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3. Clinical prediction of laboratory-confirmed influenza in adults with influenza-like illness in primary care:A randomized controlled trial secondary analysis in 15 European countries

Author

Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, Llor, Carl, Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, and Llor, Carl

Abstract

BACKGROUND: Clinical findings do not accurately predict laboratory diagnosis of influenza. Early identification of influenza is considered useful for proper management decisions in primary care.OBJECTIVE: We evaluated the diagnostic value of the presence and the severity of symptoms for the diagnosis of laboratory-confirmed influenza infection among adults presenting with influenza-like illness (ILI) in primary care.METHODS: Secondary analysis of patients with ILI who participated in a clinical trial from 2015 to 2018 in 15 European countries. Patients rated signs and symptoms as absent, minor, moderate, or major problem. A nasopharyngeal swab was taken for microbiological identification of influenza and other microorganisms. Models were generated considering (i) the presence of individual symptoms and (ii) the severity rating of symptoms.RESULTS: A total of 2,639 patients aged 18 or older were included in the analysis. The mean age was 41.8 ± 14.7 years, and 1,099 were men (42.1%). Influenza was microbiologically confirmed in 1,337 patients (51.1%). The area under the curve (AUC) of the model for the presence of any of seven symptoms for detecting influenza was 0.66 (95% confidence interval [CI]: 0.65-0.68), whereas the AUC of the symptom severity model, which included eight variables-cough, fever, muscle aches, sweating and/or chills, moderate to severe overall disease, age, abdominal pain, and sore throat-was 0.70 (95% CI: 0.69-0.72).CONCLUSION: Clinical prediction of microbiologically confirmed influenza in adults with ILI is slightly more accurate when based on patient reported symptom severity than when based on the presence or absence of symptoms.

Published
2022

4. Clinical prediction of laboratory-confirmed influenza in adults with influenza-like illness in primary care. A randomized controlled trial secondary analysis in 15 European countries

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, Llor, Carl, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, and Llor, Carl

Published
2022

6. Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data

Author

Verheij, Theo J, primary, Cianci, Daniela, additional, van der Velden, Alike W, additional, Butler, Christopher C, additional, Bongard, Emily, additional, Coenen, Samuel, additional, Colliers, Annelies, additional, Francis, Nick A, additional, Little, Paul, additional, Godycki-Cwirko, Maciek, additional, Llor, Carl, additional, Chlabicz, Sławomir, additional, Lionis, Christos, additional, Sundvall, Pär-Daniel, additional, Bjerrum, Lars, additional, De Sutter, An, additional, Aabenhus, Rune, additional, Harbin, Nicolay Jonassen, additional, Lindbæk, Morten, additional, Glinz, Dominik, additional, Bucher, Heiner C, additional, Kovács, Bernadett, additional, Seifert, Bohumil, additional, Jurgute, Ruta Radzeviciene, additional, Lundgren, Pia Touboul, additional, de Paor, Muireann, additional, Matheeussen, Veerle, additional, Goossens, Herman, additional, and Ieven, Margareta, additional

Published
2021
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7. Clinical prediction of laboratory-confirmed influenza in adults with influenza-like illness in primary care. A randomized controlled trial secondary analysis in 15 European countries

Author

Ouchi, Dan, primary, García-Sangenís, Ana, additional, Moragas, Ana, additional, van der Velden, Alike W, additional, Verheij, Theo J, additional, Butler, Christopher C, additional, Bongard, Emily, additional, Coenen, Samuel, additional, Cook, Johanna, additional, Francis, Nick A, additional, Godycki-Cwirko, Maciek, additional, Lundgren, Pia Touboul, additional, Lionis, Christos, additional, Radzeviciene Jurgute, Ruta, additional, Chlabicz, Sławomir, additional, De Sutter, An, additional, Bucher, Heiner C, additional, Seifert, Bohumil, additional, Kovács, Bernadett, additional, de Paor, Muireann, additional, Sundvall, Pär-Daniel, additional, Aabenhus, Rune, additional, Harbin, Nicolay Jonassen, additional, Ieven, Greet, additional, Goossens, Herman, additional, Lindbæk, Morten, additional, Bjerrum, Lars, additional, and Llor, Carl, additional

Published
2021
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8. Does C-reactive protein predict time to recovery and benefit from oseltamivir treatment in primary care patients with influenza-like illness? A randomized controlled trial secondary analysis

Author

Harbin, Nicolay Jonassen, primary, Rystedt, Karin, additional, Lindbaek, Morten, additional, Radzeviciene, Ruta, additional, Westin, Johan, additional, Gunnarsson, Ronny, additional, Butler, Christopher C., additional, van der Velden, Alike W., additional, Verheij, Theo J., additional, and Sundvall, Pär-Daniel, additional

Published
2021
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9. Does C-reactive protein predict time to recovery and benefit from oseltamivir treatment in primary care patients with influenza-like illness?: A randomized controlled trial secondary analysis

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Harbin, Nicolay Jonassen, Rystedt, Karin, Lindbaek, Morten, Radzeviciene, Ruta, Westin, Johan, Gunnarsson, Ronny, Butler, Christopher C, van der Velden, Alike W, Verheij, Theo J, Sundvall, Pär-Daniel, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Harbin, Nicolay Jonassen, Rystedt, Karin, Lindbaek, Morten, Radzeviciene, Ruta, Westin, Johan, Gunnarsson, Ronny, Butler, Christopher C, van der Velden, Alike W, Verheij, Theo J, and Sundvall, Pär-Daniel

Published
2021

11. Is C-reactive protein associated with influenza A or B in primary care patients with influenza-like illness? A cross-sectional study

Author

Rystedt, Karin, primary, Harbin, Nicolay Jonassen, additional, Lindbaek, Morten, additional, Radzeviciene, Ruta, additional, Gunnarsson, Ronny, additional, Eggertsen, Robert, additional, C. Butler, Christopher, additional, van der Velden, Alike W., additional, J. Verheij, Theo, additional, and Sundvall, Pär-Daniel, additional

Published
2020
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12. Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data.

Author

Verheij, Theo J, Cianci, Daniela, van der Velden, Alike W, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Colliers, Annelies, Francis, Nick A, Little, Paul, Godycki-Cwirko, Maciek, Llor, Carl, Chlabicz, Sławomir, Lionis, Christos, Sundvall, Pär-Daniel, Bjerrum, Lars, De Sutter, An, Aabenhus, Rune, Harbin, Nicolay Jonassen, Lindbæk, Morten, and Glinz, Dominik

Subjects
INFLUENZA, ETIOLOGY of diseases, DISEASE progression, RANDOMIZED controlled trials, SYMPTOMS, RESPIRATORY infections
Abstract

Background: There is little evidence about the relationship between aetiology, illness severity, and clinical course of respiratory tract infections (RTIs) in primary care. Understanding these associations would aid in the development of effective management strategies for these infections.Aim: To investigate whether clinical presentation and illness course differ between RTIs where a viral pathogen was detected and those where a potential bacterial pathogen was found.Design and Setting: Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with flu-like illness in primary care (n = 3266) in 15 European countries.Method: Patient characteristics and their signs and symptoms of disease were registered at baseline. Nasopharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for polymerase chain reaction analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan-Meier curves were used to analyse the relationship between aetiology, clinical presentation at baseline, and course of disease including complications.Results: Except for a less prominent congested nose (odds ratio [OR] 0.55, 95% confidence interval [CI] = 0.35 to 0.86) and acute cough (OR 0.42, 95% CI = 0.27 to 0.65) in patients with flu-like illness in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology compared with those with a viral aetiology. Also, course of disease and complications were not related to aetiology.Conclusion: Given current available microbiological tests and antimicrobial treatments, and outside pandemics such as COVID-19, microbiological testing in primary care patients with flu-like illness seems to have limited value. A wait-and-see policy in most of these patients with flu-like illness seems the best option. [ABSTRACT FROM AUTHOR]

Published
2022
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13. Is C-reactive protein associated with influenza A or B in primary care patients with influenza-like illness?: A cross-sectional study

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectious Diseases, Rystedt, Karin, Harbin, Nicolay Jonassen, Lindbaek, Morten, Radzeviciene, Ruta, Gunnarsson, Ronny, Eggertsen, Robert, C Butler, Christopher, van der Velden, Alike W, J Verheij, Theo, Sundvall, Pär-Daniel, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectious Diseases, Rystedt, Karin, Harbin, Nicolay Jonassen, Lindbaek, Morten, Radzeviciene, Ruta, Gunnarsson, Ronny, Eggertsen, Robert, C Butler, Christopher, van der Velden, Alike W, J Verheij, Theo, and Sundvall, Pär-Daniel

Published
2020

14. Oseltamivir Plus Usual Care versus Usual Primary Care for Influenza-Like-Illness: An Open-Label, Pragmatic, Randomized Controlled Trial

Author

Butler, Christopher, primary, van der Velden, Alike W., additional, Bongard, Emily, additional, Saville, Benjamin R., additional, Holmes, Jane, additional, Cook, Johanna, additional, Coenen, Samuel, additional, Francis, Nick A., additional, Lewis, Roger J., additional, Godycki-Cwirko, Maciek, additional, Llor, Carl, additional, Chlabicz, Sławomir, additional, Lionis, Christos, additional, Seifert, Bohumil, additional, Sundvall, Pär-Daniel, additional, Colliers, Annelies, additional, Aabenhus, Rune, additional, Bjerrum, Lars, additional, Harbin, Nicolay Jonassen, additional, Lindbæk, Morten, additional, Glinz, Dominik, additional, Bucher, Heiner C., additional, Kovács, Bernadett, additional, Jurgute, Ruta Radzeviciene, additional, Lundgren, Pia Touboul, additional, Little, Paul, additional, Murphy, Andrew W., additional, de Sutter, An, additional, Openshaw, Peter, additional, de Jong, Menno D., additional, Connor, Jason T., additional, Matheeussen, Veerle, additional, Ieven, Margareta, additional, Goossens, Herman, additional, and Verheij, Theo J., additional

Published
2019
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15. Clinical prediction of laboratory-confirmed influenza in adults with influenza-like illness in primary care. A randomized controlled trial secondary analysis in 15 European countries.

Author

Ouchi D, García-Sangenís A, Moragas A, van der Velden AW, Verheij TJ, Butler CC, Bongard E, Coenen S, Cook J, Francis NA, Godycki-Cwirko M, Lundgren PT, Lionis C, Radzeviciene Jurgute R, Chlabicz S, De Sutter A, Bucher HC, Seifert B, Kovács B, de Paor M, Sundvall PD, Aabenhus R, Harbin NJ, Ieven G, Goossens H, Lindbæk M, Bjerrum L, and Llor C

Subjects
Adult, Clinical Laboratory Techniques, Cough, Female, Fever, Humans, Male, Middle Aged, Primary Health Care, Influenza, Human diagnosis, Influenza, Human epidemiology
Abstract

Background: Clinical findings do not accurately predict laboratory diagnosis of influenza. Early identification of influenza is considered useful for proper management decisions in primary care., Objective: We evaluated the diagnostic value of the presence and the severity of symptoms for the diagnosis of laboratory-confirmed influenza infection among adults presenting with influenza-like illness (ILI) in primary care., Methods: Secondary analysis of patients with ILI who participated in a clinical trial from 2015 to 2018 in 15 European countries. Patients rated signs and symptoms as absent, minor, moderate, or major problem. A nasopharyngeal swab was taken for microbiological identification of influenza and other microorganisms. Models were generated considering (i) the presence of individual symptoms and (ii) the severity rating of symptoms., Results: A total of 2,639 patients aged 18 or older were included in the analysis. The mean age was 41.8 ± 14.7 years, and 1,099 were men (42.1%). Influenza was microbiologically confirmed in 1,337 patients (51.1%). The area under the curve (AUC) of the model for the presence of any of seven symptoms for detecting influenza was 0.66 (95% confidence interval [CI]: 0.65-0.68), whereas the AUC of the symptom severity model, which included eight variables-cough, fever, muscle aches, sweating and/or chills, moderate to severe overall disease, age, abdominal pain, and sore throat-was 0.70 (95% CI: 0.69-0.72)., Conclusion: Clinical prediction of microbiologically confirmed influenza in adults with ILI is slightly more accurate when based on patient reported symptom severity than when based on the presence or absence of symptoms., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2022
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