The effect of low-to-moderate doses of corticosteroids on human infections with avian influenza A (H7N9) virus_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CAO Lin ¹ , GONG Yu ¹ ,  XIA Hongtao ¹ , JING Yi ¹ , ZHAO Jie ² , LI Yi ³ , HE Yang ⁴ , LIU Tao ⁵ , LUO Huayu ³ , ZHAO Chuan ³ , HE Zhengguang ²

1. Department of Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
2. Department of Respiratory Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
3. Department of Infection, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
4. Department of Critical Care Medicine, The First Suining People’s Hospital, Suining, Sichuan 629000, P. R. China;
5. Department of Critical Care Medicine, Suining Traditional Chinese Medicine Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding author：

XIA Hongtao, Email: 149546109@qq.com

Keywords：

Corticosteroids; Human infections with avian influenza A (H7N9) virus; Acute respiratory distress syndrome

DOI：

10.7507/1671-6205.201708057

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ObjectiveTo evaluate the effect of low-to-moderate doses of corticosteroids on human infections with avian influenza A (H7N9) virus, and explore when to initiate the treatment of corticosteroids and the duration of corticosteroids administration.MethodsThe study collected clinical data of 8 cases with avian influenza A (H7N9) virus infection admitted from January 25, 2017 to May 12, 2017. The final analysis included 5 severe patients who had received adjuvant corticosteroid treatment. The variation curves of WBC, CRP, PCT, CK, HBDH, LDH, temperature, ratio of SpO₂/FiO₂ were depicted and analyzed. The progress of clinical improvements, deterioration and prognosis were observed and discussed.ResultsThere were 1 female and 4 males in the 5 included patients with a median age of 58.0 years, among them 3 survived. The median time of illness onset to hospitalization and diagnosis confirmed were 4 days and 8 days respectively; the median duration of hospitalization to admission to infective ICU were 3 days. The first course of adjuvant corticosteroid treatment was initiated 11 days (median) after admission with a duration of 4 days (median), during which, the serum levels of HBDH and LDH decreased remarkably except the patient 3, and the oxygenation (SpO₂/FiO₂) improved except the patient 3. The second course of systemic administration of corticosteroid was given at a median of 26.5 days after admission with a duration of 9 days (median), during which, the patients survived with improved oxygenation (SpO₂/FiO₂), and weaned from mechanical ventilation.ConclusionsFor patients suffered severe human infection with avian influenza A (H7N9) virus, low-to-moderate doses of corticosteroids may decrease the level of inflammation, regulate the aberrant immune response, improve the oxygenation, make an early unassisted breathing. And corticosteroids treatment can be initiated at the time of disease deterioration, after/at the peak inflammatory response, and within 10-14 days of ARDS. Also, the adjuvant corticosteroids may be administered when oxygenation is dificult to be improved by other ways, or dificult to be liberated from mechanical ventilation, suffering severe septic shock, and refractory fever. And the duration of corticosteroids may be prolonged to 10-14 days, or until the higher level of HBDH and LDH decreased again.

Citation： CAO Lin, GONG Yu, XIA Hongtao, JING Yi, ZHAO Jie, LI Yi, HE Yang, LIU Tao, LUO Huayu, ZHAO Chuan, HE Zhengguang. The effect of low-to-moderate doses of corticosteroids on human infections with avian influenza A (H7N9) virus. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(1): 33-41. doi: 10.7507/1671-6205.201708057 Copy

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2. Wang X, Jiang H, Wu P, et al. Epidemiology of avian influenza A H7N9 virus in human beings across five epidemics in mainland China, 2013-17: an epidemiological study of laboratory-confirmed case series. Lancet Infect Dis, 2017, 17(8): 822-832.
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9. Xiang N, Li X, Ren R, et al. Assessing change in avian influenza A (H7N9) virus infections during the Fourth Epidemic - China, September 2015-August 2016. Morb Mortal Wkly Rep, 2016;65(49): 1390-1394.
10. Ke C, Mok CKP, Zhu W, et al. Human infection with highly pathogenic avian influenza A(H7N9) virus, China. Emerg Infect Dis, 2017, 23(8): 1332-1340.
11. Cao B, Gao H, Zhou B, et al. Adjuvant Corticosteroid Treatment in Adults With Influenza A (H7N9) Viral Pneumonia. Crit Care Med, 2016, 44(6): e318-28.
12. 中华人民共和国国家卫生和计划生育委员会. 人感染 H7N9 禽流感诊疗方案(2017 年第一版). 中华临床感染病杂志, 2017, 10(1): 1-4.
13. Bilan N, Dastranji A, Ghalehgolab Behbahani A. Comparison of the spo2/fio2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or acute respiratory distress syndrome. J Cardiovasc Thorac Res, 2015, 7(1): 28-31.
14. Quispe-Laime A, Bracco J, Barberio P, et al. H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment. Intensive Care Med, 2010, 36(1): 33-41.
15. Diaz E, Martin-Loeches I, Canadell L, et al. Corticosteroid therapy in patients with primary viral pneumonia due to pandemic (H1N1) 2009 influenza.J Infect, 2012, 64(3): 311-318.
16. Liem N, Tung C, Hien N, et al. Clinical features of human influenza A (H5N1) infection in Vietnam: 2004-2006.Clin Infect Dis, 2009, 48(12): 1639-1646.
17. Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev, 2016, 3: CD010406.
18. Zhou J, Wang D, Gao R, et al. Biological features of novel avian influenza A (H7N9) virus. Nature, 2013, 499(7459): 500-503.
19. Chi Y, Zhu Y, Wen T, et al. Cytokine and chemokine levels in patients infected with the novel avian influenza A (H7N9) virus in China. J Infect Dis, 2013, 208(12): 1962-1967.
20. Bentzer P, Fjell C, Walley KR, et al. Plasma cytokine levels predict response to corticosteroids in septic shock. Intensive Care Med, 2016, 42(12): 1970-1979.
21. Gao HN, Lu HZ, Cao B, et al. Clinical findings in 111 cases of influenza A (H7N9) virus infection. N Engl J Med, 2013, 368(24): 2277-2285.
22. Ma W, Huang H, Chen J, et al. Predictors for fatal human infections with avian H7N9 influenza, evidence from four epidemic waves in Jiangsu Province, Eastern China, 2013-2016. Influenza Other Respir Viruses, 2017, 11(5):418-424.
23. Zheng S, Wu J, Yu F, et al. Elevation of creatine kinase is linked to disease severity and predicts fatal outcomes in H7N9 infection. Clin Chem Lab Med, 2017, 55(8): e163-e166.
24. Meduri GU, Bridges L, Shih MC, et al. Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature. Intensive Care Med, 2016, 42(5): 829-840.
25. Sweeney RM, McAuley DF. Acute respiratory distress syndrome. Lancet, 2016, 388(10058): 2416-2430.

Chinese Journal of Respiratory and Critical Care Medicine

The effect of low-to-moderate doses of corticosteroids on human infections with avian influenza A (H7N9) virus

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