毒感染的所有患者，年龄≥ 3岁，有可用的病历。危重患者是任何确诊的、住院的pH 1 N1患者，其发生了以下情况中的≥ 1种：死亡、呼吸衰竭、感染性休克、≥ 2个非肺器官衰竭或功能不全、机械通气或ICU入院。在一项回顾性队列研究中，我们评估了与早期（流感样疾病[ILI]发作< 72小时）糖皮质激素治疗相关的危重病发生风险。在83名住院病例中，46%的患者病情危重，17%的患者死亡，37%的患者康复出院。危重患者和其他患者在基础疾病和严重程度、首次门诊访视时的中位体温和其他测量的风险因素方面没有差异。在接受早期糖皮质激素治疗的17例患者中，71%的患者随后发展为危重疾病，而在接受晚期（> 72小时）或未接受糖皮质激素治疗的66例患者中，39%的患者随后发展为危重疾病（RRM-H = 1.8，95%CI = 1.2-2.8，调整2个汇总变量后;即，存在基础疾病和存在基础风险因素）。比例风险模型显示，使用糖皮质激素使发生危重疾病的风险增加3倍（风险比[HR] = 2.9，95%CI = 1.3-6.2，调整相同的汇总变量后）。早期使用胃肠外糖皮质激素治疗以减少发热和预防肺炎会增加因pH 1 N1感染而发生危重疾病或死亡的风险。我们建议制定并执行糖皮质激素使用指南。
Background. Glucocorticoids increase the risk of developing critical disease from viral infections. However, primary care practitioners in China use them as antipyretics, potentially exposing hundreds of millions to this risk.Methods. We enrolled all patients with confirmed pandemic influenza A (pH1N1) virus infection aged >= 3 years with available medical records at 4 Shenyang City hospitals from 20 October to 30 November 2009. A critical patient was any confirmed, hospitalized pH1N1 patient who developed >= 1 of the following: death, respiratory failure, septic shock, failure or insufficiency of >= 2 nonpulmonary organs, mechanical ventilation, or ICU admission. In a retrospective cohort study, we evaluated the risk of developing critical illness in relation to early (< 72 hours of influenza-like illness [ILI] onset) glucocorticoids treatment.Results. Of the 83 hospitalized case-patients, 46% developed critical illness, 17% died, and 37% recovered and were discharged. Critically ill and other patients did not differ by underlying conditions and severity, median temperature at first clinic visit, and other measured risk factors. Of 17 patients who received early glucocorticoid treatment, 71% subsequently developed critical disease compared with 39% of 66 patients who received late (> 72 hours) or no glucocorticoid treatment (RRM-H = 1.8, 95% CI = 1.2-2.8, after adjusting for 2 summary variables; ie, presence of underlying diseases and presence of underlying risk factors). Proportional hazards modeling showed that use of glucocorticoids tripled the hazard of developing critical disease (hazard ratio [HR] = 2.9, 95% CI = 1.3-6.2, after adjusting for the same summary variables).Conclusions. Early use of parenteral glucocorticoids therapy for fever reduction and pneumonia prevention increases the risk for critical disease or death from pH1N1 infection. We recommend that guidelines on glucocorticoid use be established and enforced.