Tenforde Mark W, Noah Kameela P, O'Halloran Alissa C, Kirley Pam Daily, Hoover Cora, Alden Nisha B, Armistead Isaac, Meek James, Yousey-Hindes Kimberly, Openo Kyle P, Witt Lucy S, Monroe Maya L, Ryan Patricia A, Falkowski Anna, Reeg Libby, Lynfield Ruth, McMahon Melissa, Hancock Emily B, Hoffman Marisa R, McGuire Suzanne, Spina Nancy L, Felsen Christina B, Gaitan Maria A, Lung Krista, Shiltz Eli, Thomas Ann, Schaffner William, Talbot H Keipp, Crossland Melanie T, Price Andrea, Masalovich Svetlana, Adams Katherine, Holstein Rachel, Sundaresan Devi, Uyeki Timothy M, Reed Carrie, Bozio Catherine H, Garg Shikha
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
California Emerging Infections Program, Oakland, California, USA.
Clin Infect Dis. 2025 Feb 24;80(2):461-468. doi: 10.1093/cid/ciae427.
Pneumonia is common in adults hospitalized with laboratory-confirmed influenza, but the association between timeliness of influenza antiviral treatment and severe clinical outcomes in patients with influenza-associated pneumonia is not well characterized.
We included adults aged ≥18 years hospitalized with laboratory-confirmed influenza and a discharge diagnosis of pneumonia over 7 influenza seasons (2012-2019) sampled from a multistate population-based surveillance network. We evaluated 3 treatment groups based on timing of influenza antiviral initiation relative to admission date (day 0, day 1, days 2-5). Baseline characteristics and clinical outcomes were compared across groups using unweighted counts and weighted percentages accounting for the complex survey design. Logistic regression models were generated to evaluate the association between delayed treatment and 30-day all-cause mortality.
A total of 26 233 adults were sampled in the analysis. Median age was 71 years and most (92.2%) had ≥1 non-immunocompromising condition. Overall, 60.9% started antiviral treatment on day 0, 29.5% on day 1, and 9.7% on days 2-5 (median, 2 days). Baseline characteristics were similar across groups. Thirty-day mortality occurred in 7.5%, 8.5%, and 10.2% of patients who started treatment on day 0, day 1, and days 2-5, respectively. Compared to those treated on day 0, adjusted odds ratio for death was 1.14 (95% confidence interval [CI], 1.01-1.27) in those starting treatment on day 1 and 1.40 (95% CI, 1.17-1.66) in those starting on days 2-5.
Delayed initiation of antiviral treatment in patients hospitalized with influenza-associated pneumonia was associated with higher risk of death, highlighting the importance of timely initiation of antiviral treatment at admission.
肺炎在因实验室确诊流感而住院的成人中很常见，但流感抗病毒治疗的及时性与流感相关性肺炎患者严重临床结局之间的关联尚未得到充分描述。
我们纳入了来自一个基于多州人群的监测网络、在7个流感季节（2012 - 2019年）因实验室确诊流感且出院诊断为肺炎而住院的≥18岁成人。我们根据流感抗病毒药物开始使用时间相对于入院日期（第0天、第1天、第2 - 5天）评估了3个治疗组。使用未加权计数和考虑复杂调查设计的加权百分比对各组的基线特征和临床结局进行比较。生成逻辑回归模型以评估延迟治疗与30天全因死亡率之间的关联。
分析中共纳入了26233名成人。中位年龄为71岁，大多数（92.2%）有≥1种非免疫功能低下情况。总体而言，60.9%的患者在第0天开始抗病毒治疗，29.5%在第1天开始，9.7%在第2 - 5天开始（中位时间为2天）。各组基线特征相似。在第0天、第1天和第2 - 5天开始治疗的患者中，30天死亡率分别为7.5%、8.5%和10.2%。与在第0天接受治疗的患者相比，在第1天开始治疗的患者调整后的死亡比值比为1.14（95%置信区间[CI]，1.01 - 1.27），在第2 - 5天开始治疗的患者中为1.40（95%CI，1.17 - 1.66）。
流感相关性肺炎住院患者延迟开始抗病毒治疗与死亡风险较高相关，突出了入院时及时开始抗病毒治疗的重要性。
