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Multicenter Study
. 2020 Aug 26;20(1):628.
doi: 10.1186/s12879-020-05322-x.

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

Liang Chen  1 , Xiudi Han  2 , Yan Li Li  3 , Chunxiao Zhang  4 , Xiqian Xing  5
Affiliations
Multicenter Study

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

Liang Chen et al. BMC Infect Dis. .

Abstract

Background: Guidelines 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.

Methods: Data 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.

Results: In 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.

Conclusions: Early NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.

Keywords: Clinical outcome; Community-acquired pneumonia; Influenza a; Neuraminidase inhibitor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient screening algorithm for FluA-p
Fig. 2
Fig. 2
Forrest plot of the impact of early NAI therapy on the outcomes in the FluA-p patients. ▲: Adjusted for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use
Fig. 3
Fig. 3
The proportion of early NAI treatment and RIDT-positive FluA-p patients treated during 2013–2018 in China
See this image and copyright information in PMC

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