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Multicenter Study
. 2022 Nov;16(6):1172-1182.
doi: 10.1111/irv.13050. Epub 2022 Sep 7.

Impact of respiratory viral infections on mortality and critical illness among hospitalized patients with chronic obstructive pulmonary disease

Sunita Mulpuru  1   2   3 , Melissa K Andrew  4   5 , Lingyun Ye  5 , Todd Hatchette  6   7   5 , Jason LeBlanc  7   5 , May El-Sherif  5 , Donna MacKinnon-Cameron  5 , Shawn D Aaron  1   2   3 , Gonzalo G Alvarez  1   2   3 , Alan J Forster  1   2   3 , Ardith Ambrose  5 , Shelly A McNeil  6   5 ; Serious Outcomes Surveillance and Canadian Immunization Research Network (CIRN) Investigators
Affiliations
Multicenter Study

Impact of respiratory viral infections on mortality and critical illness among hospitalized patients with chronic obstructive pulmonary disease

Sunita Mulpuru et al. Influenza Other Respir Viruses. 2022 Nov.

Abstract

Background: Seasonal respiratory viral infections are associated with exacerbations and morbidity among patients with COPD. The real-world clinical outcomes associated with seasonal viral infections are less well established among hospitalized patients.

Research question: To estimate the association between seasonal respiratory viral infections, 30-day mortality, and intensive care unit (ICU) admission among hospitalized COPD patients.

Study design and methods: We conducted an analysis of a national prospective multicenter cohort of COPD patients hospitalized with acute respiratory illness during winter seasons (2011-2015) in Canada. Nasopharyngeal swabs were performed on all patients at the onset of hospital admission for diagnosis of viral infection. Primary outcomes were 30-day mortality and ICU admissions. Secondary outcomes included invasive/non-invasive ventilation use.

Results: Among 3931 hospitalized patients with COPD, 28.5% (1122/3931) were diagnosed with seasonal respiratory viral infection. Viral infection was associated with increased admission to ICU (OR 1.5, 95% CI 1.2-1.9) and need for mechanical ventilation (OR 1.9, 95% CI 1.4-2.5), but was not associated with mortality (OR 1.1, 95% CI 0.8-1.4). Patients with respiratory syncytial virus (RSV) were equally likely to require ICU admission (OR 1.09, 95% CI 0.67-1.78), and more likely to need non-invasive ventilation (OR 3.1; 95% CI 1.8-5.1) compared to patients with influenza.

Interpretation: Our results suggest COPD patients requiring hospitalization for respiratory symptoms should routinely receive viral testing at admission, especially for RSV and influenza, to inform prognosis, clinical management, and infection control practices during winter seasons. Patients with COPD will be an important target population for newly developed RSV therapeutics.

Clinical trial registration: ClinicalTrials.gov ID: NCT01517191.

Keywords: COPD; RSV; influenza; mortality; respiratory viruses.

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Conflict of interest statement

SM, LY, JL, DM, ME, SDA, GGA, AJF, and AA have no conflicts of interest related to this work to disclose. TH reports grants from GSK and grants from Pfizer, during the conduct of the study. MKA reports grants from Canadian Institutes of Health Research, grants from Public Health Agency of Canada, and grants from GSK, during the conduct of the study and grants from Sanofi, grants from GSK, grants from Pfizer, grants from Canadian Frailty Network, personal fees from Sanofi, personal fees from Pfizer, and personal fees from Immunovaccine Technologies, outside the submitted work. SAM reports grant and clinical trials funding from GSK, Merck, Pfizer and Sanofi, and payments from GSK, Pfizer, Sanofi, and Merck outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Patients with chronic obstructive pulmonary disease (COPD) who were hospitalized for infectious respiratory symptoms during consecutive winter seasons in Canada, 2011–2015
FIGURE 2
FIGURE 2
Distribution of respiratory viruses identified by RV15 polymerase chain reaction (PCR) from hospitalized adults with chronic obstructive pulmonary disease (COPD) over four consecutive winter seasons, n = 3931 individuals. Note: Seasonal coronaviruses include strains OC43, 229E/NL63. Co‐infections with multiple viruses are detailed in Appendix A.
See this image and copyright information in PMC

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