Journal Article

Respiratory syncytial virus‐associated acute respiratory illness in adult non‐immunocompromised patients: Outcomes, determinants of outcomes, and the effect of oral ribavirin treatment

Wongsurakiat, Phunsup, Muangman, Nisa, Sunhapanit, Siwadol

2022

Overview

Background Respiratory syncytial virus (RSV) is an increasingly common cause of respiratory illness in adult non‐immunocompromised patients. Oral ribavirin was reported to improve outcomes of RSV infection in immunocompromised patients. This study aimed to determine the outcomes of non‐immunocompromised patients hospitalized with RSV‐associated acute respiratory illnesses (RSV‐ARI), the factors independently associated with the outcomes and the effect of oral ribavirin treatment. Methods This retrospective, observational cohort study included 175 adults admitted to the hospital with virologically confirmed RSV‐ARI during 2014–2019. Severe ARI was identified using Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) criteria for severe community‐acquired pneumonia. The primary outcome was all‐cause mortality within 30 days after enrollment. A multivariable Cox model was performed to identify significant predictors of mortality. Results Mean age was 76 ± 12.7 years. Seventy‐eight (44.6%) patients met the diagnostic criteria for severe ARI. Thirty‐six (20.6%) patients required invasive mechanical ventilation, and 11 (6.3%) required vasopressor. Ninety‐nine (56.6%) patients received oral ribavirin treatment, and 52 (29.7%) received systemic corticosteroids. Forty‐one (23.4%) patients had evidence of bacterial infection. Overall mortality was 7.4%. Mortality among patients with non‐severe ARI and severe ARI was 1.04% and 15.4%, respectively. Estimated glomerular filtration rate <50 ml/min/1.73 m2, severe ARI, systemic corticosteroids, and bacterial infection were independently associated with higher risk of mortality. Treatment with oral ribavirin was the only factor associated with reduced mortality (adjusted HR: 0.19, 95% CI: 0.04–0.9, P = 0.03). Conclusion RSV‐ARI may result in significant mortality and health care utilization. Treatment with oral ribavirin may improve survival in these patients.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: acute respiratory illness / Adrenal Cortex Hormones / Adult / adult non‐immunocompromised patients / Adults / Aged / Aged, 80 and over / Antibiotics / Antiviral Agents - therapeutic use / Antiviral drugs / Bacterial diseases / Bacterial infections / Clinical outcomes / Communicable Diseases - drug therapy / Corticoids / Corticosteroids / Criteria / Data collection / Glomerular filtration rate / Health care / Health services / Hospitalization / hospital‐free days / Humans / Illnesses / Immunocompromised Host / Immunocompromised hosts / Infectious diseases / Influenza / Mechanical ventilation / Middle Aged / Mortality / Mortality risk / Nosocomial infections / Observational studies / oral ribavirin / Original / outcomes / Pathogens / Patients / Pneumonia / Polymerase chain reaction / Regression analysis / Respiratory diseases / Respiratory syncytial virus / Respiratory Syncytial Virus Infections / Respiratory Syncytial Virus, Human / Retrospective Studies / Ribavirin / Ribavirin - therapeutic use / Steroids / Thorax / Variables / Ventilators / Viruses