流感疫苗对 COPD 住院患者住院和严重结局风险因素的有效性。
Effectiveness of Influenza Vaccination on Hospitalizations and Risk Factors for Severe Outcomes in Hospitalized Patients With COPD.
机构信息
Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, ON, Canada.
Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada.
出版信息
Chest. 2019 Jan;155(1):69-78. doi: 10.1016/j.chest.2018.10.044.
BACKGROUND
The effectiveness of influenza vaccination in reducing influenza-related hospitalizations among patients with COPD is not well described, and influenza vaccination uptake remains suboptimal.
METHODS
Data were analyzed from a national, prospective, multicenter cohort study including patients with COPD, hospitalized with any acute respiratory illness or exacerbation between 2011 and 2015. All patients underwent nasopharyngeal swab screening with polymerase chain reaction (PCR) testing for influenza. The primary outcome was an influenza-related hospitalization. We identified influenza-positive cases and negative control subjects and used multivariable logistic regression with a standard test-negative design to estimate the vaccine effectiveness for preventing influenza-related hospitalizations.
RESULTS
Among 4,755 hospitalized patients with COPD, 4,198 (88.3%) patients with known vaccination status were analyzed. The adjusted analysis showed a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated individuals. Influenza-positive patients (n = 1,833 [38.5%]) experienced higher crude mortality (9.7% vs 7.9%; P = .047) and critical illness (17.2% vs 12.1%; P < .001) compared with influenza-negative patients. Risk factors for mortality in influenza-positive patients included age > 75 years (OR, 3.7 [95% CI, 0.4-30.3]), cardiac comorbidity (OR, 2.0 [95% CI, 1.3-3.2]), residence in long-term care (OR, 2.6 [95% CI, 1.5-4.5]), and home oxygen use (OR, 2.9 [95% CI, 1.6-5.1]).
CONCLUSIONS
Influenza vaccination significantly reduced influenza-related hospitalization among patients with COPD. Initiatives to increase vaccination uptake and early use of antiviral agents among patients with COPD could reduce influenza-related hospitalization and critical illness and improve health-care costs in this vulnerable population.
TRIAL REGISTRY
ClinicalTrials.govNo.:NCT01517191; URL www.clinicaltrials.gov.
背景
流感疫苗在降低 COPD 患者因流感相关住院的效果尚不清楚，流感疫苗接种率仍然不理想。
方法
本研究数据来自一项全国性、前瞻性、多中心队列研究，纳入了 2011 年至 2015 年间因任何急性呼吸道疾病或加重而住院的 COPD 患者。所有患者均接受了鼻咽拭子聚合酶链反应（PCR）检测流感病毒。主要结局是流感相关住院。我们确定了流感阳性病例和阴性对照病例，并使用标准的检测阴性设计的多变量逻辑回归来估计预防流感相关住院的疫苗有效性。
结果
在 4755 例因 COPD 住院的患者中，分析了 4198 例（88.3%）已知疫苗接种情况的患者。调整分析显示，接种疫苗的个体与未接种疫苗的个体相比，流感相关住院的风险降低了 38%。流感阳性患者（n=1833[38.5%]）的粗死亡率（9.7% vs 7.9%；P=0.047）和危重症发生率（17.2% vs 12.1%；P<0.001）均高于流感阴性患者。流感阳性患者死亡的危险因素包括年龄>75 岁（OR，3.7[95%CI，0.4-30.3]）、合并心脏疾病（OR，2.0[95%CI，1.3-3.2]）、居住在长期护理机构（OR，2.6[95%CI，1.5-4.5]）和家庭氧疗（OR，2.9[95%CI，1.6-5.1]）。
结论
流感疫苗显著降低了 COPD 患者的流感相关住院率。在 COPD 患者中，增加疫苗接种率和早期使用抗病毒药物的举措可能会降低流感相关住院和危重症的发生，并改善这一脆弱人群的医疗保健费用。
试验注册
ClinicalTrials.gov 编号：NCT01517191；网址：www.clinicaltrials.gov。
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