Risk of mortality associated with respiratory syncytial virus and influenza infection in adults

Abstract

Background: Respiratory syncytial virus (RSV) infection constitutes a substantial disease burden in the general population. However, the risk of death for RSV infection has been rarely evaluated with confounders or comorbidities adjusted. We aimed to evaluate whether RSV infection is associated with higher mortality than seasonal influenza after adjusting for confounders and comorbidities and the effect of oseltamivir on the mortality in patients with influenza infection.

Methods: A retrospective cohort study was conducted on adult (≥18 years) patients admitted to the emergency department and ward of a university teaching hospital for suspected viral infection during 2013-2015 (N = 3743). RSV infection was diagnosed by multiplex PCR (N = 87). Adults hospitalized for seasonal influenza during the study period were enrolled as a comparison group (n = 312). The main outcome was 20-day all-cause mortality.We used Cox proportional hazard regression analyses to calculate the relative risk of death.

Results: Adult patients were less likely to be diagnosed with RSV than with influenza (2.3 vs 8.3%, respectively), were older and more likely to be diagnosed with pneumonia, chronic obstructive pulmonary disease, hypoxemia, and bacterial co-infection. In patients with RSV infection, the 20-day all-cause mortality was higher than that for influenza, (18.4 vs 6.7%, respectively). RSV infection showed significantly higher risk of death compared to the seasonal influenza group, with hazard ratio, 2.32 (95% CI, 1.17-4.58). Oseltamivir had no significant effect on mortality in patients with influenza.

Conclusions: RSV infection was significantly associated with a higher risk of death than seasonal influenza, adjusted for potential confounders and comorbidities.

Keywords: Influenza, human; Mortality; Respiratory syncytial viruses.

Fig. 1

Flow chart of patients suffering from respiratory virus infection

Fig. 2

Time of hospital admission of 87 adult patients with virologically confirmed respiratory syncytial virus (RSV) infection, and 312 adult patients with influenza infection, Daegu, Korea, 2013–2015. RSV seasonal peaks occurred during January in 2013, December in 2014, and January in 2015; the percentage test positivity rates during these periods were 11.4% and 40.8% for RSV and influenza, respectively among virus identified patients. Abbreviation: RSV, respiratory syncytial virus

Fig. 3

Kaplan-Meier survival curves of 399 adults hospitalized with respiratory syncytial virus (RSV, red line) and influenza infection (blue line). Patients with RSV infection were shown to have lower survival rates. Between RSV and influenza infected patients, the crude 20-day all-cause mortality rate among RSV and influenza infected patients was 18.4% and 6.7%, respectively

Fig. 4

Kaplan-Meier survival curves of 312 adults hospitalized for influenza virus infection, who did not undergo oseltamivir therapy (red line, n = 65) and who did undergo oseltamivir therapy (blue line, n = 247). Twenty-day all-cause mortality rates among influenza patients treated with and without oseltamivir were 6.4% and 7.6%, respectively (P = 0.72)