Lee Nelson, Chan Paul K S, Choi Kin Wing, Lui Grace, Wong Bonnie, Cockram Clive S, Hui David S C, Lai Raymond, Tang Julian W, Sung Joseph J Y
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Antivir Ther. 2007;12(4):501-8.
Understanding factors affecting length of hospital stay (LOS) in patients with severe influenza may improve their management.
A retrospective cohort study on laboratory-confirmed, adult influenza patients hospitalized in 2004 and 2005 was conducted. For all influenza cases during that period, immunofluorescence assay on nasopharyngeal aspirate was used for rapid diagnosis, and oseltamivir (75 mg twice daily for 5 days) prescribed if the patient presented within 2 days of symptom onset. Independent factors associated with time to discharge were identified using Cox proportional hazards models. An adjusted hazard ratio (aHR) >1 signifies a higher chance of early discharge. Viral shedding and influenza vaccination history were studied during one 'flu' season.
A total of 356 patients (influenza A 93.5%) were studied. The majority of patients were old (70.2 +/- 8.4 years), had > or = 1 comorbid illness (69.1%) and developed respiratory or cardiovascular complications (69.4%). Oseltamivir initiated within 2 days of illness was associated with shorter total LOS (Kaplan-Meier estimated median 4 versus 6 days [-33%]; aHR for discharge 1.54, 95% confidence intervals [95% CI] 1.23-1.92, P < 0.0001). Older age (> or = 70 years), comorbidities and complications were associated with prolonged LOS. Prolonged viral RNA detection >day 4 of illness (23 out of 99 consecutive patients) was also independently associated with longer LOS (aHR 0.36 [95% CI 0.19-0.71], P = 0.003), whereas influenza vaccination within 6 months was associated with shorter LOS (aHR 2.14 [95% CI 1.18-3.85], P = 0.012).
Our analyses suggest that timely oseltamivir treatment is independently associated with shorter LOS in patients hospitalized for severe influenza. Efforts to ensure early diagnosis and therapeutic intervention are warranted.
了解影响重症流感患者住院时间（LOS）的因素可能有助于改善对他们的治疗。
对2004年和2005年住院的实验室确诊的成年流感患者进行了一项回顾性队列研究。对于该期间的所有流感病例，采用鼻咽抽吸物免疫荧光测定法进行快速诊断，若患者在症状出现后2天内就诊，则给予奥司他韦（75毫克，每日两次，共5天）治疗。使用Cox比例风险模型确定与出院时间相关的独立因素。调整后的风险比（aHR）>1表示早期出院的可能性更高。在一个“流感”季节中研究了病毒脱落情况和流感疫苗接种史。
共研究了356例患者（甲型流感占93.5%）。大多数患者年龄较大（70.2±8.4岁），患有≥1种合并症（69.1%），并出现了呼吸或心血管并发症（69.4%）。在发病2天内开始使用奥司他韦与总住院时间缩短相关（Kaplan-Meier估计中位数为4天对6天[-33%]；出院的aHR为1.54，95%置信区间[95%CI]为1.23 - 1.92，P < 0.0001）。年龄较大（≥70岁）、合并症和并发症与住院时间延长相关。发病后第4天仍有病毒RNA持续检测阳性（99例连续患者中有23例）也与住院时间延长独立相关（aHR 0.36 [95%CI 0.19 - 0.71]，P = 0.003），而在6个月内接种流感疫苗与住院时间缩短相关（aHR 2.14 [95%CI 1.18 - 3.85]，P = 0.012）。
我们的分析表明，对于因重症流感住院的患者，及时使用奥司他韦治疗与住院时间缩短独立相关。有必要努力确保早期诊断和治疗干预。
