Background Pneumonia is common in adults hospitalized with laboratory-confirmed influenza, but the association between timeliness of influenza antiviral treatment and severe clinical outcomes in patients with influenza-associated pneumonia is not well characterized. Methods We included adults aged ≥18 years hospitalized with laboratory-confirmed influenza and a discharge diagnosis of pneumonia over 7 influenza seasons (2012–2019) sampled from a multistate population-based surveillance network. We evaluated 3 treatment groups based on timing of influenza antiviral initiation relative to admission date (day 0, day 1, days 2–5). Baseline characteristics and clinical outcomes were compared across groups using unweighted counts and weighted percentages accounting for the complex survey design. Logistic regression models were generated to evaluate the association between delayed treatment and 30-day all-cause mortality. Results A total of 26 233 adults were sampled in the analysis. Median age was 71 years and most (92.2%) had ≥1 non-immunocompromising condition. Overall, 60.9% started antiviral treatment on day 0, 29.5% on day 1, and 9.7% on days 2–5 (median, 2 days). Baseline characteristics were similar across groups. Thirty-day mortality occurred in 7.5%, 8.5%, and 10.2% of patients who started treatment on day 0, day 1, and days 2–5, respectively. Compared to those treated on day 0, adjusted odds ratio for death was 1.14 (95% confidence interval [CI], 1.01–1.27) in those starting treatment on day 1 and 1.40 (95% CI, 1.17–1.66) in those starting on days 2–5. Conclusions Delayed initiation of antiviral treatment in patients hospitalized with influenza-associated pneumonia was associated with higher risk of death, highlighting the importance of timely initiation of antiviral treatment at admission.

中文翻译：

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流感抗病毒治疗的时机和成人因流感相关肺炎住院的死亡风险，流感住院监测网络 （FluSurv-NET），2012-2019 年


背景 肺炎在实验室确诊的流感住院成人中很常见，但流感抗病毒治疗的及时性与流感相关肺炎患者严重临床结局之间的关联尚未得到很好的表征。方法 我们纳入了 7 个流感季节 （2012-2019） 中因实验室确诊流感住院且出院诊断为肺炎的 ≥ 岁成年人，这些成年人是从多州基于人群的监测网络中抽样的。我们根据流感抗病毒药物开始的时间相对于入院日期 （第 0 天、第 1 天、第 2-5 天） 评估了 3 个治疗组。使用未加权计数和加权百分比比较各组的基线特征和临床结果，并考虑复杂的调查设计。生成 Logistic 回归模型以评估延迟治疗与 30 天全因死亡率之间的关联。结果 分析共对 26 233 只成年小鼠进行采样。中位年龄为 71 岁，大多数 （92.2%） 患有 ≥1 种非免疫功能低下的情况。总体而言，60.9% 的患者在第 0 天开始抗病毒治疗，29.5% 的患者在第 1 天开始，9.7% 的患者在第 2-5 天开始（中位数为 2 天）。各组的基线特征相似。在第 0 天、第 1 天和第 2-5 天开始治疗的患者中，分别有 7.5% 、 8.5% 和 10.2% 的患者发生 30 天死亡率。与第 0 天治疗的患者相比，第 1 天开始治疗的患者调整后死亡比值比为 1.14（95% 置信区间 [CI]，1.01-1.27），第 2-5 天开始治疗的患者为 1.40（95% CI，1.17-1.66）。 结论 流感相关肺炎住院患者延迟开始抗病毒治疗与较高的死亡风险相关，凸显了入院时及时开始抗病毒治疗的重要性。