Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus

Kevin C Ma¹, Diya Surie¹, Yuwei Zhu², Carlos G Grijalva², Paul W Blair³, Basmah Safdar⁴, Adit A Ginde⁵, Ithan D Peltan⁶, Samuel M Brown⁶, Manjusha Gaglani⁷, Shekhar Ghamande⁸, Cristie Columbus⁹, Nicholas M Mohr¹⁰, Kevin W Gibbs¹¹, David N Hager¹², Matthew E Prekker¹³, Michelle N Gong¹⁴, Amira Mohamed¹⁴, Nicholas J Johnson¹⁵, Jay S Steingrub¹⁶, Akram Khan¹⁷, Catherine L Hough¹⁸, Abhijit Duggal¹⁹, Alexandra June Gordon²⁰, Nida Qadir²¹, Steven Y Chang²¹, Christopher Mallow²², Laurence W Busse²³, Jennie H Kwon²⁴, Matthew C Exline²⁵, Ivana A Vaughn²⁶, Mayur Ramesh²⁷, Adam S Lauring²⁸, Emily T Martin²⁹, Aleda M Leis²⁹, Jarrod M Mosier³⁰, Estelle S Harris³¹, Adrienne Baughman³², Cassandra Johnson², Jonathan D Casey³³, Natasha Halasa³⁴, James D Chappell³⁴, Nathaniel Lewis³⁵, Sascha Ellington³⁵, Wesley H Self³⁶, Fatimah S Dawood¹

Affiliations

¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Yale University School of Medicine, New Haven, Connecticut, USA.
⁵ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁶ Department of Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA.
⁷ Baylor Scott and White Health, Temple and Dallas, Texas, and Baylor College of Medicine, Temple, Texas, USA.
⁸ Baylor Scott and White Health, Baylor College of Medicine, Temple, Texas, USA.
⁹ Baylor, Scott & White Health, Texas A&M University College of Medicine, Dallas, Texas, USA.
¹⁰ University of Iowa, Iowa City, Iowa, USA.
¹¹ Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹² Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹³ Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
¹⁴ Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁵ Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA.
¹⁶ Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA.
¹⁷ Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA.
¹⁸ Department of Medicine, Oregon Health and Sciences University, Portland, USA.
¹⁹ Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
²⁰ Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
²¹ Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
²² Department of Medicine, University of Miami, Miami, Florida, USA.
²³ Department of Medicine, Emory University, Atlanta, Georgia, USA.
²⁴ Department of Medicine, Washington University, St. Louis, Missouri, USA.
²⁵ Department of Medicine, The Ohio State University, Columbus, Ohio, USA.
²⁶ Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
²⁷ Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan, USA.
²⁸ Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA.
²⁹ School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
³⁰ Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA.
³¹ Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
³² Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³³ Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁴ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁵ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
³⁶ Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PMID: 40708527
DOI: 10.1093/cid/ciaf405

Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus

Kevin C Ma et al. Clin Infect Dis. 2025.

. 2025 Jul 24:ciaf405.

doi: 10.1093/cid/ciaf405. Online ahead of print.

Authors

Affiliations

¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Yale University School of Medicine, New Haven, Connecticut, USA.
⁵ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁶ Department of Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA.
⁷ Baylor Scott and White Health, Temple and Dallas, Texas, and Baylor College of Medicine, Temple, Texas, USA.
⁸ Baylor Scott and White Health, Baylor College of Medicine, Temple, Texas, USA.
⁹ Baylor, Scott & White Health, Texas A&M University College of Medicine, Dallas, Texas, USA.
¹⁰ University of Iowa, Iowa City, Iowa, USA.
¹¹ Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹² Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹³ Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
¹⁴ Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁵ Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA.
¹⁶ Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA.
¹⁷ Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA.
¹⁸ Department of Medicine, Oregon Health and Sciences University, Portland, USA.
¹⁹ Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
²⁰ Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
²¹ Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
²² Department of Medicine, University of Miami, Miami, Florida, USA.
²³ Department of Medicine, Emory University, Atlanta, Georgia, USA.
²⁴ Department of Medicine, Washington University, St. Louis, Missouri, USA.
²⁵ Department of Medicine, The Ohio State University, Columbus, Ohio, USA.
²⁶ Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
²⁷ Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan, USA.
²⁸ Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA.
²⁹ School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
³⁰ Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA.
³¹ Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
³² Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³³ Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁴ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁵ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
³⁶ Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PMID: 40708527
DOI: 10.1093/cid/ciaf405

Abstract

Background: Adults hospitalized with acute respiratory infections, including respiratory syncytial virus (RSV), often have multiple underlying conditions. Few data are available on the combined effect of conditions on risk of severe outcomes from RSV disease.

Methods: We enrolled adults hospitalized with RSV at 26 hospitals in 20 US states admitted January 2022-July 2024. Seventeen underlying conditions were selected after excluding those with rare prevalence (≤1%) or high pairwise correlation (≥0.7). We applied Bayesian profile regression to identify profiles of conditions associated with increased risk of RSV severe outcomes, stratifying among adults aged 18-59 and ≥60 years.

Results: We analyzed data from 1111 adults hospitalized with RSV (median age [IQR] = 66 [53-75]). Among 397 adults aged 18-59 years, two profiles were identified: (1) minimal prevalence with fewer underlying conditions and a posterior median ICU admission risk of 21% (95% credible interval = [16‒25]); (2) cardiorenal/diabetes with frequent heart failure, chronic kidney disease, diabetes, and increased ICU admission risk (37% [27‒48]). Among 714 adults aged ≥60 years, four profiles were identified: (1) minimal prevalence (ICU admission risk = 22% [18‒26]), (2) cardiorenal/diabetes (27% [21‒34]), (3) hematologic malignancy and transplant receipt (12% [6‒21]), and (4) chronic pulmonary disease with home oxygen dependence (44% [25‒66]).

Conclusion: Distinct underlying condition profiles with varying risks of critical illness were observed among inpatients with RSV. These findings could support recognition of high-risk patients to inform RSV prevention strategies and suggest the role of multimorbidity in severe RSV disease risk warrants further attention.

Keywords: ICU admission; respiratory syncytial virus; risk factors; statistical clustering; underlying conditions.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2025.

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Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus

Affiliations

Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus

Authors

Affiliations

Abstract

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