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他汀类药物与 2017-2018 年实验室确诊流感住院患者结局的关系。

Statins and outcomes of hospitalized patients with laboratory-confirmed 2017-2018 influenza.

机构信息

Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, 49100, Petah Tikva, Israel.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Eur J Clin Microbiol Infect Dis. 2019 Dec;38(12):2341-2348. doi: 10.1007/s10096-019-03684-y. Epub 2019 Aug 28.

Abstract

No studies evaluating the association between statins and outcomes of patients with seasonal influenza have been performed since the 2007-2008 and the 2009 pandemic H1N1 influenza seasons. All consecutive hospitalized patients between October 2017 and April 2018, diagnosed with laboratory-confirmed influenza A and B virus, were included. Patients were divided into two groups: statin and non-statin users. Outcomes were 30- and 90-day mortality, complications (pneumonia, myocarditis, encephalitis, intensive care unit (ICU) transfer, mechanical ventilation, vasopressor support), length of hospital stay, and readmission rates. A multivariate analysis was performed to adjust for mortality risk factors. To compare the groups, we matched patients to the nearest neighbor propensity score. Of the 526 patients ill with influenza A (201/526) and B (325/526), 36% (188/526) were statin users; 64% (338/526) were not. Statin users were older (78 vs.70; p = < 0.05) and suffered from more comorbidities (Charlson comorbidity scores of 6 vs.4; p < 0.005). The 30-day mortality rate among statin vs. non-statin users was 6% vs. 8% (p = 0.3). On multivariate analysis, statin use was not associated with mortality benefit (OR = 0.67 (0.29-1.36)). After propensity score matching, the results were unchanged (OR = 0.71 (0.29-1.71)). Statin users were diagnosed with less complicated diseases as they were less likely to receive vasopressor support, mechanical ventilation, and/or transfer to the ICU. Although statin users were significantly older and exhibited more comorbidities, 30-day mortality rates did not differ between statin users and non-users, which may signify a protective role of statins on seasonal influenza patients. Further studies performed during different influenza seasons and different subtypes are essential.

摘要

自 2007-2008 年和 2009 年大流行性 H1N1 流感季节以来,尚未有研究评估他汀类药物与季节性流感患者结局之间的关系。所有在 2017 年 10 月至 2018 年 4 月期间连续住院、诊断为实验室确诊的甲型和乙型流感病毒的患者均被纳入研究。患者分为他汀类药物使用者和非他汀类药物使用者两组。研究结局包括 30 天和 90 天死亡率、并发症(肺炎、心肌炎、脑炎、重症监护病房(ICU)转科、机械通气、血管升压药支持)、住院时间和再入院率。进行多变量分析以调整死亡率风险因素。为了比较两组患者,我们使用最近邻倾向评分匹配患者。在 526 例流感 A 患者(201/526)和 B 患者(325/526)中,36%(188/526)为他汀类药物使用者;64%(338/526)为非他汀类药物使用者。他汀类药物使用者年龄较大(78 岁 vs.70 岁;p < 0.05),合并症更多(Charlson 合并症评分 6 分 vs.4 分;p < 0.005)。他汀类药物使用者与非他汀类药物使用者的 30 天死亡率分别为 6%和 8%(p = 0.3)。多变量分析显示,他汀类药物使用与死亡率降低无关(OR = 0.67(0.29-1.36))。经过倾向评分匹配后,结果保持不变(OR = 0.71(0.29-1.71))。他汀类药物使用者接受血管升压药支持、机械通气和/或转入 ICU 的可能性较低,因此诊断为疾病并发症较少。尽管他汀类药物使用者年龄较大,合并症更多,但他汀类药物使用者和非使用者的 30 天死亡率无差异,这可能表明他汀类药物对季节性流感患者具有保护作用。在不同的流感季节和不同的亚型中进行进一步的研究至关重要。

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