Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus
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Importance
Adults hospitalized with acute respiratory infections, including respiratory syncytial virus (RSV), often have multiple underlying conditions. Few data are available on the combined effect of concurrent underlying conditions on risk of severe outcomes from RSV disease among inpatients.
Objective
To identify underlying condition profiles associated with increased risk of severe outcomes among adults hospitalized with RSV.
Design
We applied Bayesian profile regression, an outcome-informed statistical clustering model, to identify profiles of conditions associated with increased risk of RSV-associated severe outcomes separately among adults aged 18–59 and ≥60 years. Seventeen underlying conditions were selected after excluding those with rare prevalence (≤1%) or high pairwise tetrachoric correlation (≥0.7).
Setting
26 hospitals in 20 U.S. states
Participants
Prospectively enrolled adults hospitalized with RSV disease admitted January 2022–July 2024
Main Outcomes and Measures
Risks of ICU admission, acute organ failure, and invasive mechanical ventilation (IMV) or death
Results
We analyzed data from 1111 adults hospitalized with RSV (median age [IQR] = 66 [53–75]). Among 397 adults aged 18–59 years, two profiles were identified characterized by (1) fewer underlying conditions (“minimal prevalence” profile; 308 cases [78%]; median number of conditions = 1; IQR 1–2) with a posterior median ICU admission risk of 20.5% (95% credible interval = [16.1‒25.0]), and (2) a cardiorenal/diabetes profile (89 cases [22%]) with frequent heart failure, chronic kidney disease, diabetes and increased ICU admission risk (37.1% [27.3‒ 47.6]). Among 714 adults aged ≥60 years, four profiles were identified: (1) minimal condition prevalence (460 cases [64%]; ICU admission risk = 21.6% [18.4‒25.5]), (2) cardiorenal/diabetes (183 cases [26%]; 27.3% [21.4‒33.6]), (3) hematologic malignancy and transplant receipt (52 cases [7%]; 11.8% [5.7‒21.0]), and (4) chronic pulmonary disease with home oxygen dependence (19 cases [3%]; 44.0% [24.5‒65.8]). Similar differences in risk were observed for acute organ failure and IMV or death.
Conclusion and Relevance
Distinct underlying condition profiles with varying risks of severe outcomes were identified in adults hospitalized with RSV. These findings could support recognition of high-risk patients to inform RSV prevention strategies and suggest that the role of multimorbidity in increasing severe RSV disease risk warrants further attention.
Key points
Question
How does multimorbidity influence risk of severe outcomes among adults hospitalized with RSV?
Findings
In this cohort study of 1,111 U.S. adults hospitalized with RSV during 2022–2024, approximately one in four patients aged 18–59 and ≥60 years had a profile of frequent heart failure, chronic kidney disease, diabetes and elevated risk of ICU admission and acute organ failure. Adults aged ≥60 years with chronic pulmonary disease with home oxygen dependence had the highest risk for ICU admission and acute organ failure.
Meaning
The role of distinct multimorbidity profiles in increasing severe RSV disease risk warrants further attention.
