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Influenza-associated mortality in hospital care: a retrospective cohort study of risk factors and impact of oseltamivir in an English teaching hospital, 2016 to 2017.

Published version
Peer-reviewed

Type

Article

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Authors

Reacher, Mark 
Reeve, Lucy 
Verlander, Neville Q 
Jones, Nicholas Keith  ORCID logo  https://orcid.org/0000-0003-4475-7761

Abstract

BackgroundEvidence of an oseltamivir treatment effect on influenza A(H3N2) virus infections in hospitalised patients is incomplete.AimsThis cohort study aimed to evaluate risk factors for death among PCR-confirmed hospitalised cases of seasonal influenza A(H3N2) of all ages and the impact of oseltamivir.MethodsParticipants included all 332 PCR-confirmed influenza A(H3N2) cases diagnosed between 30 August 2016 and 17 March 2017 in an English university teaching Hospital. Oseltamivir treatment effect on odds of inpatient death was assessed by backward stepwise multivariable logistic regression analysis.ResultsThe odds of death were reduced by two thirds (odds ratio (OR): 0.32; 95% confidence interval (CI): 0.11-0.93), in inpatients treated with a standard course of oseltamivir 75 mg two times daily for 5 days - compared with those untreated with oseltamivir, after adjustment for age, sex, current excess alcohol intake, receipt of 2016/17 seasonal influenza vaccine, serum haemoglobin and hospital vs community attribution of acquisition of influenza.ConclusionsOseltamivir treatment given according to National Institutes of Clinical Excellence (NICE); United States Centres for Disease Control and Prevention (CDC); Infectious Diseases Society of America (IDSA) and World Health Organization (WHO) guidelines was shown to be effective in reducing the odds of mortality in inpatients with PCR-confirmed seasonal influenza A(H3N2) after adjustment in a busy routine English hospital setting. Our results highlight the importance of hospitals complying with relevant guidelines for prompt seasonal influenza PCR testing and ensuring standard oseltamivir treatment to all PCR-confirmed cases of seasonal influenza.

Description

Keywords

Historic Cohort study, in-patient mortality, influenza, logistic regression, multivariable logistic regression, risk factors, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Antiviral Agents, Child, Child, Preschool, Female, Guideline Adherence, Hospital Mortality, Hospitals, Teaching, Humans, Infant, Infant, Newborn, Influenza A Virus, H3N2 Subtype, Influenza, Human, Inpatients, Male, Middle Aged, Oseltamivir, Polymerase Chain Reaction, Retrospective Studies, Young Adult

Journal Title

Euro Surveill

Conference Name

Journal ISSN

1025-496X
1560-7917

Volume Title

24

Publisher

European Centre for Disease Control and Prevention (ECDC)