Outcomes and Prognostic Features of Patients With Influenza Requiring Hospitalization and Receiving Early Antiviral Therapy: A Prospective Multicenter Cohort Study

Takaya Maruyama; Takao Fujisawa; Shigeru Suga; Haruna Nakamura; Mizuho Nagao; Kiyosu Taniguchi; Kiyoyuki Tsutsui; Toshiaki Ihara; Michael S Niederman

doi:10.1378/chest.14-2768

Outcomes and Prognostic Features of Patients With Influenza Requiring Hospitalization and Receiving Early Antiviral Therapy: A Prospective Multicenter Cohort Study

Chest. 2016 Feb;149(2):526-534. doi: 10.1378/chest.14-2768. Epub 2016 Jan 12.

Authors

Takaya Maruyama¹, Takao Fujisawa², Shigeru Suga², Haruna Nakamura², Mizuho Nagao², Kiyosu Taniguchi², Kiyoyuki Tsutsui¹, Toshiaki Ihara², Michael S Niederman³

Affiliations

¹ Department of Respiratory Medicine, National Hospital Organization Mie National Hospital, Tsu, Mie, Japan.
² Department of Pediatrics, National Hospital Organization Mie National Hospital, Tsu, Mie, Japan.
³ Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY. Electronic address: msn9004@med.cornell.edu.

PMID: 26203671
DOI: 10.1378/chest.14-2768

Abstract

Background: In Japan, the routine use of early antiviral therapy for patients with influenza is standard.

Methods: This multicenter prospective cohort evaluation of hospitalized patients with laboratory-confirmed influenza identified prognostic factors among the patients receiving antiviral therapy.

Results: Of 1,345 patients with influenza (766 pediatric, 579 adult), excluding those aged < 1 year (who are not approved for antiviral therapy), 97.7% (1,224 of 1,253) received antiviral therapy. Among the adult patients, 24 (4.1%) died within 30 days, whereas none of the pediatric patients died. Five hundred twenty-eight (91.2%) adult patients had influenza A, 509 (87.9%) had a chronic underlying illness, and 211 (36.4%) had radiographically confirmed pneumonia. Twenty of the 24 patients who died had pneumonia of the following etiologies: Streptococcus pneumoniae (12.3%); Staphylococcus aureus (10.9%), including methicillin-resistant S aureus (MRSA) 3.3%; Enterobacteriaceae (8.1%); and Pseudomonas aeruginosa (3.3%). Of the adult patients, 151 were classified as having community-acquired pneumonia (CAP) and 60 as having health-care-associated pneumonia (HCAP). Inappropriate therapy was more common in HCAP than in CAP (15.2% vs 2%, P = .001). Potential multidrug-resistant (MDR) pathogens were more common (21.7% vs 2.6%, P < .001) in patients with HCAP, particularly MRSA (10% vs 0.7%, P = .002) and P aeruginosa (8.3% vs 1.3%, P = .021). Using Cox proportional hazards modeling with prescribed independent variables, male sex, severity score, serum albumin levels (malnutrition), and pneumonia were associated with survival 30 days from the onset of influenza.

Conclusions: Among the prognostic factors, malnutrition and pneumonia are amenable to medical intervention. An opportunity exists to improve empirical therapy for patients with HCAP and influenza.

Trial registry: Japan Medical Association Center for Clinical Trials; No.: JMA-IIA00123; URL: http://www.jmacct.med.or.jp/en/.

Keywords: influenza; microbiology; nutrition malnutrition; pneumonia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Antiviral Agents / therapeutic use*
Child
Child, Preschool
Female
Follow-Up Studies
Hospitalization*
Humans
Incidence
Influenza, Human / complications
Influenza, Human / drug therapy*
Influenza, Human / epidemiology
Japan / epidemiology
Male
Middle Aged
Pneumonia / epidemiology*
Pneumonia / etiology
Prognosis
Prospective Studies
Risk Assessment / methods*
Risk Factors
Secondary Prevention / methods*
Young Adult

Substances

Antiviral Agents