Chen Liang, Han Xiudi, Li YanLi, Zhang Chunxiao, Xing Xiqian
Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China.
Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China.
Front Med (Lausanne). 2021 Jan 18;7:574128. doi: 10.3389/fmed.2020.574128. eCollection 2020.
Respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and human parainfluenza virus (hPIV) are paramyxoviruses (PMVs) that are important etiologies of community-acquired pneumonia. However, current knowledge about the clinical features and outcomes of PMV-related pneumonia (PMV-p) is limited. We aimed to investigate the clinical characteristics and disease severity in immunocompetent adults hospitalized with hMPV-related pneumonia (hMPV-p), hPIV-related pneumonia (hPIV-p), or RSV-related pneumonia (RSV-p). We retrospectively recruited 488 patients with PMV-p (153 with RSV-p, 137 with hMPV-p, and 198 with hPIV-p) from five teaching hospitals in China during 2011-2019. Univariate and multivariate analyses were performed to identify predictors to distinguish hMPV-p/hPIV-p from RSV-p and evaluate the effects of virus types on the clinical outcomes. Compared with RSV-p, sputum production [ () 5.029, () 2.452-10.312, < 0.001] was positively associated with hMPV-p, while solid malignant tumor ( 0.346, 0.126-0.945, = 0.038), nasal congestion ( 0.102, 0.041-0.251, < 0.001), and respiratory rate ≥ 30 breaths/min ( 0.296, 0.136-0.640, = 0.002) were negatively related to hMPV-p. Sputum production ( 13.418, 6.769-26.598, < 0.001) was positively associated with hPIV-p, while nasal congestion ( 0.194, 0.098-0.387, < 0.001), dyspnea ( 0.469, 0.272-0.809, < 0.001), and respiratory rate ≥30 breaths/min ( 0.090, 0.032-0.257, < 0.001) on admission were negatively related to hPIV-p. After adjustment for confounders, multivariate logistic regression analysis suggested that hMPV-p ( 0.355, 0.135-0.932, = 0.035) and hPIV-p ( 0.311, 0.121-0.784, = 0.013) were associated with decreased 30-day mortality compared with RSV-p. RSV infection ( 4.183, 1.709-10.236, = 0.002) was identified as an independent predictor of 30-day mortality in patients with PMV-p. RSV-p caused more severe disease than hMPV-p and hPIV-p. Although some clinical features are helpful for distinguishing the diseases, etiologic diagnosis is critical in the management of the PMV-p.
呼吸道合胞病毒（RSV）、人偏肺病毒（hMPV）和人副流感病毒（hPIV）是副粘病毒（PMV），是社区获得性肺炎的重要病因。然而，目前关于PMV相关肺炎（PMV-p）的临床特征和转归的知识有限。我们旨在调查免疫功能正常的因hMPV相关肺炎（hMPV-p）、hPIV相关肺炎（hPIV-p）或RSV相关肺炎（RSV-p）住院的成年人的临床特征和疾病严重程度。我们回顾性纳入了2011年至2019年期间来自中国五家教学医院的488例PMV-p患者（153例RSV-p患者、137例hMPV-p患者和198例hPIV-p患者）。进行单因素和多因素分析以确定区分hMPV-p/hPIV-p与RSV-p的预测因素，并评估病毒类型对临床转归的影响。与RSV-p相比，咳痰[比值比（OR）5.029，95%置信区间（CI）2.452 - 10.312，P < 0.001]与hMPV-p呈正相关，而实体恶性肿瘤（OR 0.346，95%CI 0.126 - 0.945，P = 0.038）、鼻塞（OR 0.102，95%CI 0.041 - 0.251，P < 0.001）和呼吸频率≥30次/分钟（OR 0.296，95%CI 0.136 - 0.640，P = 0.002）与hMPV-p呈负相关。咳痰（OR 13.418，95%CI 6.769 - 26.598，P < 0.001）与hPIV-p呈正相关，而入院时鼻塞（OR 0.194，95%CI 0.098 - 0.387，P < 0.001）、呼吸困难（OR 0.469，95%CI 0.272 - 0.809，P < 0.001）和呼吸频率≥30次/分钟（OR 0.090，95%CI 0.032 - 0.257，P < 0.001）与hPIV-p呈负相关。在调整混杂因素后，多因素logistic回归分析表明，与RSV-p相比，hMPV-p（OR 0.355，95%CI 0.135 - 0.932，P = 0.035）和hPIV-p（OR 0.311，95%CI 0.121 - 0.784，P = 0.013）与30天死亡率降低相关。RSV感染（OR 4.183，95%CI 1.709 - 10.236，P = 0.002）被确定为PMV-p患者30天死亡率的独立预测因素。RSV-p比hMPV-p和hPIV-p导致更严重的疾病。尽管一些临床特征有助于区分这些疾病，但病因诊断在PMV-p的管理中至关重要。
