Effectiveness of prolonged versus standard-course of oseltamivir in critically ill patients with severe influenza infection: A multicentre cohort study.

Autor: Moreno G; Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain., Carbonell R; Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain., Díaz E; Critical Care Department, Universitat Autónoma de Barcelona (UAB), Hospital Parc Taulí, Sabadell, Spain., Martín-Loeches I; Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland., Restrepo MI; Department of Medicine, South Texas Veterans Health Care System and University of Texas Health, San Antonio, Texas, USA., Reyes LF; Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia., Solé-Violán J; Critical Care Department, Universidad Fernando Pessoa Canarias, Hospital Universitario Doctor Negrín, Gran Canaria, Spain., Bodí M; Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain.; Universitat Rovira i Virgili (URV)/Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Tarragona, Spain., Canadell L; Pharmacology Department, Universitat Rovira I Virgili (URV)/Institut d'Investigació Sanitaria Pere Virgili (IISPV), Hospital Universitari Joan XXIII, Tarragona, Spain., Guardiola J; Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville and Robley Rex VA Medical Center, Louisville, Kentucky, USA., Trefler S; Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain., Vidaur L; Critical Care Deptartment, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario de Donostia, San Sebastián, Spain., Papiol E; Critical Care Department, Hospital Univesitari Vall d'Hebrón, Barcelona, Spain., Socias L; Critical Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain., Correig E; Department of Biostatistics, Universitat Rovira i Virgili (URV), Reus, Spain., Marín-Corral J; Critical Care Department, Research Group in Critical Disorders (GREPAC), IMIM, Hospital Del Mar, Barcelona, Spain., Rodríguez A; Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain.; Universitat Rovira i Virgili (URV)/Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Tarragona, Spain.
Jazyk: angličtina
Zdroj: Journal of medical virology [J Med Virol] 2023 Aug; Vol. 95 (8), pp. e29010.
DOI: 10.1002/jmv.29010
Abstrakt: 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.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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