Epidemiology: Open Access
Open Access

Abstract

Background: Current most studies on glucocorticosteriods treating influenza only estimated risk of critical illness or death, which were easily confused by early and later glucocorticosteriods treatment. We used sARI as endpoint and investigated risk for receiving glucocorticosteriods before sARI onset. Methods: sARI case was defined as ILI whit pH1N1 infection and respiratory distress. Control was pH1N1 case other than sARI, randomly selected from community. We compared glucocorticosteriods and other medications used before sARI onset by matched case control study that was adjusted for age group and underlying disease, and estimated time-dependent risk and dose-response at different time periods in the course of sARI cases. Results: 34% of sARI cases received glucocorticosteriods before sARI onset compared to 3.8% of controls during equivalent days (ORM-H=17,95%CI=2.1-135).Receiving glucocorticosteriods before sARI onset increased risk of developing subsequent critical illness or death (ORM-H=5.7,95%CI=1.6-20.2),and the ORM-H increased from 5.7 to 8.5 while continued receiving them after sARI onset, only receiving glucocorticosteriods after sARI onset did not increase risk of severe illness (ORMH= 1.1,95%CI=0.3-4.6).Each increase in glucocorticosteriods dose of 1 mg/kg/day before sARI onset, the pMEWS at the time of sARI onset increased by 0.62(R2=0.87). Conclusions: Early glucocorticosteriods treatment increased risk of sARI and subsequent critical illness or death, only receiving glucocorticosteriods after sARI onset did not increase risk of severe illness.

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