title: Effects of corticosteroid and neuraminidase inhibitors on survival in patients with respiratory distress induced by influenza virus.
abstract: OBJECTIVE
  Neuraminidase inhibitors (NAIs) including oseltamivir and peramivir are used for influenza treatment. A systemic corticosteroid is usually administrated for acute respiratory distress syndrome. The aim of this study was to investigate the effect of a systemic corticosteroid and its interaction with NAIs in patients with influenza infection and respiratory distress.
  
  
  METHODS
  A retrospective survey of hospitalized patients infected with influenza from January 2012 to May 2014 was conducted in a medical center in Taiwan.
  
  
  RESULTS
  Eighty-six patients were hospitalized during the study period. Forty-eight patients had respiratory distress and 39 of them (81.3%, 39/48) were supported by a mechanical ventilator. All patients with respiratory distress received oseltamivir; 60.4% (29/48) and 31.3% (15/48) of them received a corticosteroid and salvage intravenous peramivir, respectively. All-cause mortality was 29.1% (14/48), 20% (3/15), and 31% (9/29) in patients with respiratory distress, patients who received salvage peramivir, and patients who received a systemic corticosteroid, respectively. Salvage peramivir seemed to improve prognosis in patients with H1pdm09 or type B virus infection and respiratory distress (p = 0.05). Early initiating corticosteroid had a worse prognosis than initiation after 72 hours of NAI treatment (p = 0.024). In particular, a systemic corticosteroid seemed to lead to a shorter survival time in patients with chronic lung disease (p = 0.05).
  
  
  CONCLUSIONS
  Salvage peramivir provided a better prognosis than monotherapy with oseltamivir in patients who were infected with H1pdm09 or type B virus and who developed respiratory distress. A systemic corticosteroid should be administered after initiating NAI therapy, especially in patients with chronic lung disease.
authors.affiliation: Division of Infectious Disease, Department of 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, Taiwan.
authors.forename: Shiang-Fen
authors.initials: SF
authors.lastname: Huang
authors.affiliation: Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chang-Phone
authors.initials: CP
authors.lastname: Fung
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Diahn-Warng
authors.initials: DW
authors.lastname: Perng
authors.affiliation: Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: fdwang@vghtpe.gov.tw.
authors.forename: Fu-Der
authors.initials: FD
authors.lastname: Wang
mesh_terms: D000146:Acids, Carbocyclic; D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D003517:Cyclopentanes / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006146:Guanidines / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects / Q000472:pathogenicity; D007251:Influenza, Human / Q000188:drug therapy* / Q000821:virology; D008297:Male; D024821:Metabolic Syndrome; D008875:Middle Aged; D009439:Neuraminidase / Q000187:drug effects* / Q000494:pharmacology; D009975:Orthomyxoviridae / Q000187:drug effects / Q000472:pathogenicity*; D053139:Oseltamivir / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000188:drug therapy; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D000146:Acids, Carbocyclic; D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D003517:Cyclopentanes; D004791:Enzyme Inhibitors; D006146:Guanidines; D053139:Oseltamivir; D009439:Neuraminidase; C414210:peramivir
keywords: H1N1; corticosteroid; influenza; oseltamivir; peramivir