Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients

Lee, Nelson; Leo, Yee‐Sin; Cao, Bin; Chan, Paul K.S.; Kyaw, Win Mar; Uyeki, Timothy M.; Tam, Wilson W.S.; Cheung, C. Sherman; Yung, Irene M. H.; Li, Hui; Gu, Li; Liu, Yingmei; Liu, Zhenjia; Qu, Jiuxin; Hui, David

doi:10.1183/09031936.00169714

Cited by 88 publications

(80 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pneumonia was defined as an acute lower respiratory illness with an opacity or infiltrate seen on chest radiography, which was interpreted as pneumonia by the treating physician . Nosocomial infection was diagnosed when a positive culture of a new pathogen was obtained from a lower respiratory tract specimen (sputum, bronchial/tracheal aspirates, or bronchoalveolar lavage fluid) and/or blood samples taken ≥48 hours after admission . Invasive pulmonary aspergillosis and mucormycosis were diagnosed in accordance with the revised definitions of invasive fungal diseases from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group .…”

Section: Methodsmentioning

confidence: 99%

Effect of low‐to‐moderate‐dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia

Yang

et al. 2017

Influenza Resp Viruses

Self Cite

136

137

View full text Add to dashboard Cite

BackgroundThe effect of corticosteroids on influenza A(H1N1)pdm09 viral pneumonia patients remains controversial, and the impact of dosage has never been studied.MethodsUsing data of hospitalized adolescent and adult patients with influenza A(H1N1)pdm09 viral pneumonia, prospectively collected from 407 hospitals in mainland China, the effects of low‐to‐moderate‐dose (25‐150 mg d−1) and high‐dose (>150 mg d−1) corticosteroids on 30‐day mortality, 60‐day mortality, and nosocomial infection were assessed with multivariate Cox regression and propensity score‐matched case–control analysis.ResultsIn total, 2141 patients (median age: 34 years; morality rate: 15.9%) were included. Among them, 1160 (54.2%) had PaO2/FiO2<300 mm Hg on admission, and 1055 (49.3%) received corticosteroids therapy. Corticosteroids, without consideration of dose, did not influence either 30‐day or 60‐day mortality. Further analysis revealed that, as compared with the no‐corticosteroid group, low‐to‐moderate‐dose corticosteroids were related to reduced 30‐day mortality (adjusted hazard ratio [aHR] 0.64 [95% CI 0.43‐0.96, P=.033]). In the subgroup analysis among patients with PaO2/FiO2<300 mm Hg, low‐to‐moderate‐dose corticosteroid treatment significantly reduced both 30‐day mortality (aHR 0.49 [95% CI 0.32‐0.77]) and 60‐day mortality (aHR 0.51 [95% CI 0.33‐0.78]), while high‐dose corticosteroid therapy yielded no difference. For patients with PaO2/FiO2 ≥300 mm Hg, corticosteroids (irrespective of dose) showed no benefit and even increased 60‐day mortality (aHR 3.02 [95% CI 1.06‐8.58]). Results were similar in the propensity model analysis.ConclusionsLow‐to‐moderate‐dose corticosteroids might reduce mortality of influenza A(H1N1)pdm09 viral pneumonia patients with PaO2/FiO2<300 mm Hg. Mild patients with PaO2/FiO2 ≥300 mm Hg could not benefit from corticosteroid therapy.

show abstract

Section: Methodsmentioning

confidence: 99%

Effect of low‐to‐moderate‐dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia

Yang

et al. 2017

Influenza Resp Viruses

Self Cite

136

137

View full text Add to dashboard Cite

show abstract

“…Nonetheless, while still controversial, evidence is emerging in adults with laboratory-confirmed influenza that NAIs may hasten recovery and reduce the risk of hospitalization, 152 while also providing a survival benefit for those hospitalized with severe or complicated disease. 153 Similar studies and reviews are needed in children, however, until these become available it seems reasonable to prescribe NAIs promptly (ideally within 2-days of symptom onset) for children with bronchiectasis and proven influenza with either advanced disease or if they are hospitalized with a severe, acute exacerbation. 121 Ongoing studies with small interfering RNA molecules and novel anti-viral agents directed against RSV fusion-proteins are being trialled in adults and so offer some hope for the future.…”

Section: Antiviral Agentsmentioning

confidence: 99%

Pediatric bronchiectasis: No longer an orphan disease

Goyal

Grimwood

Marchant

et al. 2016

Pediatric Pulmonology

136

140

View full text Add to dashboard Cite

Bronchiectasis is described classically as a chronic pulmonary disorder characterized by a persistent productive cough and irreversible dilatation of one or more bronchi. However, in children unable to expectorate, cough may instead be wet and intermittent and bronchial dilatation reversible in the early stages. Although still considered an orphan disease, it is being recognized increasingly as causing significant morbidity and mortality in children and adults in both affluent and developing countries. While bronchiectasis has multiple etiologies, the final common pathway involves a complex interplay between the host, respiratory pathogens and environmental factors. These interactions lead to a vicious cycle of repeated infections, airway inflammation and tissue remodelling resulting in impaired airway clearance, destruction of structural elements within the bronchial wall causing them to become dilated and small airway obstruction. In this review, the current knowledge of the epidemiology, pathobiology, clinical features, and management of bronchiectasis in children are summarized. Recent evidence has emerged to improve our understanding of this heterogeneous disease including the role of viruses, and how antibiotics, novel drugs, antiviral agents, and vaccines might be used. Importantly, the management is no longer dependent upon extrapolating from the cystic fibrosis experience. Nevertheless, substantial information gaps remain in determining the underlying disease mechanisms that initiate and sustain the pathophysiological pathways leading to bronchiectasis. National and international collaborations, standardizing definitions of clinical and research end points, and exploring novel primary prevention strategies are needed if further progress is to be made in understanding, treating and even preventing this often life-limiting disease.

show abstract

“…2 Available evidence suggests that viral replication is most active and viral load is at its peak during the earlier periods, which could have affected the therapeutic time window for antiviral agents (eg, ≤5 days for neuraminidase inhibitors, with highest benefits when given ≤2 days), in these severe infections. 3 Such observations and the futility of non-specific IVIG suggest that the predominant role of serotherapy could be neutralisation and inhibition of the invading virus, although other mechanisms such as immunomodulation might coexist. 2 Viral load reduction was not shown in Beigel and colleagues' main analysis, but sub-analysis of their data according to virus subtype and the respective virus neutralising antibody titre, and future data from the low (haemagglutination inhibition titre ≤1:10) versus high (haemagglutination inhibition titre ≥1:80) antibody concentration plasma trial (NCT02572817) might provide additional insight and help to define the actual effective titre or dose by bodyweight.…”

Section: Correspondencementioning

confidence: 99%