Impact of RSV infection on mortality, rehospitalization, and long-term pulmonary, cardiovascular, and functional outcomes in hospitalized adults: a systematic review and meta-analysis

Abstract

Background: Respiratory syncytial virus (RSV) is increasingly recognized as a significant pathogen in adults, particularly those with underlying comorbidities. However, the burden of RSV on post-hospital outcomes remains underexplored. This study aimed to assess the impact of RSV infection on mortality, rehospitalization, and long-term pulmonary, cardiovascular, and functional outcomes in hospitalized adults.

Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. A comprehensive search of major databases until February 2025 identified cohort and observational studies reporting on clinical outcomes in adults with laboratory-confirmed RSV infection. A total of seven eligible studies encompassing 180,125 patients were included. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. The risk of bias was assessed using the Newcastle-Ottawa Scale and the ROBINS-I tool. Funnel plots and Egger's test were used to assess publication bias.

Results: RSV infection was associated with significantly increased 30-day mortality (OR 0.22, 95% CI: 0.12-0.41; P < 0.01, I² = 96%) and 90-day mortality (OR 0.30, 95% CI: 0.19-0.46; P < 0.01, I² = 97%). Although the odds ratios are below 1, this indicates higher mortality in RSV-positive patients, as the reference groups had lower risk. Statistically significant associations were also found for cardiovascular complications (OR 0.46, 95% CI: 0.33-0.64) and functional impairments (OR 0.57, 95% CI: 0.42-0.78). No significant association was identified for 90-day rehospitalization (OR 0.67, 95% CI: 0.39-1.14) or pulmonary impairments (OR 1.09, 95% CI: 0.79-1.50). Heterogeneity was high across most outcomes. Publication bias was only evident for the 30-day mortality outcome.

Conclusions: RSV infection in hospitalized adults is associated with elevated short- and medium-term mortality, as well as increased risk of cardiovascular and functional complications post-discharge. These findings highlight the need for RSV-specific prevention strategies, including vaccination and post-acute care planning, particularly for vulnerable adult populations.

Clinical trial number: Not applicable.

Keywords: Cardiovascular events; Functional decline; Mortality; Pulmonary impairments; RSV infection; Rehospitalization.

Fig. 1

PRISMA 2020 flow diagram for systematic reviews, which included searches of databases and registers. This flow diagram provides an overview of the systematic review process up to February 18, 2025. Records were identified through database searches (n = 240) and register searches (n = 15). After applying inclusion and exclusion criteria, 7 studies were included in the review. No additional reports from these studies were retrieved or reviewed. The diagram highlights the transparency and rigor in the study selection process

Fig. 2

Forest Plot – 30-Day Mortality. A total of seven studies were included in the analysis. The pooled odds ratio (OR) was 0.22 (95% CI: 0.12–0.41), calculated using a random-effects model with the inverse variance method. This indicates a statistically significant association between RSV infection and higher short-term mortality compared to the reference group (P < 0.01). The I² value of 96% reflects substantial heterogeneity, suggesting that most of the variation across studies is due to real differences rather than chance. The wide prediction interval ([0.03; 1.92]) implies that future studies may observe a range of effects, including null results

Fig. 3

Funnel Plot for 30-Day Mortality. The funnel plot suggests the presence of potential publication bias, indicated by an asymmetrical distribution of study results. This observation is statistically supported by Egger’s test for funnel plot asymmetry, which yielded a significant intercept of 7.88 (95% confidence interval: 5.14–10.62, t = 5.636, P = 0.002). These findings point to small-study effects or selective publication as potential sources of bias in the included literature

Fig. 4

90-Day Mortality. Forest plot illustrating the 90-day mortality outcomes across seven studies. A random effects model using the inverse variance method was applied to compute the pooled odds ratio (OR). The overall OR is 0.30 (95% CI: 0.19–0.46), indicating a statistically significant reduction in mortality (P < 0.05). However, substantial heterogeneity was observed among studies (I² = 97%, P < 0.01), reflecting considerable variability in effect sizes and/or directions

Fig. 5

90-Day Mortality. The funnel plot does not indicate potential publication bias. Egger’s test does not support the presence of funnel plot asymmetry (intercept = 1.38, 95% CI: − 4.12 to 6.88; t = 0.491; P = 0.644)

Fig. 6

Forest Plot Rehospitalization: A total of seven studies were included in the meta-analysis. Using a random effects model with the inverse variance method, the pooled odds ratio (OR) was 0.67 (95% CI: 0.39–1.14), indicating no statistically significant effect. The test for overall effect was not significant. However, substantial heterogeneity was observed among the studies (P < 0.01), with an I² value of 99%, suggesting that nearly all variability in effect estimates is due to heterogeneity rather than chance

Fig. 7

Funnel Plot for Rehospitalization. The funnel plot does not suggest the presence of publication bias. Egger’s regression test for funnel plot asymmetry yielded a non-significant result (intercept = − 0.32, 95% CI: − 8.72 to 8.07; t = − 0.076; P = 0.943), indicating no evidence of small-study effects

Fig. 8

Pulmonary Impairments. A total of seven studies were included in the meta-analysis. Using a random effects model with the inverse variance method, the pooled odds ratio (OR) was 1.09 (95% CI: 0.79–1.50), indicating no statistically significant effect. The test for overall effect was not significant. However, substantial heterogeneity was observed among the studies (P < 0.01), with an I² value of 98%, indicating that most of the variability is due to true heterogeneity

Fig. 9

Funnel Plot for Pulmonary Impairments. The funnel plot does not indicate a potential publication bias. Egger’s test does not support the presence of funnel plot asymmetry (intercept = 1.08, 95% CI: − 5.27 to 7.42; t = 0.332; P = 0.753)

Fig. 10

Forest Plot Cardiovascular Impairments. A total of seven studies were included in the meta-analysis. The analysis was conducted using a random effects model with the inverse variance method to compare the odds ratio (OR). The pooled OR was 0.46 with a 95% confidence interval of 0.33 to 0.64, indicating a statistically significant reduction (P < 0.05). Substantial heterogeneity was observed (I² = 97%, P < 0.01), suggesting considerable variability in effect sizes across studies that is unlikely due to chance alone

Fig. 11

Funnel Plot for Cardiovascular Impairments. The funnel plot does not indicate a potential publication bias. Egger’s test does not support the presence of funnel plot asymmetry (intercept = 2.47, 95% CI: − 2.48 to 7.42; t = 0.979; P = 0.373)

Fig. 12

Forest Plot for Functional Impairments. A total of seven studies were included in the meta-analysis. Using a random effects model with the inverse variance method, the pooled odds ratio (OR) was calculated as 0.57 (95% CI: 0.42 to 0.78), indicating a statistically significant reduction (P < 0.05). A high level of heterogeneity was observed (I² = 97%, P < 0.01), suggesting substantial variability in effect size and/or direction across studies that is unlikely due to chance

Fig. 13

Funnel Plot for Functional Impairments. The funnel plot does not indicate a potential publication bias. Egger’s test does not support the presence of funnel plot asymmetry (intercept = 2.32, 95% CI: − 2.81 to 7.45; t = 0.888; P = 0.415)