Adult RSV Hospitalizations: Clinical Characteristics, Risk Factors for Severe Outcomes

Respiratory syncytial virus (RSV) is a significant pathogen among adult patients admitted to the emergency department (ED), especially among those with underlying medical conditions, show findings from a new study.¹

“This study aimed to investigate adult patients with symptomatic RSV infections in the ED of a German university hospital and their clinical course to evaluate the potential risk factors for inpatient treatment,” wrote the researchers of the study.

The observational cohort study is published in Medicine.

The study was conducted between October 1, 2022, and March 31, 2023. All adult patients 18 years and older presenting to a tertiary care ED underwent point-of-care polymerase chain reaction testing for RSV, COVID-19, and influenza. Symptomatic patients who tested positive for RSV were also included if they had at least 1 clinical symptom present upon arrival: malaise, dyspnea, cough, fever, headache, nausea, chest pain, sore throat, and myalgia.

Inpatients with RSV were significantly older and showed significantly more preconditions than outpatients. | Image credit: Jun Li - stock.adobe.com

Nasopharyngeal swabs were collected along with data of all patients who had RSV, which were obtained from electronic medical records. Patient data were further analyzed, including vital parameters, laboratory values, medical preconditions, and further diagnosis and treatment.

A total of 8050 patients were tested for RSV, COVID-19, and influenza. Of these patients, 157 (2%) tested positive for RSV, 490 (6.1%) tested positive for COVID-19, and 321 (4%) tested positive for influenza A/B. Coinfections were rarely observed. Furthermore, only 17 (10.8%) patients with RSV presented without any of the defined respiratory symptoms.

After exclusion, 35 patients with RSV were further analyzed. Of these patients, 120 (89%) reported malaise, 64 (47%) reported dyspnea, 56 (41%) reported cough, and 33 (24%) reported fever as their major complaint upon presentation.

Regarding medical preconditions as potential risk factors for inpatient treatment, 67 (50%) patients had arterial hypertension, 49 (36%) had cardiac disease, 44 (33%) had pulmonary disease, and 39 (29%) had tumors. Additionally, 14 (10%) patients were immunocompromised. Of these patients, 70 (51.8%) were prospective inpatients.

Inpatients with RSV were also significantly older and showed significantly more preconditions than outpatients.

Multivariate analysis revealed that malaise (OR, 8.4; 95% CI, 1.39-50.73; P = .021) and detection of pulmonary infiltrations (OR, 12.56; 95% CI, 3.61-43.68; P < .001) were the only independent predictors of inpatient treatment.

The researchers noted some limitations on their findings, including that all data were collected retrospectively from medical records, the study was conducted in a single center, and the primary reason for presentation was unclear in some cases, as was the specific reason for complaints.

Despite these limitations, the researchers believe the study findings show that older patients and those with certain preconditions carry a higher risk for severe RSV infection, in which inpatient treatment is often required. Furthermore, the researchers suggest RSV vaccination as a future strategy to reduce morbidity and mortality in this vulnerable patient population.

The CDC recommends that all adults 75 years and older, and adults aged 60 to 74 years who are at increased risk for severe RSV disease should receive a single dose of the RSV vaccine (Arexvy [GSK], Abrysvo [Pfizer], or mResvia [Moderna]).²

“Although the clinical picture seems similar to many common respiratory viruses, with malaise, cough, and dyspnea being the most common complaints in our cohort, the clinical course may even be more serious in this setting, with an inpatient rate of more than 50% in our group of ED patients,” wrote the researchers.¹

References

1. Fistera D, Kramer CM, Manegold RK, et al. Adult patients with severe respiratory syncytial virus infections in the emergency department. Medicine (Baltimore). 2024;103(39):e39265. doi:10.1097/MD.0000000000039265

2. Steinzor P. Updated ACIP guidelines: RSV vaccine for adults aged 60 years and older. AJMC^®. Published August 7, 2024. Accessed October 5, 2024. https://www.ajmc.com/view/updated-acip-guidelines-rsv-vaccine-for-adults-aged-60-years-and-older