成人严重流感住院治疗的结果。

Outcomes of adults hospitalised with severe influenza.

机构信息

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.

出版信息

Thorax. 2010 Jun;65(6):510-5. doi: 10.1136/thx.2009.130799.

DOI:10.1136/thx.2009.130799

PMID:20522848

Abstract

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 70+/-18 years; co-morbidities 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<0.001). Improved survival was observed with treatment started within 4 days from onset. Earlier hospital discharge (aHR 1.28 (95% CI 1.04 to 1.57); p=0.019) and faster discontinuation of oxygen therapy (aHR 1.30 (95% CI 1.01 to 1.69); p=0.043) was associated with early treatment within 2 days. Few (n=15) H1N1 isolates in this cohort had the H275Y mutation.

CONCLUSIONS

Antiviral treatment for severe influenza is associated with reduced mortality and improved clinical outcomes.

摘要

背景

本研究旨在探讨影响成人严重季节性流感住院患者临床结局的因素。

方法

这是一项前瞻性、观察性队列研究，在 24 个月内（2007-2008 年）在两家急性综合医院进行。连续招募了住院的成年患者，一旦根据协议从鼻咽抽吸物中通过病毒抗原检测和病毒分离确定了他们的流感 A/B 实验室诊断（均为阳性），就对其进行随访。研究的结局包括院内死亡、住院时间和吸氧时间。使用多变量 Cox 比例风险模型分析影响结局的因素。对可获得的 H1N1 分离株进行神经氨酸酶基因测序分析。

结果

共纳入 754 例患者（流感 A 患者 539 例，H3N2 患者占比>75%）。患者平均年龄为 70±18 岁；合并症和严重并发症较为常见（61-77%）。401 例（53.2%）和 41 例（5.4%）患者分别需要补充氧气和呼吸机支持。39 例（5.2%）患者死亡，死因分别为肺炎、呼吸衰竭和败血症。395 例（52%）患者接受了抗病毒（奥司他韦）治疗。未接受抗病毒治疗与出现症状延迟或抗原检测结果为阴性有关。治疗组和未治疗组的病死率分别为每 1000 个患者日 4.56 和 7.42；在合并症患者中，分别为每 1000 个患者日 5.62 和 11.64。多变量分析显示，抗病毒治疗与降低死亡风险相关（调整后的 HR（aHR）0.27（95% CI 0.13 至 0.55）；p<0.001）。在发病后 4 天内开始治疗可观察到生存获益。较早出院（aHR 1.28（95% CI 1.04 至 1.57）；p=0.019）和更快地停止吸氧（aHR 1.30（95% CI 1.01 至 1.69）；p=0.043）与 2 天内开始早期治疗有关。本队列中很少（n=15）H1N1 分离株具有 H275Y 突变。