Wang Yeming, Fan Guohui, Horby Peter, Hayden Fredrick, Li Qian, Wu Qiaoling, Zou Xiaohui, Li Hui, Zhan Qingyuan, Wang Chen, Cao Bin
China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.
Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Open Forum Infect Dis. 2019 Feb 15;6(3):ofz053. doi: 10.1093/ofid/ofz053. eCollection 2019 Mar.
The objective of this study was to investigate the difference in disease severity between influenza A and B among hospitalized adults using a novel ordinal scale and existing clinical outcome end points.
A prospective, observational study was conducted over the 2016-2018 influenza seasons in a central hospital. The primary outcome was the rate of clinical improvement, defined as a decline of 2 categories from admission on a 7-category ordinal scale that ranges from 1 (discharged with normal activity) to 7 (death), or hospital discharge up to day 28.
In total, 574 eligible patients were enrolled, including 369 (64.3%) influenza A cases and 205 (35.7%) influenza B cases. The proportion of patients with a worse ordinal scale at admission was higher in influenza A than influenza B ( = .0005). Clinical improvement up to 28 days occurred in 82.4% of patients with influenza A and 90.7% of patients with influenza B ( = .0067). The Cox model indicated that influenza B patients had a higher clinical improvement probability than influenza A cases (adjusted hazard ratio [HR], 1.266; 95% confidence interval [CI], 1.019-1.573; = .0335). A similar pattern was observed in weaning oxygen supplement (adjusted HR, 1.285; 95% CI, 1.030-1.603; = .0261). In-hospital mortality for influenza A was marginally higher than influenza B (11.4% vs 6.8%; = .0782).
Our findings indicated that hospitalized patients with influenza A were more ill and had delayed clinical improvement compared with those with influenza B virus infection.
本研究的目的是使用一种新的序贯量表和现有的临床结局终点指标，调查住院成人甲型流感和乙型流感之间疾病严重程度的差异。
在一家中心医院对2016 - 2018年流感季节进行了一项前瞻性观察研究。主要结局是临床改善率，定义为在从1（正常活动出院）到7（死亡）的7分类序贯量表上，自入院起下降2个类别，或在第28天前出院。
共纳入574例符合条件的患者，其中甲型流感病例369例（64.3%），乙型流感病例205例（35.7%）。入院时序贯量表评分较差的患者比例在甲型流感中高于乙型流感（P = .0005）。甲型流感患者中82.4%在28天内出现临床改善，乙型流感患者中90.7%出现临床改善（P = .0067）。Cox模型表明，乙型流感患者的临床改善概率高于甲型流感病例（调整后风险比[HR]，1.266；95%置信区间[CI]为1.019 - 1.573；P = .0335）。在撤掉氧疗方面观察到类似模式（调整后HR，1.285；95% CI为1.030 - 1.603；P = .0261）。甲型流感的院内死亡率略高于乙型流感（11.4%对6.8%；P = .0782）。
我们的研究结果表明，与感染乙型流感病毒的患者相比，住院的甲型流感患者病情更严重，临床改善延迟。
