Post-consultation acute respiratory tract infection recovery: a latent class informed analysis of individual patient data from randomised controlled trials and observational studies

Hounkpatin, Hilda, Stuart, Beth, Zhu, Shihua, Yao, Guiqing, Moore, Michael, Löffler, Christin, Little, Paul, Kenealy, Timothy, Gillespie, David ORCID: https://orcid.org/0000-0002-6934-2928, Francis, Nick A, Bostock, Jennifer, Becque, Taeko, Arroll, Bruce, Altiner, Attila, Alonso-Coello, Pablo and Hay, Alastair D 2023. Post-consultation acute respiratory tract infection recovery: a latent class informed analysis of individual patient data from randomised controlled trials and observational studies. British Journal of General Practice 73 (728) , e196-e203. 10.3399/BJGP.2022.0229

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Abstract

Background: There is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration. Aim: To describe symptom trajectories in patients with RTIs, assess baseline characteristics and adverse events associated with trajectories. Design and setting: 9103 adults and children from 12 primary care studies. Method: Individual patient data latent class-informed regression analysis of randomised controlled trials and observational cohort studies. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness and hospitalisation were assessed. Results: 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic strategy. For studies of RTI with cough as a dominant symptom (n=5314), four trajectories were identified: ‘rapid[6]’ (90% of participants recovered within 6 days)’ in 52.0%; ‘intermediate[10]’ (28.9%); ‘slow progressive improvement[27]’ (12.5%); and ‘slow initial high symptom burden[27]’ (6.6%). Older age (OR: (95% CI): 2.57 (1.72-3.85), higher presenting illness baseline severity (OR) (95% CIs): 1.51 (1.12-2.03)); presence of lung disease (OR (95% CI): 1.78 (1.44-2.21)); above median illness duration prior to consultation (OR (95% CI): 1.99 (1.68-2.37)) were associated with slower recovery (>10 days) compared to faster recovery (≤10 days). Re-consultations and hospitalisations were respectively higher in those with slower recovery (ORs: 2.15 (1.78-2.60) and 7.42 (3.49-15.78)). Conclusion: Older patients presenting with more severe, longer pre-consultation symptoms, and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Centre for Trials Research (CNTRR)
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Date of First Compliant Deposit:	2 December 2022
Date of Acceptance:	10 November 2022
Last Modified:	05 May 2023 11:13
URI:	https://orca.cardiff.ac.uk/id/eprint/154613

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