The impact of early neuraminidase inhibitor therapy on clinical outcomes in patients hospitalised with influenza A-related pneumonia: a multicenter, retrospective study

Liang Chen,Chunxiao Zhang,Yan Li Li,Xiudi Han,Xiqian Xing

doi:10.1186/s12879-020-05322-x

Abstract

BackgroundGuidelines emphasize prompt antiviral treatment in severe influenza patients. Although nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. Furthermore, data about the administration of NAIs in the real-world management of Flu-p in China are limited.MethodsData of patients hospitalised with FluA-p from five teaching hospitals in China from 1 January 2013 to 31 December 2018 were reviewed retrospectively. The impact of early NAI therapy on the outcomes in FluA-p patients, and the indications of early NAI administration by clinicians were evaluated by logistic regression analysis.ResultsIn total, 693 FluA-p patients were included. Of these patients, 33.5% (232/693) were treated early. After adjusting for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use, a multivariate logistic regression model showed that early NAI therapy was associated with decreased risk for invasive ventilation [odds ratio (OR) 0.511, 95% confidence interval (CI) 0.312–0.835, p = 0.007) and 30-day mortality (OR 0.533, 95% CI 0.210–0.807, p < 0.001) in FluA-p patients. A multivariate logistic regression model confirmed early NAI use (OR 0.415, 95% CI 0.195–0.858, p = 0.001) was a predictor for 30-day mortality in FluA-p patients and a positive rapid influenza diagnostic test was the only indication (OR 3.586, 95% CI 1.259–10.219, p < 0.001) related to the prescription of early NAI by clinicians.ConclusionsEarly NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.

Highlights

IntroductionNearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed
Guidelines emphasize prompt antiviral treatment in severe influenza patients
Muthuri [25] conducted a meta-analysis of 20,634 severely ill patients with (H1N1) pdm09 infections from nine centers all over the world using individual data rather than group data for greater accuracy. This analysis revealed that early neuraminidase inhibitor (NAI) therapy was associated with decreased risk of invasive ventilation [hazard ratio (HR) 0.68, 95% CI 0.54–0.85) and mortality (HR 0.70, 95% CI 0.55–0.88) in influenza-related pneumonia compared with late NAI therapy

Summary

Introduction

Nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. A randomized controlled trial (RCT) on uncomplicated outpatients within 48 h of symptom onset showed oseltamivir treatment decreased the duration of influenza by a median of 70 h and decreased patient-perceived severity of illness [8]. Subsequent observational studies suggested that severe influenza patients could benefit from early (≤ 2 days after illness onset) NAI administration [9,10,11]. The American and Chinese guidelines recommended early initiation of NAI therapy in the patients at high-risk of severe influenza [12, 13]

Methods

Results

Discussion

Conclusion