Abstract
Background and aims The relationship between early oseltamivir treatment (within 48 h of symptom onset) and mortality in patients admitted to intensive care units (ICUs) with severe influenza is disputed. This study aimed to investigate the association between early oseltamivir treatment and ICU mortality in critically ill patients with influenza pneumonia.
Methods This was an observational study of patients with influenza pneumonia admitted to 184 ICUs in Spain. The primary outcome was to evaluate the association between early oseltamivir treatment and ICU mortality compared to later treatment. Secondary outcomes were to compare the duration of mechanical ventilation (MV) and the ICU length of stay between the early and later oseltamivir treatment groups. To reduce biases related to observational studies, propensity score matching and a competing risk analysis were performed.
Results During the study period, 2124 met the inclusion criteria. All patients had influenza pneumonia and received oseltamivir before ICU admission. Of these, 529 (24.9%) received early oseltamivir treatment. In the multivariate analysis, early treatment was associated with reduced ICU mortality (OR 0.69, 95% CI 0.51–0.95). After propensity score matching, early oseltamivir treatment was associated with improved survival rates in the Cox regression (HR 0.77, 95% CI 0.61–0.99) and competing risk (sHR 0.67, 95% CI 0.53–0.85) analyses. The ICU length of stay and duration of MV were shorter in patients receiving early treatment.
Conclusions Early oseltamivir treatment is associated with improved survival rates in critically ill patients with influenza pneumonia and may decrease ICU length of stay and MV duration.
Footnotes
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Conflict of interest: Dr. Moreno has nothing to disclose.
Conflict of interest: Dr. Bodí has nothing to disclose.
Conflict of interest: Dr. Reyes has nothing to disclose.
Conflict of interest: Dr. Gómez has nothing to disclose.
Conflict of interest: Dr. Guardiola has nothing to disclose.
Conflict of interest: Dr. TREFLER has nothing to disclose.
Conflict of interest: Dr. Vidaur has nothing to disclose.
Conflict of interest: Dr. Papiol has nothing to disclose.
Conflict of interest: Dr. Socias has nothing to disclose.
Conflict of interest: Dr. RESTREPO has nothing to disclose.
Conflict of interest: Dr. Nguyen-Van-Tam reports grants from F. Hoffmann-La Roche, outside the submitted work; JSN-V-T was seconded to the Department of Health and Social Care (DHSC) England in 2017. The view in this article are those of the authors and not necessarily those of DHSC.
Conflict of interest: Dr. Torres has nothing to disclose.
Conflict of interest: Dr. RODRIGUEZ has nothing to disclose.
Conflict of interest: Dr. Correig Fraga has nothing to disclose.
Conflict of interest: Dr. Marin Corral has nothing to disclose.
Conflict of interest: Dr. SOLE-VIOLAN has nothing to disclose.
Conflict of interest: Dr. GARCIA VIDAL reports grants and other from Gilead Science, grants and other from Merck Sharp & Dohme; MSD, other from Novartis, other from Pfizer, other from Jannsen, other from Lilly, outside the submitted work.
Conflict of interest: Dr. DIAZ has nothing to disclose.
Conflict of interest: Dr. Martin-Loeches has nothing to disclose.
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- Received November 27, 2020.
- Accepted December 7, 2020.
- Copyright ©ERS 2021
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