呼吸道病毒感染对慢性阻塞性肺疾病住院患者死亡率和重症的影响。
Impact of respiratory viral infections on mortality and critical illness among hospitalized patients with chronic obstructive pulmonary disease.
机构信息
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
出版信息
Influenza Other Respir Viruses. 2022 Nov;16(6):1172-1182. doi: 10.1111/irv.13050. Epub 2022 Sep 7.
BACKGROUND
Seasonal respiratory viral infections are associated with exacerbations and morbidity among patients with COPD. The real-world clinical outcomes associated with seasonal viral infections are less well established among hospitalized patients.
RESEARCH QUESTION
To estimate the association between seasonal respiratory viral infections, 30-day mortality, and intensive care unit (ICU) admission among hospitalized COPD patients.
STUDY DESIGN AND METHODS
We conducted an analysis of a national prospective multicenter cohort of COPD patients hospitalized with acute respiratory illness during winter seasons (2011-2015) in Canada. Nasopharyngeal swabs were performed on all patients at the onset of hospital admission for diagnosis of viral infection. Primary outcomes were 30-day mortality and ICU admissions. Secondary outcomes included invasive/non-invasive ventilation use.
RESULTS
Among 3931 hospitalized patients with COPD, 28.5% (1122/3931) were diagnosed with seasonal respiratory viral infection. Viral infection was associated with increased admission to ICU (OR 1.5, 95% CI 1.2-1.9) and need for mechanical ventilation (OR 1.9, 95% CI 1.4-2.5), but was not associated with mortality (OR 1.1, 95% CI 0.8-1.4). Patients with respiratory syncytial virus (RSV) were equally likely to require ICU admission (OR 1.09, 95% CI 0.67-1.78), and more likely to need non-invasive ventilation (OR 3.1; 95% CI 1.8-5.1) compared to patients with influenza.
INTERPRETATION
Our results suggest COPD patients requiring hospitalization for respiratory symptoms should routinely receive viral testing at admission, especially for RSV and influenza, to inform prognosis, clinical management, and infection control practices during winter seasons. Patients with COPD will be an important target population for newly developed RSV therapeutics.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT01517191.
背景
季节性呼吸道病毒感染与 COPD 患者的恶化和发病率有关。在住院患者中，与季节性病毒感染相关的真实临床结局还不太确定。
研究问题
评估季节性呼吸道病毒感染与 COPD 住院患者 30 天死亡率和重症监护病房（ICU）入住率之间的相关性。
研究设计和方法
我们对加拿大在冬季（2011-2015 年）因急性呼吸道疾病住院的 COPD 患者进行了一项全国性前瞻性多中心队列研究分析。所有患者在入院时都进行了鼻咽拭子检测，以诊断病毒感染。主要结局为 30 天死亡率和 ICU 入住率。次要结局包括有创/无创通气的使用。
结果
在 3931 例 COPD 住院患者中，28.5%（1122/3931）被诊断为季节性呼吸道病毒感染。病毒感染与 ICU 入住率增加（OR 1.5，95%CI 1.2-1.9）和需要机械通气（OR 1.9，95%CI 1.4-2.5）相关，但与死亡率无关（OR 1.1，95%CI 0.8-1.4）。与流感患者相比，呼吸道合胞病毒（RSV）感染患者同样可能需要入住 ICU（OR 1.09，95%CI 0.67-1.78），且更可能需要无创通气（OR 3.1；95%CI 1.8-5.1）。
结论
我们的研究结果表明，因呼吸系统症状需要住院治疗的 COPD 患者应在入院时常规进行病毒检测，特别是针对 RSV 和流感，以提供预后、临床管理和冬季感染控制措施的信息。COPD 患者将是新开发的 RSV 治疗药物的重要目标人群。
临床试验注册
ClinicalTrials.gov 注册号：NCT01517191。
Zotero 插件