Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain.
Critical Care Department, Universitat Autónoma de Barcelona (UAB), Hospital Parc Taulí, Sabadell, Spain.
J Med Virol. 2023 Aug;95(8):e29010. doi: 10.1002/jmv.29010.
The aim of this study is to investigate the effectiveness of prolonged versus standard course oseltamivir treatment among critically ill patients with severe influenza. A retrospective study of a prospectively collected database including adults with influenza infection admitted to 184 intensive care units (ICUs) in Spain from 2009 to 2018. Prolonged oseltamivir was defined if patients received the treatment beyond 5 days, whereas the standard-course group received oseltamivir for 5 days. The primary outcome was all-cause ICU mortality. Propensity score matching (PSM) was constructed, and the outcome was investigated through Cox regression and RCSs. Two thousand three hundred and ninety-seven subjects were included, of whom 1943 (81.1%) received prolonged oseltamivir and 454 (18.9%) received standard treatment. An optimal full matching algorithm was performed by matching 2171 patients, 1750 treated in the prolonged oseltamivir group and 421 controls in the standard oseltamivir group. After PSM, 387 (22.1%) patients in the prolonged oseltamivir and 119 (28.3%) patients in the standard group died (p = 0.009). After adjusting confounding factors, prolonged oseltamivir significantly reduced ICU mortality (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.40-0.69). Prolonged oseltamivir may have protective effects on survival at Day 10 compared with a standard treatment course. Sensitivity analysis confirmed these findings. Compared with standard treatment, prolonged oseltamivir was associated with reduced ICU mortality in critically ill patients with severe influenza. Clinicians should consider extending the oseltamivir treatment duration to 10 days, particularly in higher-risk groups of prolonged viral shedding. Further randomized controlled trials are warranted to confirm these findings.
本研究旨在探讨重症流感患者延长奥司他韦疗程与标准疗程治疗的效果。这是一项回顾性研究，纳入了 2009 年至 2018 年期间在西班牙 184 个重症监护病房（ICU）因流感感染而入院的成年患者，这些患者的信息来自一个前瞻性收集的数据库。如果患者接受治疗超过 5 天，则定义为延长奥司他韦治疗，否则定义为标准疗程组，接受奥司他韦治疗 5 天。主要结局为 ICU 全因死亡率。构建了倾向评分匹配（PSM），并通过 Cox 回归和 RCSs 研究结局。共纳入 2397 例患者，其中 1943 例（81.1%）接受延长奥司他韦治疗，454 例（18.9%）接受标准治疗。通过最佳完全匹配算法，对 2171 例患者进行了匹配，其中 1750 例患者在延长奥司他韦组治疗，421 例患者在标准奥司他韦组作为对照。PSM 后，延长奥司他韦组有 387 例（22.1%）患者和标准组有 119 例（28.3%）患者死亡（p=0.009）。在调整混杂因素后，延长奥司他韦治疗显著降低了 ICU 死亡率（比值比 [OR]：0.53，95%置信区间 [CI]：0.40-0.69）。与标准疗程相比，延长奥司他韦治疗在第 10 天可能对生存有保护作用。敏感性分析证实了这些发现。与标准治疗相比，延长奥司他韦治疗与重症流感患者 ICU 死亡率降低相关。临床医生应考虑将奥司他韦治疗时间延长至 10 天，特别是在病毒脱落时间延长的高危人群中。需要进一步的随机对照试验来证实这些发现。
