Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
ESMO Open. 2020 Oct;5(5):e000968. doi: 10.1136/esmoopen-2020-000968.
Patients with malignancy are vulnerable to influenza viruses and are at high risk of developing serious complications. However, few studies have investigated the impact of influenza infection among hospitalised patients with malignancy.
Cancer-related hospitalisations were identified by using data from National Inpatient Sample in the USA between 2012 and 2014. We conducted a 1:1 propensity score matching analysis to compare the in-hospital outcomes between cancer patients with and without influenza. Multivariate logistic regression analyses were also performed to identify independent prognosis predictors of mortality.
We identified 13 186 849 weighted cancer-related hospitalisations during the study period, and 47 850 of them (0.36%) had a concomitant diagnosis of influenza. After propensity score matching, cancer patients with concomitant influenza had a higher mortality (5.4% vs 4.2%; OR, 1.30; 95% CI, 1.13 to 1.49; p<0.001), longer length of stay (6.3 days vs 5.6 days; p<0.001) but lower costs (US$14 605.9 vs US$14 625.5; p<0.001) in hospital than those without influenza. In addition, cancer patients with influenza had a higher incidence of complications, including pneumonia (18.4% vs 13.2%; OR, 1.49; 95% CI, 1.37 to 1.62; p<0.001), neutropenia (7.1% vs 3.4%; OR, 2.18; 95% CI, 1.91 to 2.50; p<0.001), sepsis (19.5% vs 9.3%; OR, 2.36; 95% CI, 2.16 to 2.58; p<0.001), dehydration (14.8% vs 8.8%; OR, 1.80; 95% CI, 1.65 to 1.97; p<0.001) and acute kidney injury (19.9% vs 17.6%; OR, 1.16; 95% CI, 1.08 to 1.25; p<0.001) than those without influenza. Older age, no insurance, more comorbidities, lung cancer and haematological malignancy were independently associated with higher mortality.
Influenza is associated with worse in-hospital clinical outcomes among hospitalised patients with malignancy. Annual influenza vaccination and early initiation of antiviral therapy are recommended in this high-risk population.
恶性肿瘤患者易感染流感病毒，且发生严重并发症的风险较高。然而，鲜有研究调查恶性肿瘤住院患者流感感染的影响。
在美国国家住院患者样本中，我们利用 2012 年至 2014 年的数据确定了与癌症相关的住院情况。我们进行了 1:1 倾向评分匹配分析，比较了有流感和无流感的癌症患者的住院结局。还进行了多变量逻辑回归分析，以确定死亡率的独立预后预测因素。
在研究期间，我们共确定了 13186849 例加权癌症相关住院病例，其中 47850 例（0.36%）同时诊断患有流感。经过倾向评分匹配后，伴有流感的癌症患者的死亡率更高（5.4%比 4.2%；比值比，1.30；95%置信区间，1.13 至 1.49；p<0.001），住院时间更长（6.3 天比 5.6 天；p<0.001），但住院费用更低（14605.9 美元比 14625.5 美元；p<0.001）。此外，伴有流感的癌症患者的并发症发生率更高，包括肺炎（18.4%比 13.2%；比值比，1.49；95%置信区间，1.37 至 1.62；p<0.001）、中性粒细胞减少症（7.1%比 3.4%；比值比，2.18；95%置信区间，1.91 至 2.50；p<0.001）、脓毒症（19.5%比 9.3%；比值比，2.36；95%置信区间，2.16 至 2.58；p<0.001）、脱水（14.8%比 8.8%；比值比，1.80；95%置信区间，1.65 至 1.97；p<0.001）和急性肾损伤（19.9%比 17.6%；比值比，1.16；95%置信区间，1.08 至 1.25；p<0.001）的发生率也高于无流感的患者。年龄较大、无保险、合并症更多、肺癌和血液恶性肿瘤与死亡率升高独立相关。
流感与恶性肿瘤住院患者的住院临床结局较差相关。建议在这一高危人群中进行年度流感疫苗接种和早期启动抗病毒治疗。
