title: High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections.
abstract: BACKGROUND
  Better understanding of complications and outcomes of adults hospitalized with respiratory syncytial virus (RSV) infection is necessary.
  
  
  METHODS
  A retrospective cohort study was conducted on all adults (≥ 18 years) admitted to 3 acute care general hospitals in Hong Kong with virologically confirmed RSV infection during 2009-2011 (N = 607). Adults hospitalized for seasonal influenza during the period were used for comparison (n = 547). Both infections were prospectively diagnosed following a standard protocol. Independent reviews of chest radiographs were performed by radiologists. Main outcome measures were all-cause death, respiratory failure requiring ventilatory support, and hospitalization duration. Cox proportional hazards models were used for analyses.
  
  
  RESULTS
  The mean age of RSV patients was 75 (SD, 16) years; 87% had underlying conditions. Lower respiratory and cardiovascular complications were diagnosed in 71.9% (pneumonia, 42.3%; acute bronchitis, 21.9%; chronic obstructive pulmonary disease/asthma exacerbation, 27.3%) and 14.3% of patients, respectively; 12.5% had bacterial superinfections. Supplemental oxygen and ventilatory support were required in 67.9% and 11.1%, respectively. Crude all-cause mortality was 9.1% and 11.9% within 30 days and 60 days, respectively; mean length of stay of survivors was 12 (SD, 13) days. Advanced age, radiographic pneumonia, requirement for ventilation, bacterial superinfection, and elevated urea level and white blood cell count were independently associated with poorer survival. Systemic corticosteroid use was associated with longer hospitalization and secondary infections. The overall outcomes of survival and length of stay were not significantly different from those in influenza.
  
  
  CONCLUSIONS
  RSV can cause severe lower respiratory complications in older adults, resulting in respiratory failure, prolonged hospitalization, and high mortality similar to seasonal influenza. Corticosteroids did not seem to improve outcomes. The unmet need for antiviral therapy and vaccination against RSV in adults should be promptly addressed.
authors.affiliation: Department of Medicine and Therapeutics.
authors.forename: N
authors.initials: N
authors.lastname: Lee
authors.forename: G C Y
authors.initials: GC
authors.lastname: Lui
authors.forename: K T
authors.initials: KT
authors.lastname: Wong
authors.forename: T C M
authors.initials: TC
authors.lastname: Li
authors.forename: E C M
authors.initials: EC
authors.lastname: Tse
authors.forename: J Y C
authors.initials: JY
authors.lastname: Chan
authors.forename: J
authors.initials: J
authors.lastname: Yu
authors.forename: S S M
authors.initials: SS
authors.lastname: Wong
authors.forename: K W
authors.initials: KW
authors.lastname: Choi
authors.forename: R Y K
authors.initials: RY
authors.lastname: Wong
authors.forename: K L K
authors.initials: KL
authors.lastname: Ngai
authors.forename: D S C
authors.initials: DS
authors.lastname: Hui
authors.forename: P K S
authors.initials: PK
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018357:Respiratory Syncytial Virus Infections / Q000401:mortality*; D012141:Respiratory Tract Infections / Q000401:mortality*; D012189:Retrospective Studies
keywords: RSV; adults; hospitalization; lower respiratory tract infection; respiratory failure