Xing Yuying, Bahl Amit
Corewell Health Research Institute, Royal Oak, MI 48073, USA.
Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Mile Rd, Royal Oak, MI 48073, USA.
J Clin Med. 2025 Jul 10;14(14):4894. doi: 10.3390/jcm14144894.
COVID-19, influenza, and respiratory syncytial virus (RSV) are major respiratory infections with overlapping clinical presentations. Comparative data on the severity of these infections in hospitalized adults are limited, particularly across phases of the COVID-19 pandemic. The objectives of this study are to compare the risk of severe outcomes among hospitalized patients with COVID-19, influenza, or RSV and to evaluate the role of vaccination and demographic subgroups using recent, real-world data. This is a retrospective cohort study. Setting: Eight hospitals within the Corewell Health system in Michigan, USA, were studied. The participants included adults aged ≥ 18 years hospitalized between 1 January 2021 and 20 July 2024 with a principal diagnosis of COVID-19, influenza, or RSV. The primary outcome was a composite of ICU admission, mechanical ventilation, or in-hospital death. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs), with subgroup analyses in terms of vaccination status, age group, and time period. Among 27,885 hospitalized patients (90.5% COVID-19, 7.2% influenza, 2.3% RSV), COVID-19 was associated with a higher risk of severe outcomes compared to influenza (aHR 1.30, 95% CI: 1.11-1.54). RSV showed no significant difference from influenza. Across all infection groups, older age (≥65 years), high comorbidity burden, and immunocompromised status were associated with an increased risk of severe outcomes. Recent COVID-19 vaccination was protective, particularly among older adults. Differences in severity were more pronounced in the pre-March 2022 period. Using one of the most recent large-scale datasets, this study is among the first to directly compare the severity of COVID-19, influenza, and RSV in hospitalized adults. COVID-19 continues to pose a higher risk of severe illness compared to the other viral infections. The findings underscore the importance of up-to-date vaccination and focused clinical strategies for older and high-risk individuals. This study offers timely evidence to guide future respiratory virus response strategies across hospital settings.
新冠病毒（COVID-19）、流感病毒和呼吸道合胞病毒（RSV）是临床表现重叠的主要呼吸道感染病原体。关于这些感染在住院成人患者中严重程度的比较数据有限，尤其是在新冠疫情的各个阶段。本研究的目的是比较感染新冠病毒、流感病毒或呼吸道合胞病毒的住院患者出现严重后果的风险，并利用近期的真实世界数据评估疫苗接种和人口亚组的作用。这是一项回顾性队列研究。研究地点：对美国密歇根州Corewell Health系统内的八家医院进行了研究。参与者包括2021年1月1日至2024年7月20日期间住院的年龄≥18岁的成年人，其主要诊断为新冠病毒、流感病毒或呼吸道合胞病毒感染。主要结局是入住重症监护病房（ICU）、接受机械通气或院内死亡的综合情况。采用多变量Cox比例风险模型来估计调整后的风险比（aHRs），并根据疫苗接种状况、年龄组和时间段进行亚组分析。在27885名住院患者中（90.5%为新冠病毒感染，7.2%为流感病毒感染，2.3%为呼吸道合胞病毒感染），与流感病毒感染相比，新冠病毒感染导致严重后果的风险更高（aHR 1.30，95%置信区间：1.11-1.54）。呼吸道合胞病毒感染与流感病毒感染相比无显著差异。在所有感染组中，年龄较大（≥65岁）、合并症负担高和免疫功能低下状态与严重后果风险增加相关。近期接种新冠疫苗具有保护作用，尤其是在老年人中。2022年3月之前，严重程度差异更为明显。本研究利用最新的大规模数据集之一，率先直接比较了新冠病毒、流感病毒和呼吸道合胞病毒在住院成人患者中的严重程度。与其他病毒感染相比，新冠病毒继续构成更高的重症风险。研究结果强调了及时接种疫苗以及针对老年人和高危个体采取针对性临床策略的重要性。本研究提供了及时的证据，以指导未来跨医院环境的呼吸道病毒应对策略。
