Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection
Authors: Venkatesan Sudhir , Myles Puja R , Bolton Kirsty J , Muthuri Stella G , Al Khuwaitir Tarig , Anovadiya Ashish P , Azziz-Baumgartner Eduardo , Bajjou Tahar , Bassetti Matteo , Beovic Bojana , Bertisch Barbara , Bonmarin Isabelle , Booy Robert , Borja-Aburto Victor H , Burgmann Heinz , Cao Bin , Carratala Jordi , Chinbayar Tserendorj , Cilloniz Catia , Denholm Justin T , Dominguez Samuel R , Duarte Pericles A D , Dubnov-Raz Gal , Fanella Sergio , Gao Zhancheng , Gérardin Patrick , Giannella Maddalena , Gubbels Sophie , Herberg Jethro , Higuera Iglesias Anjarath Lorena , Hoeger Peter H , Hu Xiao Yun , Islam Quazi T , Jiménez Mirela F , Keijzers Gerben , Khalili Hossein , Kusznierz Gabriela , Kuzman Ilija , Langenegger Eduard , Lankarani Kamran B , Leo Yee-Sin , Libster Romina P , Linko Rita , Madanat Faris , Maltezos Efstratios , Mamun Abdullah , Manabe Toshie , Metan Gokhan , Mickiene Auksė , Mikić Dragan , Mohn Kristin G I , Oliva Maria E , Ozkan Mehpare , Parekh Dhruv , Paul Mical , Rath Barbara A , Refaey Samir , Rodríguez Alejandro H , Sertogullarindan Bunyamin , Skręt-Magierło Joanna , Somer Ayper , Talarek Ewa , Tang Julian W , To Kelvin , Tran Dat , Uyeki Timothy M , Vaudry Wendy , Vidmar Tjasa , Zarogoulidis Paul ,   PRIDE Consortium Investigators, Amayiri Nisreen , Amin Robed , Baez Clarissa , Bantar Carlos , Bao Jing , Barhoush Mazen Mahmoud , Basher Ariful , Bettinger Julie , Bouza Emilio , Bozkurt Ilkay , Čeljuska-Tošev Elvira , Chan Kenny K C , Chen Yusheng , Cox Rebecca , Cuezzo Maria R , Cui Wei , Dashti-Khavidaki Simin , Du Bin , El Rhaffouli Hicham , Escobar Hernan , Florek-Michalska Agnieszka , Gerrard John , Gormley Stuart , Götberg Sandra , Hoffmann Matthias , Honarvar Behnam , Bautista Edgar , Kandeel Amr , Hu Jianmin , Kemen Christoph , Khandaker Gulam , Knight Marian , Koay Evelyn S C , Kojic Miroslav , Kudo Koichiro , Kwan Arthur , Amine Idriss Lahlou , Kyaw Win Mar , Leibovici Leonard , Li Hongru , Li Xiao-Li , Liu Pei , Loh Tze Ping , Macbeth Deborough , Marczyńska Magdalena , Mastalir Fabiane Pinto , McGeer Allison , Moghadami Mohsen , Moriconi Lilian , Nymadawa Pagbajabyn , Ozbay Bulent , Polack Fernando P , Poliquin Philippe Guillaume , Pöppl Wolfgang , Pacheco Alberto Rascon , Pečavar Blaž , Rahman Mahmudur , Sarrouf Elena B , Schweiger Brunhilde , Smith Fang Gao , Torres Antoni , Torun Selda Hancerli , Tripathi C B , Velyvyte Daiva , Viasus Diego F , Yu Qin , Yuen Kwok-Yung , Zhang Wei , Zuo Wei , Nguyen-Van-Tam Jonathan S 
Published: May 2019

Background

The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear.

Methods

We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded.

Results

We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78–.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS.

Conclusions

When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.