Adlhoch, CorneliaDelgado-Sanz, ConcepcionCarnahan, AnnaSaraLarrauri, AmparoPopovici, OdetteBossuyt, NathalieThomas, IsabelleKynčl, JanSlezák, PavelBrytting, MiaGuiomar, RaquelRedlberger-Fritz, MonikaMaistre Melillo, JackieMelillo, Tanyavan Gageldonk-Lafeber, Arianne BMarbus, Sierk DO'Donnell, JoanDomegan, LisaGomes Dias, JoanaOlsen, Sonja J2023-09-252023-09-252023-01Euro Surveill. 2023 Jan;28(4):2200340.http://hdl.handle.net/20.500.12105/16485Background: Timely treatment with neuraminidase inhibitors (NAI) can reduce severe outcomes in influenza patients. Aim: We assessed the impact of antiviral treatment on in-hospital deaths of laboratory-confirmed influenza patients in 11 European Union countries from 2010/11 to 2019/20. Methods: Case-based surveillance data from hospitalised patients with known age, sex, outcome, ward, vaccination status, timing of antiviral treatment, and hospitalisation were obtained. A mixed effect logistic regression model using country as random intercept was applied to estimate the adjusted odds ratio (aOR) for in-hospital death in patients treated with NAIs vs not treated. Results: Of 19,937 patients, 31% received NAIs within 48 hours of hospital admission. Older age (60-79 years aOR 3.0, 95% CI: 2.4-3.8; 80 years 8.3 (6.6-10.5)) and intensive care unit admission (3.8, 95% CI: 3.4-4.2) increased risk of dying, while early hospital admission after symptom onset decreased risk (aOR 0.91, 95% CI: 0.90-0.93). NAI treatment initiation within 48 hours and up to 7 days reduced risk of dying (0-48 hours aOR 0.51, 95% CI: 0.45-0.59; 3-4 days 0.59 (0.51-0.67); 5-7 days 0.64 (0.56-0.74)), in particular in patients 40 years and older (e.g. treatment within 48 hours: 40-59 years aOR 0.43, 95% CI: 0.28-0.66; 60-79 years 0.50 (0.39-0.63); ≥80 years 0.51 (0.42-0.63)). Conclusion: NAI treatment given within 48 hours and possibly up to 7 days after symptom onset reduced risk of in-hospital death. NAI treatment should be considered in older patients to prevent severe outcomes.engVoRhttp://creativecommons.org/licenses/by/4.0/EUInfluenzaAntiviral treatmentClinicEpidemiologyFatal outcomeHospitalInfluenza virusRisk factorsSurveillanceOseltamivirInfluenza, HumanHumansAgedNeuraminidaseHospital MortalityAntiviral AgentsEnzyme InhibitorsGuanidinesZanamivirTreatment OutcomeAtribución 4.0 Internacional36700868284220034010.2807/1560-7917.ES.2023.28.4.22003401560-7917Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletinopen access