Severe Clinical Outcomes Among Adults Hospitalized With Respiratory Syncytial Virus Infections, New York City, 2017-2019

Abstract

Objectives Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. We assessed severe clinical outcomes among hospitalized adults that were associated with RSV infections. Methods We performed a nested retrospective study in 3 New York City hospitals during 2 respiratory viral seasons, October 2017–April 2018 and October 2018–April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes and explored the effect of RSV-associated hospitalizations on changes in the living situations of surviving patients. Results Of the 403 patients studied (median age, 69 years), 119 (29.5%) were aged ≥80. Severe outcomes occurred in 19.1% of patients, including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had a 4.43 times higher likelihood of severe RSV infection compared with patients who were living in the community with or without assistance from family or home health aides. At discharge, 56 (15.1%) patients required a higher level of care than at admission. Conclusions RSV infection was associated with severe outcomes in adults. Living in a residential facility at admission was a risk factor for severe outcomes and could be a proxy for frailty rather than an independent risk factor. Our data support the development of prevention strategies for RSV infection in older populations, especially older adults living in residential living facilities.

Change in functional status associated with respiratory syncytial virus infection in hospitalized older adults

“…In a study of nursing home residents with influenza reported by Barker et al , 25% of subjects with confirmed influenza infection had a decline in function 3–4 months after illness compared with a decline in 17% of matched control subjects (p = 0.04) 22 . Further highlighting pre‐hospitalization living situation as an important predictor, we recently found that patients living in a SNF prior to a RSV‐associated hospitalization were 4.4 times more likely to have severe clinical outcomes (composite outcome: ICU care, mechanical ventilation, and death) compared with community‐dwelling adults 23 …”

Clinical impact of healthcare-associated respiratory syncytial virus in hospitalized adults

“…Living situation was classified as living independently at home, living at home with assistance from family members or home health aide or residing in an assisted living facility, or living in a rehabilitation or skilled nursing facility. 16 Patients transferred from acute-care hospitals or who were homeless were excluded from assessment of living situation at admission.…”

“…For those who survived, living situation at discharge and changes in living situation from admission to discharge that reflected the need for increased support (eg, living independently at admission versus discharge to a skilled nursing facility) were determined as previously described. 16 Patients who died, were transferred to another acute-care hospital, or were not eligible for the analysis of living situation at admission were excluded from the analysis of changes in living situation. Readmission within 30 days of discharge was also assessed.…”

“…Following RSV detection, the median length of hospitalization for patients with HA-RSV was longer than that for patients with CO-RSV (10 days [IQR, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] for HA-RSV vs 6 days [IQR, 3-10] for CO-RSV; P < .001). Although not statistically significant, the proportion of patients who died during hospitalization was higher among those with HA-RSV than those with CO-RSV (15% vs 6%; P = .25) (Table 2).…”

Respiratory Syncytial Virus Disease Burden in Community-Dwelling and Long-Term Care Facility Older Adults in Europe and the United States: A Prospective Study

“…Other recent studies indicate that the burden of RSV disease may be even greater than that of influenza in hospitalized older adults [ 11–13 ]. Older adults living in long-term care facilities (LTCFs) are known to experience a high burden of respiratory diseases [ 14 ], and several studies have shown that the risk of severe RSV infection is higher among older adults living in LTCF settings than in adults in community-dwelling (CD) [ 15 , 16 ].…”