title: Risk factors associated with death in patients with severe respiratory syncytial virus infection.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) infection is an important cause of viral respiratory tract infection in children. This retrospective study describes the clinical characteristics of severe RSV infection and determines the risk factors for death.
  
  
  METHODS
  Patients were identified through a review of all patients discharged with a diagnosis of RSV lower respiratory tract infection and admitted to hospital in the pediatric intensive care unit (PICU) of a tertiary medical center between July 1, 2001 and June 30, 2010. The medical and demographic variables were recorded and analyzed.
  
  
  RESULTS
  The 186 RSV-positive patients admitted to the PICU had a median age of 5.3 months (interquartile range 2.3-12.4 months) and included 129 boys and 57 girls. Among them, 134 had at least one underlying disease: prematurity in 92, neurological disease in 57, bronchopulmonary dysplasia in 40, congenital heart disease in 26, hematological malignancies in 11, and Down's syndrome in nine patients. The 10 patients who died from RSV-related causes had a median age of 20.8 months (interquartile range 6.6-89.2 months) and all had a comorbidity. In multivariate analysis, the risk factors for death in severe RSV infection were Down's syndrome (odds ratio 7.20, 95% confidence interval 1.13-45.76; p = 0.036) and nosocomial RSV infection (odds ratio 4.46, 95% confidence interval 1.09-18.27; p = 0.038).
  
  
  CONCLUSIONS
  Down's syndrome and nosocomial RSV infection are significantly associated with death in severe RSV infections. Clinicians should be alert to these conditions.
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Peng
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
authors.forename: Nan-Chang
authors.initials: NC
authors.lastname: Chiu
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Daniel Tsung-Ning
authors.initials: DT
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: chi.4531@mmh.org.tw.
authors.forename: Hsin
authors.initials: H
authors.lastname: Chi
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003428:Cross Infection / Q000150:complications*; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D013624:Taiwan; D062606:Tertiary Care Centers
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: Down's syndrome; mortality; nosocomial infection; respiratory syncytial virus; risk factors