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Risk factors for hospitalized respiratory syncytial virus disease and its severe outcomes

Wei Cai^1,2, Silke Buda¹, Ekkehard Schuler³

¹Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.

Influenza and Other Respiratory Viruses

|February 18, 2020

Insights

Young children hospitalized with respiratory syncytial virus (RSV) face severe outcomes. Infants aged 0-5 months and those with perinatal respiratory or cardiovascular disorders are at highest risk for severe RSV disease.

Area of Science:

Pediatrics
Infectious Diseases
Public Health Surveillance

Background:

Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations for acute lower respiratory tract infections.
Identifying risk factors for severe RSV disease is crucial for targeted prevention and management strategies.

Purpose of the Study:

To identify risk factors associated with hospitalized RSV disease and its severe outcomes in young children.
To quantify the risk associated with specific demographic and medical factors.

Main Methods:

Retrospective cohort study utilizing ICD-10 code-based hospital surveillance data for severe acute respiratory infections (SARI).
Univariable and multivariable logistic regression analyses were employed to assess risk factors.
Key outcomes analyzed included RSV diagnosis, intensive care unit (ICU) admission, mechanical ventilation, and death.

Main Results:

Among 8761 RSV patients (97% <5 years old), infants aged 0-5 months (OR: 20.29) and 6 months-1 year (OR: 4.59) had significantly higher odds of RSV diagnosis.
Severe outcomes like ICU admission were associated with younger age (0-5 months, OR: 2.39), low birth weight (OR: 6.77), prematurity (OR: 6.71), perinatal respiratory/cardiovascular disorders (OR: 4.97), congenital heart defects (OR: 3.65), neurological disorders (OR: 6.48), and liver disease (OR: 14.99).

Conclusions:

ICD-10-based surveillance effectively identifies risk factors for hospitalized RSV disease and severe outcomes.
Infants under one year and children with specific underlying conditions, particularly those originating in the perinatal period, face elevated risks for severe RSV disease and its complications.

Read full analysis

Abstract

Introduction:

Respiratory syncytial virus (RSV) is a major cause of hospital admission for acute lower respiratory tract infection in young children.

Objectives:

We aimed to identify risk factors for hospitalized RSV disease and its severe outcomes.

Methods:

We conducted a retrospective cohort study analyzing data of a ICD-10-code-based hospital surveillance for severe acute respiratory infections (SARI). Using univariable and multivariable logistic regression analysis, we assessed age-group, gender, season, and underlying medical conditions as possible risk factors for RSV and its severe outcomes including ICU admission, application of ventilator support, and death, respectively.

Results:

Of the 413 552 patients hospitalized with SARI in the database, 8761 were diagnosed with RSV from week 01/2009 to 20/2018 with 97% (8521) aged <5 years. Among children aged <5 years, age-groups 0-5 months (OR: 20.29, 95% CI: 18.37-22.41) and 6 months-1 year (OR: 4.59, 95% CI: 4.16-5.06), and underlying respiratory and cardiovascular disorders specific to the perinatal period (OR: 1.32, 95% CI: 1.11-1.57) were risk factors for being diagnosed with RSV. Age-group 0-5 months (OR: 2.39, 95% CI: 1.45-3.94), low birth weight (OR: 6.77, 95% CI: 1.28-35.71), preterm newborn (OR: 6.71, 95% CI: 2.19-20.61), underlying respiratory and cardiovascular disorders specific to the perinatal period (OR: 4.97, 95% CI: 3.36-7.34), congenital malformation of the heart (OR: 3.65, 95% CI: 1.90-7.02), congenital malformation of the great vessels (OR: 3.50, 95% CI: 1.10-11.18), congenital defect originating in perinatal period (OR: 4.07, 95% CI: 1.71-9.70), cardiovascular disease (OR: 5.19, 95% CI: 2.77-9.72), neurological disorders (OR: 6.48, 95% CI: 3.76-11.18), blood disease (OR: 3.67, 95% CI: 1.98-6.79), and liver disease (OR: 14.99, 95% CI: 1.49-150.82) contributed to ICU admission in RSV cases.

Conclusions:

Using ICD-10-based surveillance data allows to identify risk factors for hospitalized RSV disease and its severe outcomes, and quantify the risk in different age-groups.

Keywords:

comorbidity hospitalization intensive care units international classification of diseases logistic models respiratory syncytial virus risk factors ventilation

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