RT Journal Article
SR Electronic
T1 Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1642
OP 1652
DO 10.1183/09031936.00169714
VO 45
IS 6
A1 Nelson Lee
A1 Yee-Sin Leo
A1 Bin Cao
A1 Paul K.S. Chan
A1 W.M. Kyaw
A1 Timothy M. Uyeki
A1 Wilson W.S. Tam
A1 Catherine S.K. Cheung
A1 Irene M.H. Yung
A1 Hui Li
A1 Li Gu
A1 Yingmei Liu
A1 Zhenjia Liu
A1 Jiuxin Qu
A1 David S.C. Hui
YR 2015
UL http://erj.ersjournals.com/content/45/6/1642.abstract
AB 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 HR 0.35, 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. NAI treatment, secondary infections and corticosteroids may impact on survival of hospitalised influenza patients http://ow.ly/ErOsT