External validation and update of a prognostic model to predict mortality in hospitalized adults with RSV: A retrospective Dutch cohort study

Abstract

Respiratory syncytial virus (RSV) causes significant mortality in hospitalized adults. Prediction of poor outcomes improves targeted management and clinical outcomes. We externally validated and updated existing models to predict poor outcome in hospitalized RSV‐infected adults. In this single center, retrospective, observational cohort study, we included hospitalized adults with respiratory tract infections (RTIs) and a positive polymerase chain reaction for RSV (A/B) on respiratory tract samples (2005‐2018). We validated existing prediction models and updated the best discriminating model by revision, recalibration, and incremental value testing. We included 192 RSV‐infected patients (median age 60.7 years, 57% male, 65% immunocompromised, and 43% with lower RTI). Sixteen patients (8%) died within 30 days. During hospitalization, 16 (8%) died, 30 (16%) were admitted to intensive care unit, 21 (11%) needed invasive mechanical ventilation, and 5 (3%) noninvasive positive pressure ventilation. Existing models performed moderately at external validation, with C‐statistics 0.6 to 0.7 and moderate calibration. Updating to a model including lower RTI, chronic pulmonary disease, temperature, confusion and urea, increased the C‐statistic to 0.76 (95% confidence interval, 0.61‐0.91) to predict in‐hospital mortality. In conclusion, existing models to predict poor prognosis among hospitalized RSV‐infected adults perform moderately at external validation. A prognostic model may help to identify and treat RSV‐infected adults at high‐risk of death.

Respiratory syncytial virus‐associated acute respiratory illness in adult non‐immunocompromised patients: Outcomes, determinants of outcomes, and the effect of oral ribavirin treatment

“…We found the RSV‐ARI patients to be older adults with many coexisting medical conditions. The mortality rate was 7.4%, which is comparable with previously reported mortality rates of 6%–13% in patients hospitalized with RSV infection 3,4,6,7,21–23 . We also found that treating these infections requires substantial health care utilization.…”

“…The mortality rate was 7.4%, which is comparable with previously reported mortality rates of 6%-13% in patients hospitalized with RSV infection. 3,4,6,7,[21][22][23] We also found that treating these infections requires substantial health care utilization. The average length of stay was 9 days, and approximately 25% of patients required invasive mechanical ventilation.…”

“…Treatment with oral ribavirin was the only factor associated with reduced mortality. Factors previously reported to be associated with mortality in patients hospitalized with RSV infection were advanced age, 6 chronic cardiopulmonary disease, 2,23 multiple prior hospitalizations, 22 lower respiratory tract infection or pneumonia, 6,22,23 very severe tachypnea, 22 altered level of consciousness, 22,23 elevated blood urea level, 6,23 need for ventilatory support, 6 and bacterial coinfection 6,24–26 …”

“…Almost half of patients had an eGFR less than 50 ml/min/1.73 m 2 and was found to be an independent predictor of mortality, with a fourfold increased risk of death. Few retrospective studies reported that elevated blood urea level was associated with increase mortality of patients hospitalized with RSV infection 6,23 . It is unclear whether preexisting chronic kidney disease or direct renal injury by RSV infection or both led to this finding.…”

“…Few retrospective studies reported that elevated blood urea level was associated with increase mortality of patients hospitalized with RSV infection. 6 , 23 It is unclear whether preexisting chronic kidney disease or direct renal injury by RSV infection or both led to this finding. An animal model demonstrated that RSV could aggravate renal injury via cytokine release and direct renal injury.…”