High Morbidity and Mortality in Adults Hospitalized for Respiratory Syncytial Virus Infections.
Clin Infect Dis. 2013 Jul 21;
Authors: Lee N, Lui GC, Wong KT, Li TC, Tse EC, Chan JY, Yu J, Wong SS, Choi KW, Wong RY, Ngai KL, Hui DS, Chan PK
Abstract
Background. Better understanding on complications and outcomes of adults hospitalized with RSV infection is necessary. Methods. A retrospective cohort study was conducted on all adults (≥18 years) admitted to three acute general hospitals in Hong Kong with virologically-confirmed RSV infection during 2009-2011 (n=607). Adults hospitalized for seasonal influenza during the period were used for comparison (n=547). Both infections were prospectively diagnosed following a standard protocol. Independent reviews of chest-radiographs were performed by radiologists. Main outcome measures were all-cause death, respiratory failure requiring ventilatory support and hospitalization duration. Cox proportional hazards models were used for analyses. Findings. The mean±S.D. age of RSV patients was 75±16 years; 87% had underlying conditions. Lower respiratory and cardiovascular complications were diagnosed in 71.9% (pneumonia, 42.3%; acute bronchitis, 21.9%; COPD/asthma exacerbation, 27.3%) and 14.3% respectively; 12.5% had bacterial superinfections. Supplemental oxygen and ventilatory support was required in 67.9% and 11.1%, respectively. Crude all-cause mortality was 9.1% and 11.9% within 30 days and 60 days respectively; mean±S.D length-of-stay of survivors was 12±13 days. Advanced age, radiographic pneumonia, requirement for ventilation, bacterial superinfection, elevated urea and WBC were independently associated with poorer survival. Systemic corticosteroid use was associated with longer hospitalization and secondary infections. The overall outcomes of survival and length-of-stay were not significantly different from influenza. Interpretation. RSV can cause severe lower respiratory complications in the older adults, resulting in respiratory failure, prolonged hospitalization and high mortality similar to seasonal influenza. Corticosteroids did not seem to improve outcomes. The unmet need for antiviral therapy and vaccination against RSV in adults should be promptly addressed.
PMID: 23876395 [PubMed - as supplied by publisher]