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Meta-Analysis
. 2016 Jul:80:45-56.
doi: 10.1016/j.jcv.2016.04.019. Epub 2016 Apr 30.

Respiratory viral coinfection and disease severity in children: A systematic review and meta-analysis

Marcelo Comerlato Scotta  1 , Valentina Coutinho Baldoto Gava Chakr  2 , Angela de Moura  1 , Rafaela Garces Becker  1 , Ana Paula Duarte de Souza  1 , Marcus Herbert Jones  1 , Leonardo Araújo Pinto  1 , Edgar Enrique Sarria  3 , Paulo Marcio Pitrez  1 , Renato Tetelbom Stein  1 , Rita Mattiello  4
Affiliations
Meta-Analysis

Respiratory viral coinfection and disease severity in children: A systematic review and meta-analysis

Marcelo Comerlato Scotta et al. J Clin Virol. 2016 Jul.

Abstract

Background: With advent of molecular diagnostic technologies, studies have reported detection of two or more respiratory viruses in about 30% of children with respiratory infections. However, prognostic role of coinfection remains unclear.

Objective: Evaluate relation between respiratory viral confection and illness severity in children.

Study design: MEDLINE (through PUBMED), EMBASE, EBSCO, LILACS databases were searched up to March 2015 by two independent reviewers. Studies assessing severity of viral coinfection in patients aged less than 18 years were included. Standardized forms were used for data extraction of population, study design, clinical syndromes, virus combinations compared and severity outcomes. Risk of bias and quality of evidence were assessed through EPHPP and GRADE. Subgroup analysis was performed according to age and viral combinations.

Results: Of 5218 records screened, 43 were included in analysis. Viral coinfection did not influence risks of all outcomes assessed: length of stay (mean difference in days in coinfection, -0.10 [95% confidence interval: -0.51 to 0.31]), length of supplemental oxygen (-0.42 [-1.05 to 0.20]), need of hospitalization (odds ratio of coinfection, 0.96 [95% confidence interval: 0.61-1.51]), supplemental oxygen (0.94 [0.66 to 1.34]), need of intensive care (0.99 [0.64 to 1.54]), mechanical ventilation (0.81 [0.33 to 2.01]) and death (2.22 [0.83 to 5.95]). Sub-analyses according to age and viral combinations have not shown influence of these factors in outcomes.

Conclusions: Respiratory viral coinfection did not increase severity in all outcomes assessed. Further studies are necessary to confirm this finding, especially regarding role of specific viral interactions.

Keywords: Child; Coinfection; Prognosis; Respiratory insufficiency; Respiratory tract infections; Viruses.

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Figures

Fig. 1
Fig. 1
Flow diagram of study selection process.
Fig. 2
Fig. 2
Meta-analysis for length of stay comparing patients with viral coinfections and single infections in three age groups. Negative value indicates shorter time in patients with coinfections.
Fig. 3
Fig. 3
Meta-analysis for risk of death comparing patients with viral coinfections and single infections in three age groups. Value higher than one indicates higher risk in patients with coinfections.
Fig. 4
Fig. 4
Meta-analysis for risk of hospitalization comparing patients with viral coinfections and single infections in three age groups. Value less than one indicates less risk in patients with coinfections.
Fig. 5
Fig. 5
Meta-analysis for risk of mechanical ventilation comparing patients with viral coinfections and single infections in three age groups. Value less than one indicates less risk in patients with coinfections.
See this image and copyright information in PMC

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