title: Effect of immunomodulatory therapies in patients with pandemic influenza A (H1N1) 2009 complicated by pneumonia.
abstract: OBJECTIVE
  To determine the effect of immunomodulatory therapies on the development of severe disease in hospitalized adults with laboratory-confirmed pandemic influenza A (H1N1) 2009 complicated by pneumonia.
  
  
  METHODS
  Observational, prospective cohort study at thirteen tertiary hospitals in Spain. The use of corticosteroids, macrolides and statins was recorded. The outcome of interest was severe disease, defined as the composite of intensive care unit admission or death after the first day of hospitalization.
  
  
  RESULTS
  Of the 197 patients with pandemic influenza A (H1N1) 2009 complicated by pneumonia, 68 (34.5%) received some anti-inflammatory therapy since hospital admission (corticosteroids in 37, macrolides in 31 and statins in 12). Severe disease occurred in 29 (14.7%) patients. After adjustment for confounding factors, immunomodulatory therapies as a group were not associated with a lower risk for developing severe disease (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.22-1.86). In a further a priori analysis, corticosteroids, macrolides and statins were included in a multivariate model. None of these therapies was found to be associated with a lower risk for developing severe disease.
  
  
  CONCLUSIONS
  Immunomodulatory therapies use since hospital admission did not prevent the development of severe disease in adults with pandemic influenza A (H1N1) 2009 complicated by pneumonia.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona, Feixa Llarga s/n, Barcelona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Viasus
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Paño-Pardo
authors.forename: Elisa
authors.initials: E
authors.lastname: Cordero
authors.forename: Antoni
authors.initials: A
authors.lastname: Campins
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Medrano
authors.forename: Aroa
authors.initials: A
authors.lastname: Villoslada
authors.forename: Maria C
authors.initials: MC
authors.lastname: Fariñas
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Oteo
authors.forename: Joaquín
authors.initials: J
authors.lastname: Martínez-Montauti
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: Ferrán
authors.initials: F
authors.lastname: Segura
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage*; D056747:Immunomodulation; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000401:mortality / Q000628:therapy* / Q000821:virology; D018942:Macrolides / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D013030:Spain; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007155:Immunologic Factors; D018942:Macrolides