Pastula Susan T, Hackett Judith, Coalson Jenna, Jiang Xiaohui, Villafana Tonya, Ambrose Christopher, Fryzek Jon
Epidstat Institute, Ann Arbor, Michigan.
AstraZeneca/Medimmune, Gaithersburg, Maryland.
Open Forum Infect Dis. 2017 Jan 9;4(1):ofw270. doi: 10.1093/ofid/ofw270. eCollection 2017 Winter.
Respiratory syncytial virus (RSV) is an established cause of serious lower respiratory disease in children, but the burden in adults is less well studied.
We conducted a retrospective study of hospitalizations among adults ≥20 years from the 1997-2012 National Inpatient Sample. Trends in RSV admissions were described relative to unspecified viral pneumonia admissions. Hospitalization severity indicators were compared among immunocompromised RSV, non-immunocompromised RSV, and influenza admissions.
An estimated 28237 adult RSV hospitalizations occurred, compared with 652818 influenza hospitalizations; 34% were immunocompromised individuals. Respiratory syncytial virus and influenza patients had similar age, gender, and race distributions, but RSV was more often diagnosed in urban teaching hospitals (73.0% for RSV vs 34.6% for influenza) and large hospitals (71.9% vs 56.4%). Respiratory syncytial virus hospitalization rates increased from 1997 to 2012, particularly for those ≥60, increasing from 0.5 to 4.6 per 100000, whereas unspecified pneumonia admission rates decreased significantly ( < .001). Immunocompromised patients with RSV hospitalization had significantly higher inpatient mortality ( = .013), use of mechanical ventilation ( = .016), mean length of stay (LOS) ( < .001), and mean cost ( < .001) than non-immunocompromised RSV hospitalizations. Overall, RSV hospitalizations were more severe than influenza hospitalizations (6.2% mortality for RSV vs 3.0% for influenza, 16.7% vs 7.2% mechanical ventilation, mean LOS of 6.0 vs 3.6 days, and mean cost of $38828 vs $14519).
Respiratory syncytial virus hospitalizations in adults are increasing, likely due to increasing recognition and diagnosis. The burden of RSV in adults deserves attention. Although there are fewer hospitalizations than influenza, those that are diagnosed are on average more severe.
呼吸道合胞病毒（RSV）是儿童严重下呼吸道疾病的既定病因，但在成人中的疾病负担研究较少。
我们对1997 - 2012年全国住院患者样本中年龄≥20岁的成年人住院情况进行了回顾性研究。描述了RSV住院率相对于未指明病毒肺炎住院率的趋势。比较了免疫功能低下的RSV、非免疫功能低下的RSV和流感住院患者的住院严重程度指标。
估计发生了28237例成人RSV住院病例，而流感住院病例为652818例；34%为免疫功能低下个体。RSV和流感患者在年龄、性别和种族分布上相似，但RSV在城市教学医院（RSV为73.0%，流感为34.6%）和大型医院（71.9%对56.4%）更常被诊断出来。RSV住院率从1997年到2012年有所上升，尤其是60岁及以上人群，从每10万人0.5例增至4.6例，而未指明肺炎的住院率显著下降（P <.001）。与非免疫功能低下的RSV住院患者相比，免疫功能低下的RSV住院患者的住院死亡率（P =.013）、机械通气使用率（P =.016）、平均住院时间（LOS）（P <.001）和平均费用（P <.001）显著更高。总体而言，RSV住院病例比流感住院病例更严重（RSV死亡率为6.2%，流感为3.0%；机械通气率为16.7%对7.2%；平均住院时间为6.0天对3.6天；平均费用为38828美元对14519美元）。
成人RSV住院病例正在增加，可能是由于认识和诊断的增加。成人RSV的疾病负担值得关注。虽然RSV住院病例比流感少，但确诊的病例平均病情更严重。
