Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
J Med Virol. 2019 Dec;91(12):2117-2124. doi: 10.1002/jmv.25568. Epub 2019 Aug 28.
Respiratory syncytial virus (RSV) causes significant mortality in hospitalized adults. Prediction of poor outcomes improves targeted management and clinical outcomes. We externally validated and updated existing models to predict poor outcome in hospitalized RSV-infected adults. In this single center, retrospective, observational cohort study, we included hospitalized adults with respiratory tract infections (RTIs) and a positive polymerase chain reaction for RSV (A/B) on respiratory tract samples (2005-2018). We validated existing prediction models and updated the best discriminating model by revision, recalibration, and incremental value testing. We included 192 RSV-infected patients (median age 60.7 years, 57% male, 65% immunocompromised, and 43% with lower RTI). Sixteen patients (8%) died within 30 days. During hospitalization, 16 (8%) died, 30 (16%) were admitted to intensive care unit, 21 (11%) needed invasive mechanical ventilation, and 5 (3%) noninvasive positive pressure ventilation. Existing models performed moderately at external validation, with C-statistics 0.6 to 0.7 and moderate calibration. Updating to a model including lower RTI, chronic pulmonary disease, temperature, confusion and urea, increased the C-statistic to 0.76 (95% confidence interval, 0.61-0.91) to predict in-hospital mortality. In conclusion, existing models to predict poor prognosis among hospitalized RSV-infected adults perform moderately at external validation. A prognostic model may help to identify and treat RSV-infected adults at high-risk of death.
呼吸道合胞病毒（RSV）可导致住院成人的死亡率显著增加。对不良结局的预测可改善针对性管理和临床结局。我们对现有的预测模型进行了外部验证和更新，以预测住院的 RSV 感染成人的不良结局。在这项单中心、回顾性、观察性队列研究中，我们纳入了因呼吸道感染（RTI）且呼吸道样本中 RSV（A/B）的聚合酶链反应阳性而住院的成年患者（2005-2018 年）。我们验证了现有的预测模型，并通过修订、重新校准和增量值检验更新了最佳判别模型。我们纳入了 192 例 RSV 感染患者（中位年龄 60.7 岁，57%为男性，65%免疫功能低下，43%患有下呼吸道感染）。有 16 例患者（8%）在 30 天内死亡。住院期间，16 例（8%）死亡，30 例（16%）入住重症监护病房，21 例（11%）需要有创机械通气，5 例（3%）使用无创正压通气。在外部验证中，现有模型的表现中等，C 统计量为 0.6 至 0.7，校准度中等。更新为包括下呼吸道感染、慢性肺部疾病、体温、意识障碍和尿素的模型，可使预测住院死亡率的 C 统计量增加至 0.76（95%置信区间，0.61-0.91）。总之，现有的预测模型对住院 RSV 感染成人的不良预后预测效果中等。预后模型可能有助于识别和治疗有死亡高风险的 RSV 感染成人。
