Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units
Background: Few studies have investigated patients with severe influenza who receive intravenous peramivir for salvage therapy. Methods: We retrospectively analyzed data from 71 patients with severe influenza who received intravenous peramivir therapy in the intensive care units of three medical cen...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-12-01
|
| Series: | Journal of Microbiology, Immunology and Infection |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118217300774 |
| _version_ | 1818975274084073472 |
|---|---|
| author | Ching-Yuan Yeh Fu-Der Wang Yu-Chung Chuang Chia-Jui Yang Shiang-Fen Huang Wen-Sung Weng Chun-Hsin Liaw Wang-Huei Sheng |
| author_facet | Ching-Yuan Yeh Fu-Der Wang Yu-Chung Chuang Chia-Jui Yang Shiang-Fen Huang Wen-Sung Weng Chun-Hsin Liaw Wang-Huei Sheng |
| author_sort | Ching-Yuan Yeh |
| collection | DOAJ |
| description | Background: Few studies have investigated patients with severe influenza who receive intravenous peramivir for salvage therapy. Methods: We retrospectively analyzed data from 71 patients with severe influenza who received intravenous peramivir therapy in the intensive care units of three medical centers between 2012 and 2016. All patients received oseltamivir or zanamivir before the administration of peramivir. Results: A total of 44 men and 27 women with a median age of 55 years were enrolled. Fifty-five (78%) had underlying comorbidities and 57 (80%) patients were infected with influenza type A. Forty-four (62%) patients survived and 27 (38%) died. Five patients (7%) had attributable adverse events, including elevated hepatic aminotransferase levels (n = 2), hyperbilirubinemia (n = 2), leukopenia (n = 1), and skin rash (n = 1). Multivariable logistic regression analysis revealed that initial bacteremia (odds ratio [OR], 27.59; 95% confidence interval [95% CI], 2.36–322.07; P = 0.008) and septic shock (OR, 8.00; 95% CI, 1.69–37.90; P = 0.009) were the independent predictors of mortality. However, there was also a trend towards a positive correlation between mortality and steroid use (OR, 11.29; 95% CI, 0.67–188.86; P = 0.092). Conclusion: As a salvage therapy, intravenous peramivir provided a survival rate of 62% and was well tolerated in patients with severe influenza. The initiation of effective antiviral treatment as early as possible within 48 h is recommended for hospitalized patients. Keywords: Critical illness, Influenza, Intravenous peramivir, Pneumonia, Steroid |
| first_indexed | 2024-12-20T15:53:21Z |
| format | Article |
| id | doaj.art-431fe9df5a674da28baec78c0075f8dd |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-12-20T15:53:21Z |
| publishDate | 2018-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-431fe9df5a674da28baec78c0075f8dd2022-12-21T19:34:34ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822018-12-01516697704Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care unitsChing-Yuan Yeh0Fu-Der Wang1Yu-Chung Chuang2Chia-Jui Yang3Shiang-Fen Huang4Wen-Sung Weng5Chun-Hsin Liaw6Wang-Huei Sheng7Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDepartment of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDepartment of Internal Medicine, Far Eastern Memorial Hospital, Taipei, TaiwanDepartment of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, TaiwanDepartment of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Internal Medicine, Far Eastern Memorial Hospital, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. Fax: +886 2 23936192.Background: Few studies have investigated patients with severe influenza who receive intravenous peramivir for salvage therapy. Methods: We retrospectively analyzed data from 71 patients with severe influenza who received intravenous peramivir therapy in the intensive care units of three medical centers between 2012 and 2016. All patients received oseltamivir or zanamivir before the administration of peramivir. Results: A total of 44 men and 27 women with a median age of 55 years were enrolled. Fifty-five (78%) had underlying comorbidities and 57 (80%) patients were infected with influenza type A. Forty-four (62%) patients survived and 27 (38%) died. Five patients (7%) had attributable adverse events, including elevated hepatic aminotransferase levels (n = 2), hyperbilirubinemia (n = 2), leukopenia (n = 1), and skin rash (n = 1). Multivariable logistic regression analysis revealed that initial bacteremia (odds ratio [OR], 27.59; 95% confidence interval [95% CI], 2.36–322.07; P = 0.008) and septic shock (OR, 8.00; 95% CI, 1.69–37.90; P = 0.009) were the independent predictors of mortality. However, there was also a trend towards a positive correlation between mortality and steroid use (OR, 11.29; 95% CI, 0.67–188.86; P = 0.092). Conclusion: As a salvage therapy, intravenous peramivir provided a survival rate of 62% and was well tolerated in patients with severe influenza. The initiation of effective antiviral treatment as early as possible within 48 h is recommended for hospitalized patients. Keywords: Critical illness, Influenza, Intravenous peramivir, Pneumonia, Steroidhttp://www.sciencedirect.com/science/article/pii/S1684118217300774 |
| spellingShingle | Ching-Yuan Yeh Fu-Der Wang Yu-Chung Chuang Chia-Jui Yang Shiang-Fen Huang Wen-Sung Weng Chun-Hsin Liaw Wang-Huei Sheng Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units Journal of Microbiology, Immunology and Infection |
| title | Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units |
| title_full | Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units |
| title_fullStr | Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units |
| title_full_unstemmed | Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units |
| title_short | Clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units |
| title_sort | clinical outcomes and prognostic factors of patients with severe influenza receiving intravenous peramivir salvage therapy in intensive care units |
| url | http://www.sciencedirect.com/science/article/pii/S1684118217300774 |
| work_keys_str_mv | AT chingyuanyeh clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits AT fuderwang clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits AT yuchungchuang clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits AT chiajuiyang clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits AT shiangfenhuang clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits AT wensungweng clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits AT chunhsinliaw clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits AT wanghueisheng clinicaloutcomesandprognosticfactorsofpatientswithsevereinfluenzareceivingintravenousperamivirsalvagetherapyinintensivecareunits |