Laboratory Confirmation of Respiratory Syncytial Virus Infection Is Not Associated With an Increased Risk of Death in Adults With Acute Respiratory Illness - Report - MDSpire
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Laboratory Confirmation of Respiratory Syncytial Virus Infection Is Not Associated With an Increased Risk of Death in Adults With Acute Respiratory Illness
RSV Infection in Adults With Acute Respiratory Illness Not Linked to Increased Mortality
Overview
In a large prospective cohort study of over 1.2 million adults with acute respiratory illness (ARI) presenting to emergency departments, laboratory-confirmed respiratory syncytial virus (RSV) infection was not associated with increased 30-day mortality or hospitalization risk. Despite higher mortality rates observed in older adults with RSV, multivariable analysis showed RSV positivity was linked to lower odds of death and hospitalization compared to RSV-negative patients.
Background
Respiratory syncytial virus (RSV) is a known cause of respiratory infections across all ages, with particular concern for morbidity and mortality in older adults. Previous studies estimated RSV-associated mortality rates of 7%–8% in adults and hospitalization rates of approximately 267 per 100,000 adults over 65 years annually. Emergency departments (EDs) serve as critical points for acute respiratory illness (ARI) care and increasingly utilize PCR-based testing for viral pathogens including RSV. The RESP-LENS network, sponsored by the CDC, prospectively collects national data on viral infections in ED patients with ARI, enabling evaluation of RSV prevalence and associated clinical outcomes.
Data Highlights
Parameter
Value
Total ARI patients enrolled
1,210,394
Adults tested for RSV
345,185 (28.5%)
RSV positive rate
2.4%
Overall mortality rate in RSV+ adults
1.9%
Overall mortality rate in RSV− adults
2.9%
Mortality rate in RSV+ adults ≥65 years
3.8% (95% CI, 3.1%–4.5%)
Adjusted odds ratio for hospitalization with RSV+
0.79 (95% CI, 0.75–0.84)
Adjusted odds ratio for 30-day mortality with RSV+
0.62 (95% CI, 0.53–0.74)
Key Findings
Among adults with ARI tested for RSV, only 2.4% were RSV positive.
RSV-positive adults had a lower overall 30-day mortality rate (1.9%) compared to RSV-negative adults (2.9%).
Mortality increased with age ≥65 years in RSV-positive patients to 3.8%, but RSV positivity was not independently associated with increased mortality after adjustment.
Multivariable analysis showed RSV positivity was associated with decreased odds of hospitalization (adjusted OR 0.79) and death (adjusted OR 0.62) relative to RSV-negative patients.
Independent predictors of death included age ≥65 years, worsening vital signs, male sex, and heart failure, but not RSV status.
RSV infection in adults presenting to EDs does not increase risk of ICU admission or death compared to other ARI causes.
Clinical Implications
Clinicians should recognize that laboratory-confirmed RSV infection in adults with acute respiratory illness presenting to emergency departments does not confer an increased risk of hospitalization or 30-day mortality compared to RSV-negative patients. Risk stratification should focus on established factors such as advanced age, vital sign abnormalities, male sex, and comorbid heart failure rather than RSV status alone. These findings may inform clinical decision-making and resource allocation during respiratory virus seasons.
Conclusion
In a large national cohort of adults with ARI, RSV positivity was not associated with increased hospitalization or mortality risk after adjustment for confounders. RSV infection alone should not be considered a marker of poor prognosis in this population.
References
RESP-LENS Network/CDC/2024 -- Confirmation of Respiratory Syncytial Virus Infection in Adults With Acute Respiratory Illness Does Not Correlate With Elevated Mortality Risk
by Jeffrey A Kline, Robert D Welch, Christopher Kabrhel, Daniel Mark Courtney, Carlos A Camargo, RESP-LENS site investigators, Michael J Roshon, Danielle E Turner-Lawrence, Michael A Puskarich, Ka Ming Gordon Ngai, Benton R Hunter, Joseph Bledsoe, James K d'Ettiene, Stephen S Lim, Christopher W Kabrhel, Esther J Choo, Steven M H Moore, Katherine R Buck, David M Beiser, James G Galbraith, Joby E Thoppil, Chris Kelly, Edward W Castillo, Israel E Green-Hopkins, Kristen S Nordenholz, Faheem C Guirgis, Bryan Wilson, Michael L Pulia, Stacey House, Justine M Pagenhardt
