Influenza A-associated severe pneumonia in hospitalized patients: Risk factors and NAI treatments
Influenza A-associated severe pneumonia in hospitalized patients: Risk factors and NAI treatments
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住院患者甲型流感相关重症肺炎的危险因素和 NAI 治疗
DOI：
10.1016/j.ijid.2020.01.017
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发表时间：
2020-03-01
影响因子：
8.4
通讯作者：
Chen, Yu
中科院分区：
文献类型：
--
作者：
Zou, Qianda;Zheng, Shufa;Chen, Yu
目的：NAI治疗对重症甲型流感相关性肺炎患者的危险因素和影响尚不清楚。方法：在2017年8月至2018年5月的严重流感流行期间，在中国浙江进行了一项多中心、回顾性、观察性研究。将实验室确诊的甲型流感病毒感染住院患者（>14岁）的临床记录和发生重度肺炎的患者与轻中度肺炎患者进行比较。与肺炎严重程度和NAI治疗（帕拉米韦和奥司他韦单药治疗和联合治疗）的效果相关的危险因素进行了分析。结果：202例甲型流感相关性重症肺炎患者入组，其中84例（41.6%）死亡。男性性别（OR = 1.782; 95%CI：1.089-2.917; P = 0.022），慢性肺疾病（OR = 2.581; 95% CI：1.447-4.603; P = 0.001）和糖尿病（OR = 2.042; 95% CI：1.135-3.673; P = 0.017）是与甲型流感肺炎严重程度相关的危险因素。在考克斯比例风险模型中，双倍剂量奥司他韦（300 mg/d）治疗的重症肺炎患者的生存率高于单剂量奥司他韦（150 mg/d）治疗的患者（HR = 0.475，95%CI：0.254-0.887，P = 0.019）。然而，不同剂量的帕拉米韦（300 mg/d vs. 600 mg/d）和联合治疗（奥司他韦-帕拉米韦vs.单药治疗）显示60天死亡率无差异（P = 0.392和P = 0.658，分别）。结论：男性、慢性肺部疾病或糖尿病患者在甲型流感感染后发生重症肺炎的风险较高。在治疗甲型流感相关重症肺炎时，可考虑使用双倍剂量的奥司他韦。(C)2020作者由Elsevier Ltd代表国际传染病学会出版。
Objective: The risk factors and the impact of NAI treatments in patients with severe influenza A-associated pneumonia remain unclear.Methods: A multicenter, retrospective, observational study was conducted in Zhejiang, China during a severe influenza epidemic in August 2017-May 2018. Clinical records of patients (>14 y) hospitalized with laboratory-confirmed influenza A virus infection and who developed severe pneumonia were compared to those with mild-to-moderate pneumonia. Risk factors related to pneumonia severity and effects of NAI treatments (monotherapy and combination of peramivir and oseltamivir) were analyzed.Results: 202 patients with influenza A-associated severe pneumonia were enrolled, of whom 84 (41.6%) had died. Male gender (OR = 1.782; 95% CI: 1.089-2.917; P = 0.022), chronic pulmonary disease (OR = 2.581; 95% CI: 1.447-4.603; P = 0.001) and diabetes mellitus (OR = 2.042; 95% CI: 1.135-3.673; P = 0.017) were risk factors related to influenza A pneumonia severity. In cox proportional hazards model, severe pneumonia patients treated with double dose oseltamivir (300mg/d) had a better survival rate compared to those receiving a single dose (150 mg/d) (HR = 0.475; 95%CI: 0.254-0.887; P = 0.019). However, different doses of peramivir (300 mg/d vs. 600 mg/d) and combination therapy (oseltamivir-peramivir vs. monotherapy) showed no differences in 60-day mortality (P = 0.392 and P = 0.658, respectively).Conclusions: Patients with male gender, chronic pulmonary disease, or diabetes mellitus were at high risk of developing severe pneumonia after influenza A infection. Double dose oseltamivir might be considered in treating influenza A-associated severe pneumonia. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.