呼吸道合胞病毒负担以及在急诊科出现流感样症状或急性呼吸衰竭的患者中发生严重疾病的危险因素。

Respiratory syncytial virus burden and risk factors for severe disease in patients presenting to the emergency department with flu-like symptoms or acute respiratory failure.

机构信息

Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Via G. B. Grassi 74, 20157 Milano, Italy.

出版信息

Respir Med. 2023 Nov;218:107404. doi: 10.1016/j.rmed.2023.107404. Epub 2023 Sep 6.

DOI:10.1016/j.rmed.2023.107404

PMID:37683776

Abstract

BACKGROUND

Predictors of Respiratory Syncytial Virus (RSV) infection and determinants of RSV unfavorable outcomes are still unclear. We assessed RSV burden and investigated the risk factors associated with RSV positive swab and RSV severe disease.

METHODS

A retrospective, single center, cohort study included all consecutive patients referred to the emergency department of L. Sacco University Hospital (Milan) with flu-like symptoms or acute respiratory failure (aRF) tested per protocol for SARS-CoV-2, RSV, Influenza A (InvA) during the 2022-2023 autumn/winter season. Clinical characteristics and patients' outcomes were registered. Respiratory failure, need for respiratory support, shock, sepsis or in-hospital death defined severe disease.

MAIN FINDINGS

The analysis included 717 patients (65.1% negative swab, 14.1% InvA, 8.5% RSV, 8.6% SARS-CoV-2, 3.6% other viruses). Compared with the study cohort, RSV patients had the highest occurrence of aRF (62.7%) and severe disease (70.5%); mortality was similar to InvA (6.6% vs 5.9%, p = 0.874). Compared with InvA patients, RSV patients were older (p = 0.009), had higher Charlson index (p = 0.001), higher prevalence of chronic heart failure (p = 0.001) and were more frequently on ICS (p = 0.026) and immunosuppressants (p = 0.018). Heart failure [OR (95%CI):3.286 (1.031-10.835); p = 0.041], chronic exposure to ICS [OR (95%CI):2.377 (1.254-4.505); p = 0.008] and immunosuppressants [OR (95%CI):3.661 (1.246-10.754); p = 0.018] predicted RSV infection. Glycaemia ≥120 mg/dL [OR (95%CI):5.839 (1.155-29.519); p = 0.033], leucocytes ≥8000 cells/μL [OR (95%CI):5.929 (1.090-32.268); p = 0.039], and past/active smoking [OR (95%CI):7.347 (1.301-41.500); p = 0.024] predicted severe RSV disease.

CONCLUSIONS

RSV infection is associated with significant mortality and morbidity. Preventive strategies for RSV infection such as vaccination are highly warranted, especially in older patients with cardiovascular and chronic respiratory conditions.

摘要

背景

呼吸道合胞病毒（RSV）感染的预测因素和 RSV 不良结局的决定因素仍不清楚。我们评估了 RSV 负担，并调查了与 RSV 阳性拭子和 RSV 严重疾病相关的危险因素。

方法

这是一项回顾性、单中心、队列研究，纳入了 2022-2023 年秋冬季节按照方案因流感样症状或急性呼吸衰竭（aRF）就诊于米兰 L. Sacco 大学医院急诊科、接受 SARS-CoV-2、RSV、甲型流感（InvA）检测的所有连续患者。登记了临床特征和患者结局。呼吸衰竭、需要呼吸支持、休克、败血症或院内死亡定义为严重疾病。

主要发现

该分析纳入了 717 名患者（65.1%拭子阴性，14.1% InvA，8.5% RSV，8.6% SARS-CoV-2，3.6%其他病毒）。与研究队列相比，RSV 患者的 aRF 发生率（62.7%）和严重疾病发生率（70.5%）最高；死亡率与 InvA 相似（6.6% vs 5.9%，p=0.874）。与 InvA 患者相比，RSV 患者年龄更大（p=0.009），Charlson 指数更高（p=0.001），慢性心力衰竭患病率更高（p=0.001），更常接受 ICS（p=0.026）和免疫抑制剂（p=0.018）治疗。心力衰竭 [比值比（95%CI）：3.286（1.031-10.835）；p=0.041]、慢性暴露于 ICS [比值比（95%CI）：2.377（1.254-4.505）；p=0.008]和免疫抑制剂 [比值比（95%CI）：3.661（1.246-10.754）；p=0.018] 预测 RSV 感染。血糖≥120mg/dL [比值比（95%CI）：5.839（1.155-29.519）；p=0.033]、白细胞≥8000 个/μL [比值比（95%CI）：5.929（1.090-32.268）；p=0.039]和既往/当前吸烟 [比值比（95%CI）：7.347（1.301-41.500）；p=0.024] 预测严重 RSV 疾病。