Respiratory syncytial virus (RSV)-related mortality and morbidity in adults is significant and comparable to that of Influenza A (InvA), according to study findings published in Respiratory Medicine.

Limited data exist related to risk factors for severe RSV disease in adults and which patients should undergo a nasopharyngeal swab for RSV. Investigators therefore aimed to evaluate the risk factors associated with RSV infection in adults and to assess the clinical characteristics of adults with RSV and severe RSV disease.

The investigators conducted a retrospective, single-center cohort study at L. Sacco University Hospital, Milan, Italy, from October 2022 through March 2023. The study included 717 consecutive adult patients (47% female) referred to the emergency department with acute respiratory failure (aRF) or influenza-like symptoms, who were subsequently tested per protocol (by means of a multiplex nasopharyngeal swab) for SARS-CoV-2, InvA/B, and RSV. Severe disease was defined as respiratory failure, shock, sepsis, the need for respiratory support, or in-hospital death.

The investigators found that 101 patients (14.1%) had a positive swab for InvA; 62 patients (8.6%) were positive for SARS-CoV-2; 61 patients (8.5%) had RSV; and 26 patients (3.6%) had other respiratory viruses.

Compared with patients with InvA and those who were negative for RSV, patients positive for RSV were older (P =.028), had higher prevalence of chronic heart failure (P =.001), had a higher Charlson index (P =.001), were more frequently treated with inhaled corticosteroids (ICS) (P =.026) and immunosuppressants (P =.018), and were more likely exposed to bronchodilators (P =.032).

Preventive strategies for RSV infection such as vaccination are highly warranted, especially in older patients with cardiovascular and chronic respiratory conditions.

Compared with patients with InvA, the investigators noted patients with RSV had more frequent history of immune depression and hepatopathy. Cumulative exposure to ICS therapy did not differ between those with InvA and RSV.

Patients with RSV had the highest occurrence of acute respiratory failure (62.7%) and severe disease (70.5%) compared with the overall study cohort. The investigators noted RSV mortality was similar to mortality of patients with InvA (6.6% vs 5.9%; P =.874), respectively.  

RSV infection was predicted by chronic exposure to immunosuppressants (odds ratio [OR], 3.661; 95% CI, 1.246-10.754; P =.018); heart failure (OR, 3.286; 95% CI, 1.031-10.835; P =.041); and chronic exposure to ICS (OR, 2.377; 95% CI, 1.254-4.505; P =.008).

Severe RSV disease was predicted by past/active smoking (OR, 7.347; 95% CI, 1.301-41.500; P =.024); leucocytes at least 8000 cells/µL (OR, 5.929; 95% CI, 1.090-32-268; P =.039); and glycemia at least 120 mg/dL (OR, 5.839; 95% CI, 1.155-29.519; P =.033). Although smoking history was included in this model, it was not included in the model related to RSV infection because of missing data on smoking habits for 30% of patients.

Study limitations include the retrospective and monocentric design, underpowered sample size, and lack of ethnic heterogeneity.

“Overall, respiratory failure and severe disease were more frequent in RSV patients,” said study authors, who concluded that “Preventive strategies for RSV infection such as vaccination are highly warranted, especially in older patients with cardiovascular and chronic respiratory conditions.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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