The Clinical Characteristics and Outcomes of Adult Patients With Pneumonia Related to Three Paramyxoviruses.

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.