Department of Medicine and Therapeutics.
Clin Infect Dis. 2013 Oct;57(8):1069-77. doi: 10.1093/cid/cit471. Epub 2013 Jul 21.
Better understanding of complications and outcomes of adults hospitalized with respiratory syncytial virus (RSV) infection is necessary.
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.
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.
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.
需要更好地了解因呼吸道合胞病毒(RSV)感染住院的成年人的并发症和结局。
对 2009 年至 2011 年期间在香港 3 家急性护理综合医院因病毒学确诊 RSV 感染住院的所有成年人(≥18 岁,N=607)进行回顾性队列研究。在此期间,因季节性流感住院的成年人用作比较(n=547)。这两种感染均按照标准方案进行前瞻性诊断。放射科医生对胸部 X 光片进行独立评估。主要观察指标为全因死亡、需要通气支持的呼吸衰竭和住院时间。采用 Cox 比例风险模型进行分析。
RSV 患者的平均年龄为 75(SD,16)岁,87%有基础疾病。71.9%(肺炎 42.3%、急性支气管炎 21.9%、慢性阻塞性肺疾病/哮喘恶化 27.3%)和 14.3%的患者分别诊断出下呼吸道和心血管并发症;12.5%的患者发生细菌合并感染。分别有 67.9%和 11.1%的患者需要补充氧气和通气支持。未校正的 30 天和 60 天全因死亡率分别为 9.1%和 11.9%;幸存者的平均住院时间为 12(SD,13)天。高龄、X 线胸片肺炎、需要通气、细菌合并感染以及血尿素氮和白细胞计数升高与生存率降低独立相关。全身皮质类固醇的使用与住院时间延长和继发感染相关。生存和住院时间的总体结果与流感没有显著差异。
RSV 可导致老年患者出现严重的下呼吸道并发症,导致呼吸衰竭、住院时间延长和死亡率高,与季节性流感相似。皮质类固醇似乎并不能改善结局。应立即解决成人抗病毒治疗和 RSV 疫苗接种的未满足需求。