Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study

被引：163

作者：

Arabi, Yaseen M. ^{[1
]}

Shalhoub, Sarah ^{[2
,3
]}

Mandourah, Yasser ^{[4
]}

Al-Hameed, Fahad ^{[5
]}

Al-Omari, Awad ^{[6
]}

Al Qasim, Eman ^{[1
]}

Jose, Jesna ^{[1
]}

Alraddadi, Basem ^{[7
,8
]}

Almotairi, Abdullah ^{[9
]}

Al Khatib, Kasim ^{[10
]}

Abdulmomen, Ahmed ^{[11
]}

Qushmaq, Ismael ^{[7
]}

Sindi, Anees A. ^{[12
]}

Mady, Ahmed ^{[13
,14
]}

Solaiman, Othman ^{[15
]}

Al-Raddadi, Rajaa ^{[16
]}

Maghrabi, Khalid ^{[15
]}

Ragab, Ahmed ^{[17
]}

Al Mekhlafi, Ghaleb A. ^{[18
]}

Balkhy, Hanan H. ^{[19
]}

Al Harthy, Abdulrahman ^{[13
]}

Kharaba, Ayman ^{[20
]}

Gramish, Jawaher A. ^{[21
]}

Al-Aithan, Abdulsalam M. ^{[22
]}

Al-Dawood, Abdulaziz ^{[1
]}

Merson, Laura ^{[23
]}

Hayden, Frederick G. ^{[23
]}

Fowler, Robert ^{[24
,25
]}

机构：

[1] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdulaziz Med City, King Abdullah Int Med Res Ctr, Intens Care Dept,Coll Med, Riyadh, Saudi Arabia

[2] Univ Western Ontario, Schulich Sch Med & Dent, Dept Med, London, ON, Canada

[3] King Fahad Armed Forces Hosp, Jeddah, Saudi Arabia

[4] Prince Sultan Mil Med City, Minist Def, Mil Med Serv, Riyadh, Saudi Arabia

[5] King Saud bin Abdulaziz Univ Hlth Sci, King Abdulaziz Med City, King Abdullah Int Med Res Ctr, Dept Intens Care,Coll Med, Jeddah, Saudi Arabia

[6] Alfaisal Univ, Dr Sulaiman Al Habib Grp Hosp, Coll Med, Dept Intens Care, Riyadh, Saudi Arabia

[7] King Faisal Specialist Hosp & Res Ctr, Dept Med, Jeddah, Saudi Arabia

[8] Univ Jeddah, Dept Med, Riyadh, Saudi Arabia

[9] King Fahad Med City, Dept Crit Care Med, Riyadh, Saudi Arabia

[10] Al Noor Specialist Hosp, Intens Care Dept, Mecca, Saudi Arabia

[11] King Saud Univ, Dept Crit Care Med, Riyadh, Saudi Arabia

[12] King Abdulaziz Univ, Fac Med, Dept Anesthesia & Crit Care, Jeddah, Saudi Arabia

[13] King Saud Med City, Intens Care Dept, Riyadh, Saudi Arabia

[14] Tanta Univ Hosp, Tanta, Egypt

[15] King Faisal Specialist Hosp & Res Ctr, Intens Care Dept, Riyadh, Saudi Arabia

[16] King Abdulaziz Univ, Fac Med, Dept Community Med, Jeddah, Saudi Arabia

[17] King Fahad Cent Hosp, Intens Care Dept, Jeddah, Saudi Arabia

[18] Prince Sultan Mil Med City, Dept Intens Care Serv, Riyadh, Saudi Arabia

[19] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdulaziz Med City, King Abdullah Int Med Res Ctr, Dept Infect Prevent & Control,Coll Med, Riyadh, Saudi Arabia

[20] Ohoud Hosp, King Fahad Hosp, Dept Crit Care, Al Madinah, Saudi Arabia

[21] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdulaziz Med City, King Abdullah Int Med Res Ctr, Pharmaceut Care Dept,Coll Pharm, Riyadh, Saudi Arabia

[22] King Abdulaziz Hosp, Crit Care Div, Dept Med, Al Hasa, Saudi Arabia

[23] Univ Oxford, Infect Dis Data Observ, Int Severe Acute Resp & Emerging Infect Consortiu, Oxford, England

[24] Univ Toronto, Dept Crit Care Med, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[25] Sunnybrook Med Ctr, Dept Med, Toronto, ON, Canada

来源：

CLINICAL INFECTIOUS DISEASES | 2020年 / 70卷 / 09期

关键词：

coronavirus; Middle East respiratory syndrome; pneumonia; ribavirin; interferon; MARGINAL STRUCTURAL MODELS; IMMORTAL TIME BIAS; SYNDROME CORONAVIRUS; MERS-COV;

D O I：

10.1093/cid/ciz544

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: The objective of this study was to evaluate the effect of ribavirin and recombinant interferon (RBV/rIFN) therapy on the outcomes of critically ill patients with Middle East respiratory syndrome (MERS), accounting for time-varying confounders. Methods: This is a retrospective cohort study of critically ill patients with laboratory-confirmed MERS from 14 hospitals in Saudi Arabia diagnosed between September 2012 and January 2018. We evaluated the association of RBV/rIFN with 90-day mortality and MERS coronavirus (MERS-CoV) RNA clearance using marginal structural modeling to account for baseline and time-varying confounders. Results: Of 349 MERS patients, 144 (41.3%) patients received RBV/rIFN (RBV and/or rIFN-alpha 2a, rIFN-alpha 2b, or rIFN-beta 1a; none received rIFN-beta 1b). RBV/rIFN was initiated at a median of 2 days (Q1, Q3: 1, 3 days) from intensive care unit admission. Crude 90-day mortality was higher in patients with RBV/rIFN compared to no RBV/rIFN (106/144 [73.6%] vs 126/205 [61.5%]; P = .02]. After adjusting for baseline and time-varying confounders using a marginal structural model, RBV/rIFN was not associated with changes in 90-day mortality (adjusted odds ratio, 1.03 [95% confidence interval {CI}, .73-1.44]; P = .87) or with more rapid MERS-CoV RNA clearance (adjusted hazard ratio, 0.65 [95% CI, .30-1.44]; P = .29). Conclusions: In this observational study, RBV/rIFN (RBV and/or rIFN-alpha 2a, rIFN-alpha 2b, or rIFN-beta 1a) therapy was commonly used in critically ill MERS patients but was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance.

引用

页码：1837 / 1844

页数：8

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