Article ; Online: Respiratory syncytial virus burden and risk factors for severe disease in patients presenting to the emergency department with flu-like symptoms or acute respiratory failure.
2023 Volume 218, Page(s) 107404
Abstract: Background: Predictors of Respiratory Syncytial Virus (RSV) infection and determinants of RSV unfavorable outcomes are still unclear. We assessed RSV burden and investigated the risk factors associated with RSV positive swab and RSV severe disease.: ... ...
| Abstract | Background: Predictors of Respiratory Syncytial Virus (RSV) infection and determinants of RSV unfavorable outcomes are still unclear. We assessed RSV burden and investigated the risk factors associated with RSV positive swab and RSV severe disease. Methods: A retrospective, single center, cohort study included all consecutive patients referred to the emergency department of L. Sacco University Hospital (Milan) with flu-like symptoms or acute respiratory failure (aRF) tested per protocol for SARS-CoV-2, RSV, Influenza A (InvA) during the 2022-2023 autumn/winter season. Clinical characteristics and patients' outcomes were registered. Respiratory failure, need for respiratory support, shock, sepsis or in-hospital death defined severe disease. Main findings: The analysis included 717 patients (65.1% negative swab, 14.1% InvA, 8.5% RSV, 8.6% SARS-CoV-2, 3.6% other viruses). Compared with the study cohort, RSV patients had the highest occurrence of aRF (62.7%) and severe disease (70.5%); mortality was similar to InvA (6.6% vs 5.9%, p = 0.874). Compared with InvA patients, RSV patients were older (p = 0.009), had higher Charlson index (p = 0.001), higher prevalence of chronic heart failure (p = 0.001) and were more frequently on ICS (p = 0.026) and immunosuppressants (p = 0.018). Heart failure [OR (95%CI):3.286 (1.031-10.835); p = 0.041], chronic exposure to ICS [OR (95%CI):2.377 (1.254-4.505); p = 0.008] and immunosuppressants [OR (95%CI):3.661 (1.246-10.754); p = 0.018] predicted RSV infection. Glycaemia ≥120 mg/dL [OR (95%CI):5.839 (1.155-29.519); p = 0.033], leucocytes ≥8000 cells/μL [OR (95%CI):5.929 (1.090-32.268); p = 0.039], and past/active smoking [OR (95%CI):7.347 (1.301-41.500); p = 0.024] predicted severe RSV disease. Conclusions: RSV infection is associated with significant mortality and morbidity. Preventive strategies for RSV infection such as vaccination are highly warranted, especially in older patients with cardiovascular and chronic respiratory conditions. |
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| MeSH term(s) | Humans ; Aged ; Cohort Studies ; Retrospective Studies ; Hospital Mortality ; Respiratory Syncytial Virus, Human ; Respiratory Syncytial Virus Infections/complications ; Respiratory Syncytial Virus Infections/epidemiology ; Influenza, Human/complications ; Influenza, Human/epidemiology ; Heart Failure/epidemiology ; Respiratory Distress Syndrome ; Risk Factors ; Emergency Service, Hospital ; Respiratory Insufficiency/epidemiology ; Immunosuppressive Agents |
| Chemical Substances | Immunosuppressive Agents |
| Language | English |
| Publishing date | 2023-09-06 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 1003348-8 |
| ISSN | 1532-3064 ; 0954-6111 |
| ISSN (online) | 1532-3064 |
| ISSN | 0954-6111 |
| DOI | 10.1016/j.rmed.2023.107404 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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