title: Factors predicting life-threatening infections with respiratory syncytial virus in adult patients.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is a significant cause of acute respiratory illness with a clinical spectrum ranging from self-limiting upper respiratory infection to severe lower respiratory infection in elderly persons as well as young children. However, there are limited data on risk factors for life-threatening infections that could guide the appropriate use of antiviral agents in adult patients with RSV.
  
  
  METHODS
  We conducted a retrospective cohort study from October 2013 to September 2015. Adult patients with RSV who visited the emergency department were enrolled. Primary outcome was life-threatening infection (admission to intensive care unit, need for ventilator care or in-hospital death).
  
  
  RESULTS
  A total of 227 patients were analysed. Thirty-four (15%) were classified as having life-threatening infections. By logistic regression, lower respiratory infection, chronic lung disease and bacterial co-infection were independent predictors of life-threatening infections. We developed a simple clinical scoring system using these variables (lower respiratory tract infection = score 4, chronic respiratory disease = score 3, bacterial co-infection = score 3 and fever ≥38 °C = score 2) to predict life-threatening infection. A score of >5 differentiated life-threatening RSV from non-life-threatening RSV with 82% sensitivity (95% CI, 66-93) and 72% specificity (95% CI, 65-78).
  
  
  CONCLUSIONS
  The use of a clinical scoring system based on lower respiratory infection, chronic respiratory disease, bacterial co-infection and fever appears to be useful for outcome prediction and risk stratification in order to select patients who may need early antiviral therapy.
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.|b Division of Infectious Diseases, Department of Internal Medicine , Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine , Seoul , Republic of Korea.
authors.forename: Se Yoon
authors.initials: SY
authors.lastname: Park
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Taeeun
authors.initials: T
authors.lastname: Kim
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Young Rock
authors.initials: YR
authors.lastname: Jang
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Min-Chul
authors.initials: MC
authors.lastname: Kim
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Yong Pil
authors.initials: YP
authors.lastname: Chong
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.affiliation: a Department of Infectious Diseases, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Respiratory syncytial virus; adult; lower respiratory tract infection; risk factors