Critical Care Center, ParcTaulí Hospital-Sabadell, CIBERes, ParcTauli s/n, 08208, Sabadell, Spain.
Intensive Care Med. 2013 Apr;39(4):693-702. doi: 10.1007/s00134-013-2829-8. Epub 2013 Jan 24.
To determine whether macrolide-based treatment is associated with mortality in critically ill H1N1 patients with primary viral pneumonia.
Secondary analysis of a prospective, observational, multicenter study conducted across 148 Intensive Care Units (ICU) in Spain.
Primary viral pneumonia was present in 733 ICU patients with pandemic influenza A (H1N1) virus infection with severe respiratory failure. Macrolide-based treatment was administered to 190 (25.9 %) patients. Patients who received macrolides had chronic obstructive pulmonary disease more often, lower severity on admission (APACHE II score on ICU admission (13.1 ± 6.8 vs. 14.4 ± 7.4 points, p < 0.05), and multiple organ dysfunction syndrome less often (23.4 vs. 30.1 %, p < 0.05). Length of ICU stay in survivors was not significantly different in patients who received macrolides compared to patients who did not (10 (IQR 4-20) vs. 10 (IQR 5-20), p = 0.9). ICU mortality was 24.1 % (n = 177). Patients with macrolide-based treatment had lower ICU mortality in the univariate analysis (19.2 vs. 28.1 %, p = 0.02); however, a propensity score analysis showed no effect of macrolide-based treatment on ICU mortality (OR = 0.87; 95 % CI 0.55-1.37, p = 0.5). Moreover, the sensitivity analysis revealed very similar results (OR = 0.91; 95 % CI 0.58-1.44, p = 0.7). A separate analysis of patients under mechanical ventilation yielded similar results (OR = 0.77; 95 % CI 0.44-1.35, p = 0.4).
Our results suggest that macrolide-based treatment was not associated with improved survival in critically ill H1N1 patients with primary viral pneumonia.
确定大环内酯类药物治疗与原发性病毒性肺炎的危重症 H1N1 患者的死亡率之间是否存在关联。
对在西班牙 148 个重症监护病房（ICU）进行的一项前瞻性、观察性、多中心研究进行二次分析。
原发性病毒性肺炎存在于 733 例患有严重呼吸衰竭的大流行性流感 A（H1N1）病毒感染的 ICU 患者中。190 例（25.9%）患者接受了大环内酯类药物治疗。接受大环内酯类药物治疗的患者更常患有慢性阻塞性肺疾病，入院时的严重程度较低（入住 ICU 时的急性生理学和慢性健康评估 II 评分（13.1±6.8 与 14.4±7.4 分，p<0.05），且多器官功能障碍综合征发生率较低（23.4%与 30.1%，p<0.05）。与未接受大环内酯类药物治疗的患者相比，接受大环内酯类药物治疗的幸存者 ICU 住院时间无显著差异（10（IQR 4-20）与 10（IQR 5-20），p=0.9）。ICU 死亡率为 24.1%（n=177）。在单变量分析中，接受大环内酯类药物治疗的患者 ICU 死亡率较低（19.2%与 28.1%，p=0.02）；然而，倾向评分分析显示大环内酯类药物治疗对 ICU 死亡率没有影响（OR=0.87；95%CI 0.55-1.37，p=0.5）。此外，敏感性分析显示结果非常相似（OR=0.91；95%CI 0.58-1.44，p=0.7）。对接受机械通气的患者进行的单独分析得出了类似的结果（OR=0.77；95%CI 0.44-1.35，p=0.4）。
我们的研究结果表明，在原发性病毒性肺炎的危重症 H1N1 患者中，大环内酯类药物治疗与生存率的提高无关。
