Effectiveness of prolonged versus standard-course of oseltamivir in critically ill patients with severe influenza infection: A multicentre cohort study

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Effectiveness of prolonged versus standard-course of oseltamivir in critically ill patients with severe influenza infection: A multicentre cohort study

Publicated to:Journal Of Medical Virology. 95 (8): e29010-e29010 - 2023-08-01 95(8), DOI: 10.1002/jmv.29010

Authors: Moreno, Gerard; Carbonell, Raquel; Diaz, Emili; Martin-Loeches, Ignacio; Restrepo, Marcos I; Reyes, Luis F; Sole-Violan, Jordi; Bodi, Maria; Canadell, Laura; Guardiola, Juan; Trefler, Sandra; Vidaur, Loreto; Papiol, Elisabeth; Socias, Lorenzo; Correig, Eudald; Marin-Corral, Judith; Rodriguez, Alejandro

Affiliations

Critical Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain. - Author

Critical Care Department, Hospital Univesitari Vall d'Hebrón, Barcelona, Spain. - Author

Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain. - Author

Critical Care Department, Research Group in Critical Disorders (GREPAC), IMIM, Hospital Del Mar, Barcelona, Spain. - Author

Critical Care Department, Universidad Fernando Pessoa Canarias, Hospital Universitario Doctor Negrín, Gran Canaria, Spain. - Author

Critical Care Department, Universitat Autónoma de Barcelona (UAB), Hospital Parc Taulí, Sabadell, Spain. - Author

Critical Care Deptartment, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario de Donostia, San Sebastián, Spain. - Author

Department of Biostatistics, Universitat Rovira i Virgili (URV), Reus, Spain. - Author

Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. - Author

Department of Medicine, South Texas Veterans Health Care System and University of Texas Health, San Antonio, Texas, USA. - Author

Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville and Robley Rex VA Medical Center, Louisville, Kentucky, USA. - Author

Hosp Del Mar, Crit Care Dept, Res Grp Crit Disorders GREPAC, IMIM, Barcelona, Spain - Author

Hosp Son Llatzer, Crit Care Dept, Palma De Mallorca, Spain - Author

Hosp Univ Donostia, Crit Care Dept, Inst Invest Sanit Biodonostia, San Sebastian, Spain - Author

Hosp Univ Joan XXII, Inst Invest Sanit Pere Virgili IISPV, Crit Care Dept, C Dr Mallafre Guasch,4, Tarragona 43005, Spain - Author

Hosp Univ Joan XXIII, Inst Invest Sanit Pere Virgili IISPV, Crit Care Dept, Tarragona, Spain - Author

Hosp Univ Vall Hebron, Crit Care Dept, Barcelona, Spain - Author

Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia. - Author

NULL - Author

Pharmacology Department, Universitat Rovira I Virgili (URV)/Institut d'Investigació Sanitaria Pere Virgili (IISPV), Hospital Universitari Joan XXIII, Tarragona, Spain. - Author

Robley Rex VA Med Ctr, Louisville, KY USA - Author

South Texas Vet Hlth Care Syst, Dept Med, San Antonio, TX USA - Author

St James Hosp, Dept Intens Care Med, Multidisciplinary Intens Care Res Org MICRO, Dublin, Ireland - Author

Univ Autonoma Barcelona UAB, Hosp Parc Tauli, Crit Care Dept, Sabadell, Spain - Author

Univ Fernando Pessoa Canarias, Hosp Univ Doctor Negrin, Crit Care Dept, Gran Canaria, Spain - Author

Univ La Sabana, Infect Dis Dept, Chia, Colombia - Author

Univ Louisville, Div Pulm Crit Care & Sleep Med, Louisville, KY USA - Author

Univ Rovira i Virgili URV, Ctr Invest Biomed Red Enfermedades Respiratorias C, Tarragona, Spain - Author

Univ Rovira i Virgili URV, Dept Biostat, Reus, Spain - Author

Univ Rovira I Virgili URV, Hosp Universitari Joan 23, Inst Invest Sanit Pere Virgili IISPV, Pharmacol Dept, Tarragona, Spain - Author

Univ Texas Hlth, San Antonio, TX USA - Author

Universitat Rovira i Virgili (URV)/Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Tarragona, Spain. - Author

Abstract

The aim of this study is to investigate the effectiveness of prolonged versus standard course oseltamivir treatment among critically ill patients with severe influenza. A retrospective study of a prospectively collected database including adults with influenza infection admitted to 184 intensive care units (ICUs) in Spain from 2009 to 2018. Prolonged oseltamivir was defined if patients received the treatment beyond 5 days, whereas the standard-course group received oseltamivir for 5 days. The primary outcome was all-cause ICU mortality. Propensity score matching (PSM) was constructed, and the outcome was investigated through Cox regression and RCSs. Two thousand three hundred and ninety-seven subjects were included, of whom 1943 (81.1%) received prolonged oseltamivir and 454 (18.9%) received standard treatment. An optimal full matching algorithm was performed by matching 2171 patients, 1750 treated in the prolonged oseltamivir group and 421 controls in the standard oseltamivir group. After PSM, 387 (22.1%) patients in the prolonged oseltamivir and 119 (28.3%) patients in the standard group died (p = 0.009). After adjusting confounding factors, prolonged oseltamivir significantly reduced ICU mortality (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.40-0.69). Prolonged oseltamivir may have protective effects on survival at Day 10 compared with a standard treatment course. Sensitivity analysis confirmed these findings. Compared with standard treatment, prolonged oseltamivir was associated with reduced ICU mortality in critically ill patients with severe influenza. Clinicians should consider extending the oseltamivir treatment duration to 10 days, particularly in higher-risk groups of prolonged viral shedding. Further randomized controlled trials are warranted to confirm these findings.© 2023 Wiley Periodicals LLC.

Keywords

AdultAntiviral agentsCritical illnessCritically illHumansIcu mortalityInfluenza, humanOseltamivirProlonged oseltamivirRetrospective studiesSevere influenza

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Medical Virology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 4/41, thus managing to position itself as a Q1 (Primer Cuartil), in the category Virology. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 3.52, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-02, the following number of citations:

WoS: 1
Scopus: 1

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Colombia; United Kingdom; United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Moreno G) .

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