Outcomes of adults hospitalised with severe influenza
Outcomes of adults hospitalised with severe influenza
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DOI：
10.1136/thx.2009.130799
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发表时间：
2010-06-01
期刊：
影响因子：
10
通讯作者：
Sung, J. J. Y.
中科院分区：
文献类型：
--
作者：
Lee, N.;Choi, K. W.;Sung, J. J. Y.
背景本研究的目的是调查严重的季节性流感住院的成人的临床结局的影响因素。方法前瞻性，观察性队列研究进行了24个月（2007-2008年），在两个急性综合医院。招募连续住院的成人患者，并在确定其实验室诊断为甲型/B型流感后对其进行随访（基于根据方案采集的鼻咽抽吸物中的病毒抗原检测和病毒分离）。研究的结果包括住院死亡、住院时间和氧疗时间。采用多变量考克斯比例风险模型分析影响结局的因素。结果754例患者（A型流感，n=539; > 75%H3N2）进行了研究。他们的平均年龄为70 - 618岁;合并症和严重并发症很常见（61-77%）。分别有401例（53.2%）和41例（5.4%）患者需要补充氧气和呼吸支持。39例（5.2%）患者死亡;肺炎、呼吸衰竭和败血症是原因。395例（52%）患者接受抗病毒（奥司他韦）治疗。忽略抗病毒治疗与延迟呈递或阴性抗原检测结果相关。治疗和未治疗患者的死亡率分别为4.56和7.42/1000患者-天;在合并症患者中，死亡率分别为5.62和11.64/1000患者-天。在多变量分析中，抗病毒治疗与死亡风险降低相关（校正HR（aHR）0.27（95%CI 0.13 - 0.55）; p
Background The aim of this study was to investigate factors affecting clinical outcomes of adults hospitalised with severe seasonal influenza.Methods A prospective, observational cohort study was conducted over 24 months (2007-2008) in two acute, general hospitals. Consecutive, hospitalised adult patients were recruited and followed once their laboratory diagnosis of influenza A/B was established (based on viral antigen detection and virus isolation from nasopharyngeal aspirates collected per protocol). Outcomes studied included in-hospital death, length of stay and duration of oxygen therapy. Factors affecting outcomes were analysed using multivariate Cox proportional hazards models. Sequencing analysis on the neuraminidase gene was performed for available H1N1 isolates.Results 754 patients were studied (influenza A, n=539; >75% H3N2). Their mean age was 70618 years; comorbidities and serious complications were common (61-77%). Supplemental oxygen and ventilatory support was required in 401 (53.2%) and 41 (5.4%) patients, respectively. 39 (5.2%) patients died; pneumonia, respiratory failure and sepsis were the causes. 395 (52%) patients received antiviral (oseltamivir) treatment. Omission of antiviral treatment was associated with delayed presentation or negative antigen detection results. The mortality rate was 4.56 and 7.42 per 1000 patient-days in the treated and untreated patients, respectively; among those with co-morbidities, it was 5.62 and 11.64 per 1000 patient-days, respectively. In multivariate analysis, antiviral use was associated with reduced risk of death (adjusted HR (aHR) 0.27 (95% CI 0.13 to 0.55); p