The Impact of Pulmonary Hypertension on Hospitalization Risk in Adults with Respiratory Syncytial Virus Infection

Background/Objectives: RSV infection can lead to significant complications, particularly among those with underlying cardiovascular and pulmonary complications. Patients with pulmonary hypertension (PH) are susceptible to clinical deterioration triggered by respiratory infections due to their limited cardiopulmonary reserve. This study aimed to assess the risk of hospitalization in RSV-infected adults with and without PH. Methods: : We conducted a retrospective cohort study using the research network TriNetX to assess the risk of hospitalization in a cohort of patients with RSV infection compared with and without PH. Propensity score matching was performed for demographic variables and RSV risk factors between the two cohorts. Risk of hospitalization was expressed as adjusted odds ratio (aOR) with 95% confidence interval(CI). Results: There were 193,256 patients in the RSV with PH cohort and 2,843,714 in the RSV without PH cohort (all aged >18 years). The mean age of the RSV with PH cohort was 68.2+/-15.3 years, 50.6% were females, 64% were white, and 64.2% were group 2 PH. The RSV with PH cohort was at an increased risk of hospitalization (aOR 1.89, 95% CI 1.87–1.92, p value 0.02). There was a significant risk (aOR 1.29, 95% CI 1.27–1.32) for the 32 composite outcome of hospitalization-related complications between the 2 cohorts. Comorbid conditions (diabetes, cardiovascular disease, chronic lung disease, and chronic kidney disease) increased the risk of hospitalization in the RSV with PH group, with the most effect noted with underlying cardiovascular disease. Similarly, Group 2 PH noted a higher risk of hospitalization compared to the other PH groups. Remarkably, all PH groups noted increased hospitalization risk compared to the RSV without PH cohort. Conclusions: We found that patients > 18 years of age with PH and RSV infection are at an increased risk of hospitalization with subsequently higher RSV infection-related complications. All PH groups noted higher hospitalization risk compared to RSV without PH, likely denoting PH as an independent risk factor for worse RSV infection-related outcomes. RSV vaccination, therefore, may benefit all age groups in patients with PH. Our study also reiterates the current RSV vaccination recommendation for patients with underlying cardiovascular disease.