Gsenger Julia, Bruckner Thomas, Ihling Clara Marlene, Rehbein Rebecca Marie, Schnee Sarah Valerie, Hoos Johannes, Manuel Britta, Pfeil Johannes, Schnitzler Paul, Tabatabai Julia
Center for Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany.
German Center for Infectious Diseases (DZIF), Heidelberg, Germany.
J Med Virol. 2023 Feb;95(2):e28541. doi: 10.1002/jmv.28541.
Respiratory syncytial virus (RSV) is the most common cause of acute respiratory tract infection in infants and young children often leading to severe disease requiring hospitalization. However, validated tools for systematic assessment of disease severity are lacking. This study aimed at creating and validating a standardized, simple-to-use disease severity score for RSV infection in children-the RSV-CLASS (Clinical Assessment Severity Score). Therefore, data from over 700 RSV-infected children over six winter seasons (2014-2020) was analyzed using univariate and multiple regression analyses for the prediction of lower respiratory tract infection (LRTI) as a proxy for a severe course of the disease. Testing a broad range of respiratory symptoms, they eventually yielded seven items. Performing stepwise selection, these were reduced to the final four items: cough, tachypnea, rales, and wheezing, each receiving one point in the proposed score named RSV-CLASS. The score was calculated for children in two cohorts A and B, one for development and one for validation, with an area under the curve of 0.90 and 0.87, respectively. With a score value of 3 or 4, 97.8% and 100% of the children, respectively, were admitted with LRTI and classified correctly. The RSV-CLASS is a disease severity score based on a neutral, analytical approach using prospective data from a large study cohort. It will contribute to systematically assessing the disease severity of RSV infection and can be used for evidence-based clinical decision-making as well as for research settings.
呼吸道合胞病毒（RSV）是婴幼儿急性呼吸道感染最常见的病因，常导致严重疾病，需要住院治疗。然而，目前缺乏用于系统评估疾病严重程度的有效工具。本研究旨在创建并验证一种针对儿童RSV感染的标准化、易于使用的疾病严重程度评分系统——RSV-CLASS（临床评估严重程度评分）。因此，我们分析了六个冬季（2014 - 2020年）700多名RSV感染儿童的数据，采用单变量和多元回归分析来预测下呼吸道感染（LRTI），以此作为疾病严重病程的替代指标。通过测试一系列广泛的呼吸道症状，他们最终确定了七个项目。经过逐步筛选，这些项目减少到最终的四个项目：咳嗽、呼吸急促、啰音和喘息，在所提议的名为RSV-CLASS的评分系统中，每个项目得1分。对队列A和队列B中的儿童计算该评分，一个用于开发，一个用于验证，曲线下面积分别为0.90和0.87。评分值为3或4时，分别有97.8%和100%的儿童因下呼吸道感染入院且分类正确。RSV-CLASS是一种基于中性分析方法的疾病严重程度评分系统，使用了来自大型研究队列的前瞻性数据。它将有助于系统地评估RSV感染的疾病严重程度，可用于基于证据的临床决策以及研究环境。
