Moreno Gerard, Rodríguez Alejandro, Sole-Violán Jordi, Martín-Loeches Ignacio, Díaz Emili, Bodí María, Reyes Luis F, Gómez Josep, Guardiola Juan, Trefler Sandra, Vidaur Loreto, Papiol Elisabet, Socias Lorenzo, García-Vidal Carolina, Correig Eudald, Marín-Corral Judith, Restrepo Marcos I, Nguyen-Van-Tam Jonathan S, Torres Antoni
Critical Care Dept, Hospital Universitari de Tarragona Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain.
These authors contributed equally.
ERJ Open Res. 2021 Mar 8;7(1). doi: 10.1183/23120541.00888-2020. eCollection 2021 Jan.
The relationship between early oseltamivir treatment (within 48 h of symptom onset) and mortality in patients admitted to intensive care units (ICUs) with severe influenza is disputed. This study aimed to investigate the association between early oseltamivir treatment and ICU mortality in critically ill patients with influenza pneumonia.
This was an observational study of patients with influenza pneumonia admitted to 184 ICUs in Spain during 2009-2018. The primary outcome was to evaluate the association between early oseltamivir treatment and ICU mortality compared with later treatment. Secondary outcomes were to compare the duration of mechanical ventilation and ICU length of stay between the early and later oseltamivir treatment groups. To reduce biases related to observational studies, propensity score matching and a competing risk analysis were performed.
During the study period, 2124 patients met the inclusion criteria. All patients had influenza pneumonia and received oseltamivir before ICU admission. Of these, 529 (24.9%) received early oseltamivir treatment. In the multivariate analysis, early treatment was associated with reduced ICU mortality (OR 0.69, 95% CI 0.51-0.95). After propensity score matching, early oseltamivir treatment was associated with improved survival rates in the Cox regression (hazard ratio 0.77, 95% CI 0.61-0.99) and competing risk (subdistribution hazard ratio 0.67, 95% CI 0.53-0.85) analyses. The ICU length of stay and duration of mechanical ventilation were shorter in patients receiving early treatment.
Early oseltamivir treatment is associated with improved survival rates in critically ill patients with influenza pneumonia, and may decrease ICU length of stay and mechanical ventilation duration.
对于入住重症监护病房（ICU）的重症流感患者，早期（症状出现后48小时内）使用奥司他韦治疗与死亡率之间的关系存在争议。本研究旨在调查早期奥司他韦治疗与流感肺炎重症患者ICU死亡率之间的关联。
这是一项对2009年至2018年期间西班牙184个ICU收治的流感肺炎患者的观察性研究。主要结局是评估早期奥司他韦治疗与后期治疗相比，与ICU死亡率之间的关联。次要结局是比较早期和后期奥司他韦治疗组之间机械通气时间和ICU住院时间。为减少与观察性研究相关的偏倚，进行了倾向评分匹配和竞争风险分析。
在研究期间，2124例患者符合纳入标准。所有患者均患有流感肺炎，且在入住ICU前接受了奥司他韦治疗。其中，529例（24.9%）接受了早期奥司他韦治疗。在多变量分析中，早期治疗与降低ICU死亡率相关（比值比0.69，95%置信区间0.51 - 0.95）。经过倾向评分匹配后，在Cox回归（风险比0.77，95%置信区间0.61 - 0.99）和竞争风险（亚分布风险比0.67，95%置信区间0.53 - 0.85）分析中，早期奥司他韦治疗与生存率提高相关。接受早期治疗的患者ICU住院时间和机械通气时间较短。
早期奥司他韦治疗与流感肺炎重症患者生存率提高相关，且可能缩短ICU住院时间和机械通气时间。
