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Abstract
BackgroundThere is limited data on the clinical outcome of patients with pandemic H1N1 (pH1N1) pneumonia who received oseltamivir treatment, especially when the treatment was administered more than 48 hours after symptom onset.MethodsDuring the pandemic in 2009, a cohort of pH1N1 influenza pneumonia was built in China, and their clinical information was collected systematically, and analyzed with Cox models.Results920 adults and 541 children with pneumonia who didn't receive corticosteroids were analyzed. In-hospital mortality was higher in adults who did not receive antiviral therapy (18.2%) than those with who received oseltamivir ≤ 2days (2.9%), between 2–5 days (4.6%) and >5 days after illness onset (4.9%), p<0.01. A similar trend was observed in pediatric patients. Cox regression showed that at 60 days after symptoms onset, 11 patients (10.8%) who did not receive antivirals died versus 4 (1.8%), 18 (3.3%), and 23 (3.7%) patients whose oseltamivir treatment was started ≤ 2days, between 2–5days, and >5 days, respectively. For males patients, aged ≥ 14 years and baseline PaO2/FiO2<200, oseltamivir administration reduced the mortality risk by 92.1%, 88% and 83.5%, respectively. Higher doses of oseltamivir (>3.8 mg/kg/d) did not improve clinical outcome (mortality, higher dose 2.5% vs standard dose 2.8%, p>0.05).ConclusionsAntiviral therapy might reduce mortality of patients with pH1N1 pneumonia, even when initiated more than 48 hours after onset of illness. Greater protective effects might be in males, patients aged 14–60 years, and patients with PaO2/FiO2<200.
Highlights
In early April 2009, human infections caused by influenza A pandemic H1N1 2009 virus were identified in the United States [1] and Mexico [2] and spread rapidly to other regions of the world, resulting in the first influenza pandemic since 1968 [3]
Antiviral therapy was recommended [11], evidence was still limited about the correlation between oseltamivir treatment and clinical outcome, including hospitalization [12], admission to intensive care units (ICUs), and even death [13,14,15], especially for patients with pandemic H1N1 (pH1N1) pneumonia who were started on antiviral therapy .48 hours after illness onset [16]
A pH1N1 2009 Clinical Investigation Group of China. This is a national network for the diagnosis and treatment of pH1N1, and includes the Chinese Disease Control and Prevention (CDC) and community hospitals and teaching hospitals around China that are under the guidance by the Chinese Ministry of Health (MOH)
Summary
In early April 2009, human infections caused by influenza A pandemic H1N1 (pH1N1) 2009 virus were identified in the United States [1] and Mexico [2] and spread rapidly to other regions of the world, resulting in the first influenza pandemic since 1968 [3]. Observational studies have suggested that oseltamivir therapy of adults hospitalized with seasonal influenza (22%–43% of these patients had viral pneumonia) may reduce mortality [8,9,10]. During this pandemic, antiviral therapy was recommended [11], evidence was still limited about the correlation between oseltamivir treatment and clinical outcome, including hospitalization [12], admission to intensive care units (ICUs), and even death [13,14,15], especially for patients with pH1N1 pneumonia who were started on antiviral therapy .48 hours after illness onset [16]. There is limited data on the clinical outcome of patients with pandemic H1N1 (pH1N1) pneumonia who received oseltamivir treatment, especially when the treatment was administered more than 48 hours after symptom onset
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