Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults With Respiratory Syncytial Virus

  1. Kevin C Ma
  2. Diya Surie
  3. Yuwei Zhu
  4. Carlos G Grijalva
  5. Paul W Blair
  6. Basmah Safdar
  7. Adit A Ginde
  8. Ithan D Peltan
  9. Samuel M Brown
  10. Manjusha Gaglani
  11. Shekhar Ghamande
  12. Cristie Columbus
  13. Nicholas M Mohr
  14. Kevin W Gibbs
  15. David N Hager
  16. Matthew E Prekker
  17. Michelle N Gong
  18. Amira Mohamed
  19. Nicholas J Johnson
  20. Jay S Steingrub
  21. Akram Khan
  22. Catherine L Hough
  23. Abhijit Duggal
  24. Alexandra June Gordon
  25. Nida Qadir
  26. Steven Y Chang
  27. Christopher Mallow
  28. Laurence W Busse
  29. Jennie H Kwon
  30. Matthew C Exline
  31. Ivana A Vaughn
  32. Mayur Ramesh
  33. Adam S Lauring
  34. Emily T Martin
  35. Aleda M Leis
  36. Jarrod M Mosier
  37. Estelle S Harris
  38. Adrienne Baughman
  39. Cassandra Johnson
  40. Jonathan D Casey
  41. Natasha Halasa
  42. James D Chappell
  43. Nathaniel Lewis
  44. Sascha Ellington
  45. Wesley H Self
  46. Fatimah S Dawood
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Abstract

Background

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 conditions on risk of severe outcomes from RSV disease.

Methods

We enrolled adults hospitalized with RSV at 26 hospitals in 20 US states admitted January 2022–July 2024. Seventeen underlying conditions were selected after excluding those with rare prevalence (≤1%) or high pairwise correlation (≥0.7). We applied Bayesian profile regression to identify profiles of conditions associated with increased risk of RSV severe outcomes, stratifying among adults aged 18–59 and ≥60 years.

Results

We analyzed data from 1111 adults hospitalized with RSV (median [IQR] age, 66 [53–75] years). Among 397 adults aged 18–59 years, 2 profiles were identified: (1) minimal prevalence with fewer underlying conditions and a posterior median intensive care unit (ICU) admission risk of 21% (95% credible interval, 16%–25%) and (2) cardiorenal/diabetes with frequent heart failure, chronic kidney disease, diabetes, and increased ICU admission risk (37% [27%–48%]). Among 714 adults aged 60 years and older, 4 profiles were identified: (1) minimal prevalence (ICU admission risk, 22% [18%–26%]), (2) cardiorenal/diabetes (27% [21%–34%]), (3) hematologic malignancy and transplant receipt (12% [6%–21%]), and (4) chronic pulmonary disease with home oxygen dependence (44% [25%–66%]).

Conclusions

Distinct underlying condition profiles with varying risks of critical illness were observed among inpatients with RSV. These findings could support recognition of high-risk patients to inform RSV prevention strategies and suggest that the role of multimorbidity in severe RSV disease risk warrants further attention.

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  1. Version published to 10.1093/cid/ciaf405
  2. Version published to 10.1101/2025.05.05.25326992 on medRxiv