Wang Yanjun, Xiang Yuanxuan, Jin Ruohong, Li Bin, Feng Xingxing, Han Qian, Deng Xishu, Lu Yunfang, Zhang Chengyan, Xiao Shufang
Pediatric Intensive Care Unit, Kunming Children's Hospital, Children's Hospital Affiliated to Kunming Medical University, Kunming, 650228, Yunnan Province, China.
Department of Clinical Laboratory, Kunming Children's Hospital, Children's Hospital Affiliated to Kunming Medical University, Kunming, 650228, Yunnan Province, China.
Eur J Clin Microbiol Infect Dis. 2025 Jun 25. doi: 10.1007/s10096-025-05191-9.
In 2023, a resurgence of acute lower respiratory tract infections (ALRTI) linked to respiratory syncytial virus (RSV) was noted following the COVID-19 pandemic. Patients' outcomes, disease severity, and demographics all changed. This study aims to identify risk factors for severe disease and the impact of other viral co-infection on severity, which has not yet been extensively studied in China. This observational cohort study comprised cases of RSV-associated ALRTI among children younger than 5 years who were admitted to the hospital from January to December 2023. Demographic characteristics, co-infection status, and laboratory parameters were compared between severe and mild groups. Logistic regression analysis was used to identify risk factors for severe RSV-ALRTI and viral co-infection, with the corresponding 95% CI and P value. Receiver Operating Characteristic (ROC) curve was drawn to analyze the efficacy of specific risk factors. A total of 1036 cases with a median age of 16 (6, 38) months; 662 boys (63.9%) were admitted with RSV-associated ALRTI; 764 (73.7%) were younger than 3 years. The cohort suggests out-of-season epidemic of RSV. Severe disease was documented for 405 cases (39.1%), with a younger median age (10 (4, 32) and a higher proportion with a history of prematurity and low-body weight (P < 0.01). The most common co-infections were bacterial co-infection (18.9%) and co-infection with other respiratory viruses (15.5%). Age combined with neutrophil proportion, concentration of lactic dehydrogenase (LDH) and Na had predictive value for severe RSV-ALRTI (P < 0.001, AUC: 0.723, 95% CI: 0.691-0.754). Bacterial co-infection, particularly with Streptococcus pneumoniae, was identified as an independent risk factor for severe RSV-ALRTI (OR = 1.587, 95% CI: 1.054-2.389). There was no significant correlation between co-infection with other viruses and severe RSV-ALRTI. Patients with viral co-infection displayed stronger humoral immune activation (higher IgG, IgM, IgA, and C3 levels) and elevated serum IgM was an independent risk factor (OR = 2.641, 95%CI: 1.868-3.734), demonstrating predictive value for identifying co-infection subtypes. In this cohort study of younger than 5 years old children without serious underlying diseases hospitalized with RSV in 2023, severe RSV disease was more likely among infants. Prematurity, low body weight, younger age and bacterial co-infection were the main risk factors. Age combined with neutrophil proportion, concentration of LDH and Na had predictive value for severe RSV-ALRTI. Increased serum IgM had certain predictive value for other viral co-infection.
2023年，在新冠疫情之后，发现与呼吸道合胞病毒（RSV）相关的急性下呼吸道感染（ALRTI）有所反弹。患者的预后、疾病严重程度和人口统计学特征均发生了变化。本研究旨在确定重症疾病的风险因素以及其他病毒合并感染对疾病严重程度的影响，而这在中国尚未得到广泛研究。这项观察性队列研究纳入了2023年1月至12月期间入院的5岁以下RSV相关ALRTI患儿病例。对重症组和轻症组的人口统计学特征、合并感染情况和实验室参数进行了比较。采用逻辑回归分析确定重症RSV-ALRTI和病毒合并感染的风险因素，并给出相应的95%置信区间和P值。绘制受试者工作特征（ROC）曲线以分析特定风险因素的效能。共有1036例病例，中位年龄为16（6，38）个月；662名男孩（63.9%）因RSV相关ALRTI入院；764例（73.7%）年龄小于3岁。该队列提示RSV出现了非季节性流行。记录到405例（39.1%）重症病例，中位年龄较小（10（4，32），早产和低体重病史的比例较高（P＜0.01）。最常见的合并感染是细菌合并感染（18.9%）和与其他呼吸道病毒的合并感染（15.5%）。年龄联合中性粒细胞比例、乳酸脱氢酶（LDH）浓度和血钠对重症RSV-ALRTI具有预测价值（P＜0.001，AUC：0.723，95%CI：0.691-0.754）。细菌合并感染，尤其是肺炎链球菌感染，被确定为重症RSV-ALRTI的独立危险因素（OR=1.587，95%CI：1.054-2.389）。与其他病毒的合并感染与重症RSV-ALRTI之间无显著相关性。病毒合并感染的患者表现出更强的体液免疫激活（更高的IgG、IgM、IgA和C3水平），血清IgM升高是独立危险因素（OR=2.641，95%CI：1.868-3.734），对识别合并感染亚型具有预测价值。在这项针对2023年因RSV住院的5岁以下无严重基础疾病儿童的队列研究中，婴儿患重症RSV疾病的可能性更大。早产、低体重、年龄较小和细菌合并感染是主要风险因素。年龄联合中性粒细胞比例、LDH浓度和血钠对重症RSV-ALRTI具有预测价值。血清IgM升高对其他病毒合并感染具有一定的预测价值。
