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. 2022 Nov;16(6):1072-1081.
doi: 10.1111/irv.13004. Epub 2022 May 24.

Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2

Mackenzie A Hamilton  1   2 , Ying Liu  1 , Andrew Calzavara  1 , Maria E Sundaram  1   3 , Mohamed Djebli  1 , Dariya Darvin  2   4 , Stefan Baral  5 , Rafal Kustra  6 , Jeffrey C Kwong  1   6   7   8   9   10 , Sharmistha Mishra  2   11   12   13
Affiliations

Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2

Mackenzie A Hamilton et al. Influenza Other Respir Viruses. 2022 Nov.

Abstract

Background: Shared and divergent predictors of clinical severity across respiratory viruses may support clinical and community responses in the context of a novel respiratory pathogen.

Methods: We conducted a retrospective cohort study to identify predictors of 30-day all-cause mortality following hospitalization with influenza (N = 45,749; 2010-09 to 2019-05), respiratory syncytial virus (RSV; N = 24 345; 2010-09 to 2019-04), or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; N = 8988; 2020-03 to 2020-12; pre-vaccine) using population-based health administrative data from Ontario, Canada. Multivariable modified Poisson regression was used to assess associations between potential predictors and mortality. We compared the direction, magnitude, and confidence intervals of risk ratios to identify shared and divergent predictors of mortality.

Results: A total of 3186 (7.0%), 697 (2.9%), and 1880 (20.9%) patients died within 30 days of hospital admission with influenza, RSV, and SARS-CoV-2, respectively. Shared predictors of increased mortality included older age, male sex, residence in a long-term care home, and chronic kidney disease. Positive associations between age and mortality were largest for patients with SARS-CoV-2. Few comorbidities were associated with mortality among patients with SARS-CoV-2 as compared with those with influenza or RSV.

Conclusions: Our findings may help identify patients at greatest risk of illness secondary to a respiratory virus, anticipate hospital resource needs, and prioritize local prevention and therapeutic strategies to communities with higher prevalence of risk factors.

Keywords: SARS-CoV-2; hospitalization; influenza; mortality; respiratory syncytial virus.

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Conflict of interest statement

The authors declare no competing interests that are relevant to the content of this article.

Figures

FIGURE 1
FIGURE 1
Study cohorts and exclusions. (A) Influenza hospitalization cohort. (B) RSV hospitalization cohort. (C) SARS‐CoV‐2 hospitalization cohort. Exclusions were made in the order in which they appear. RSV, respiratory syncytial virus; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; OHIP, Ontario health insurance plan. †Influenza and RSV hospitalizations prior to the 2010–11 respiratory virus season were excluded to reduce selection bias due to changes in testing behavior following the H1N1 influenza epidemic in 2009–2010. ‡Virus seasonality was defined as November through May, and November through April for influenza and RSV, respectively
FIGURE 2
FIGURE 2
Unadjusted and adjusted predictors of 30‐day all‐cause mortality among patients hospitalized with influenza, RSV, or SARS‐CoV‐2. Modified Poisson regression was used to calculate associations between predictors and 30‐day all‐cause mortality. Adjusted models included all predictors. Influenza and RSV adjusted models additionally included season of hospital admission. Associations are presented as risk ratios (points) and 95% confidence intervals (error bars). RSV, respiratory syncytial virus; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; COPD, chronic obstructive pulmonary disease; CI, confidence interval
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