Increased Risk of Complications Found in Patients With RSV

Patients with comorbid respiratory syncytial virus (RSV) infection who already have respiratory failure have a higher risk of disease complications, according to a study published in Frontiers in Medicine. However, the 28-day mortality for patients with respiratory failure was the same regardless of RSV infection.

RSV affects children and adults and is associated with increased morbidity and mortality. Presentation is multifaceted, with some children and adults getting symptoms of an upper respiratory tract infection whereas premature infants and older adults could have symptoms of a severe lower respiratory tract infection. This study aimed to investigate the clinical outcomes, treatments, and respiratory complications for patients who have both an RSV infection and respiratory failure.

This study was conducted in a tertiary care, university-affiliated teaching hospital in Thailand. Patients who were admitted to the medical ward and needed mechanical ventilation support for more than 24 hours due to respiratory failure between January 2014 and July 2019 were considered for the study. Patients aged 18 and older and who had respiratory samples analyzed were enrolled. RSV infection was determined if respiratory pathogen testing came back positive.

All electronic health records were used to collect data on characteristics, clinical data, disease severity, hospital courses, and outcomes in enrolled patients. Respiratory failure was determined as the respiratory system’s inability to meet the requirements of a patient. The primary outcome was 28-day mortality, with ventilator-dependent days, hospital length of stay (LOS), tracheostomy after respiratory failure, and hospital death being secondary outcomes.

There were 335 patients included in the final analysis, of which 67 were in the RSV group and 268 in the non-RSV group. No significant differences were found in the baseline characteristics of the 2 groups (mean [SD] age, 72.7 [12.7] vs 71.0 [14.8] years; male, 46.3% vs 47.4%, respectively). The RSV group had a higher rate of community-acquired pneumonia and health care–associated pneumonia was more common in the non-RSV group.

Within the RSV group, there was a 38.8% 28-day mortality rate compared with 37.1% in the non-RSV group, and no significant differences were found in mortality rates, ventilator-dependent days, or LOS. Patients in the RSV group were more often given bronchodilator drugs (98.5% vs 60.8%) and ribavirin (80.6% vs 0.7%). Ventilator-associated pneumonia (52.2% vs 33.8%) and lung atelectasis (10.4% vs 3%) were more common in the patients in the RSV group compared with the non-RSV group.

Higher use of ribavirin and tracheostomy were seen in nonsurvivors vs survivors (95.8% vs 72.1%; 20.8% vs 4.7%). In-hospital death was associated with acute respiratory distress syndrome (relative risk [RR], 4.25; 95% CI, 1.58-11.42), ventilator-associated pneumonia (RR, 10.21; 95% CI, 4.83-21.59), and prolonged ventilator support (RR, 2.31; 95% CI, 1.03-5.21). RSV was not associated with increased hospital death.

Potential limitations on these findings include that biases and residual confounders can occur in an observational study, and mortality rate in the non-RSV group may not be able to reflect the rate of patients with respiratory failure patients in general practice. Organ failures also should be considered for mortality rate.

The researchers concluded that 28-day mortality was similar in patients infected and not infected with RSV. Complications, however, were more frequent in patients with an RSV infection.

Reference

Tongyoo S, Naorungroj T, Laikitmongkhon J. Predictive factors and outcomes of respiratory syncytial virus infection among patients with respiratory failure. Front Med (Lausanne). Published online March 27, 2023. doi:10.3389/fmed.2023.1148531