早期奥司他韦治疗对 2009 年甲型流感危重症患者结局的影响。
Impact of early oseltamivir treatment on outcome in critically ill patients with 2009 pandemic influenza A.
机构信息
Hospital Joan XXIII, Critical Care Department-IISPV-URV-CIBERES, Tarragona, Spain.
出版信息
J Antimicrob Chemother. 2011 May;66(5):1140-9. doi: 10.1093/jac/dkq511. Epub 2011 Jan 7.
OBJECTIVES
The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A (2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between the timing of antiviral administration and intensive care unit (ICU) outcomes.
METHODS
Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection. Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) with oseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint. Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality.
RESULTS
Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients required mechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy and were included in the study group. All patients received oseltamivir for a median duration of 10 days (interquartile range 8-14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groups were comparable in terms of main clinical variables. ICU length of stay (22.7 ± 16.7 versus 18.4 ± 14.2 days; P = 0.03), hospital length of stay (34.0 ± 20.3 versus 27.2 ± 18.2 days; P = 0.001) and MV days (17.4 ± 15.2 versus 14.0 ± 12.4; P = 0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than in ET (21.5%; OR = 1.9; 95% CI 1.06-3.41). A multivariate model identified ET (OR = 0.44; 95% CI 0.21-0.87) as an independent variable associated with reduced ICU mortality. These results were confirmed by propensity score analysis (OR = 0.44; 95% CI 0.22-0.90; P < 0.001).
CONCLUSIONS
Our findings suggest that early oseltamivir administration was associated with favourable outcomes among critically ill ventilated patients with 2009 H1N1 virus infection.
目的
奥司他韦对重症 2009 年甲型流感（2009 H1N1）患者死亡率的影响尚不清楚。本研究的主要目的是研究抗病毒药物治疗时机与重症监护病房（ICU）结局之间的关系。
方法
对确诊为 2009 H1N1 感染的 ICU 患者进行前瞻性、观察性研究。比较接受早期治疗（ET）（发病后 2 天内开始）和晚期治疗（LT）（发病后 2 天后开始）的患者的临床数据、治疗和结局。采用多变量分析和倾向评分来确定奥司他韦对 ICU 死亡率的影响。
结果
共纳入 657 例患者。其中 404 例（61.5%）需要机械通气（MV；死亡率 32.6%）。其中，385 例接受有效抗病毒治疗并纳入研究组。所有患者接受奥司他韦治疗的中位时间为 10 天（四分位距 8-14 天）。79 例 ET 患者与 306 例 LT 患者进行比较。两组主要临床变量相似。ICU 住院时间（22.7±16.7 比 18.4±14.2 天；P=0.03）、住院时间（34.0±20.3 比 27.2±18.2 天；P=0.001）和 MV 天数（17.4±15.2 比 14.0±12.4 天；P=0.04）在 LT 组中更高。LT 组 ICU 死亡率也更高（34.3%比 21.5%；OR=1.9；95%CI 1.06-3.41）。多变量模型确定 ET（OR=0.44；95%CI 0.21-0.87）是与 ICU 死亡率降低相关的独立变量。这些结果通过倾向评分分析得到证实（OR=0.44；95%CI 0.22-0.90；P<0.001）。
结论
我们的研究结果表明，在接受 2009 H1N1 病毒感染的重症 MV 患者中，早期使用奥司他韦治疗与良好的结局相关。
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