Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study
| Autor: | Laura Merson, Frederick G. Hayden, Yasser Mandourah, Fahad Al-Hameed, Awad Al-Omari, Ghaleb A. Al Mekhlafi, Abdullah Almotairi, Ismael Qushmaq, Ahmed Ragab, Hanan H. Balkhy, Ayman Kharaba, Abdulaziz Al-Dawood, Othman Solaiman, Khalid Maghrabi, Abdulrahman Al Harthy, Eman Al Qasim, Basem Alraddadi, Abdulsalam M. Al-Aithan, Kasim Al Khatib, Anees Sindi, Jawaher Gramish, Robert A. Fowler, Rajaa Al-Raddadi, Jesna Jose, Ahmed Abdulmomen, Ahmed Mady, Sarah Shalhoub, Yaseen M. Arabi |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine Microbiology (medical) medicine.medical_specialty ribavirin Critical Illness Pneumonia Viral coronavirus Saudi Arabia Marginal structural model Interferon alpha-2 Antiviral Agents law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine law Internal medicine Major Article medicine pneumonia Humans 030212 general & internal medicine Aged Retrospective Studies business.industry Middle East respiratory syndrome Ribavirin Hazard ratio Retrospective cohort study interferon Odds ratio Middle Aged medicine.disease Intensive care unit Confidence interval Intensive Care Units Treatment Outcome 030104 developmental biology Infectious Diseases chemistry Middle East Respiratory Syndrome Coronavirus RNA Viral Female Coronavirus Infections business |
| Zdroj: | Clinical Infectious Diseases Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciz544 |
| Popis: | Background The objective of this study was to evaluate the effect of ribavirin and recombinant interferon (RBV/rIFN) therapy on the outcomes of critically ill patients with Middle East respiratory syndrome (MERS), accounting for time-varying confounders. Methods This is a retrospective cohort study of critically ill patients with laboratory-confirmed MERS from 14 hospitals in Saudi Arabia diagnosed between September 2012 and January 2018. We evaluated the association of RBV/rIFN with 90-day mortality and MERS coronavirus (MERS-CoV) RNA clearance using marginal structural modeling to account for baseline and time-varying confounders. Results Of 349 MERS patients, 144 (41.3%) patients received RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a; none received rIFN-β1b). RBV/rIFN was initiated at a median of 2 days (Q1, Q3: 1, 3 days) from intensive care unit admission. Crude 90-day mortality was higher in patients with RBV/rIFN compared to no RBV/rIFN (106/144 [73.6%] vs 126/205 [61.5%]; P = .02]. After adjusting for baseline and time-varying confounders using a marginal structural model, RBV/rIFN was not associated with changes in 90-day mortality (adjusted odds ratio, 1.03 [95% confidence interval {CI}, .73–1.44]; P = .87) or with more rapid MERS-CoV RNA clearance (adjusted hazard ratio, 0.65 [95% CI, .30–1.44]; P = .29). Conclusions In this observational study, RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a) therapy was commonly used in critically ill MERS patients but was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance. In this observational study accounting for baseline and time-varying confounders, ribavirin and recombinant interferon (rIFN-α2a, rIFN-α2b, or rIFN-β1a) therapy was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance. |
| Databáze: | OpenAIRE |
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